Newsletter2008 01

The Network towards unity for health

VOLUME 27 | Number 01 | JULY 2008

NEWSLETTER

Networking within our organisation and linking with other organisations is of great importance to The Network: TUFH. We can learn from each other, and also be of help to each other. For example, since the 90’s of the last century, three Network: TUFH institutions have been supporting another member: Moi University, Kenia (see page 4). Another example of cooperation within our organisation: Maastricht students performing research at other Network: TUFH universities (see pages 24 and 25). As Jan de Maeseneer states in his Foreword: “More is needed: not only networking within the organisation but also links with other organisations/networks are important. For example, The Network: TUFH is engaged in the 15by2015 campaign, together with other important organisations, such as the world organisation of Family Doctors (Wonca), Global Health through Education Training and Service (GHETS), and the European Forum for Primary Care (EFPC)”. Read more about the 15by2015 campaign in the Foreword, and on page 27.

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: The Present and Future of the Family Doctor 12 Policy and Advocacy Integration into Training 15 Grassroots Partnership in Vietnam 20 Community Mental Health Education in Nigeria 23 15by2015: Quality Healthcare for All 27

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contents 03 Foreword Networking and Linking 04 The Network: TUFH in Action 04 Annual International Conference ‘South-North’ Collaboration: Friends of Moi University | A Cow for a Women’s Prison in Uganda | The Conference in Colombia in Brief 06 Book Review Effective IPE: Development, Delivery and Evaluation 07 Position Paper Interprofessional Education and Practice 09 Improving Health 09 Health Authorities What Would I Change if I Were Minister of Health?

10 Women’s Health HIV/AIDS in Sudan | Nutritional Status of Children of Women Sugar-Cane Farm Workers | Female Genital Mutilation 12 Health Professions The Present and Future of the Family Doctor 14 Indigenous Health American Indians and Alaska Natives in Health Careers 14 Occupational Health Noise Pollution in Pakistan 15 Integrating Medicine and Public Health Policy and Advocacy Integration into Training 16 Community Action 16 Community Interview Community at the Heart | New Brochure Education for Health 17 International Health Professions Education 17 Medical Education Teaching for Learning, Learning for Health | Prevention Education Resource Centre 18 Interprofessional Education Collaborating Across Borders | Interprofessional Education: A Personal Perspective 20 Yellow Papers Grassroots Partnership in Vietnam | Embedding Indigenous Perspectives in Health Curriculum 22 International Diary 22 Diary 2008-2009 23 Students’ Column 23 Students’ Speakers Corner Community Mental Health Education in Nigeria | Network: TUFH Institutions Welcome Maastricht Students 26 Member and Organisational News 26 Messages from the Executive Committee EC Intelligence: Ian Cameron | 15by2015: Quality Healthcare for All | Tribute to…

28 Taskforces Mini-Grants Supporting Women and Health Learning Package | New Taskforce: Social Accountability and Accreditation | Projects Related to Care for the Elderly 30 Represented at International Meetings/Conferences Frontline Medicine: From Natural Disasters to Daily Care 31 About our Members A Passion for… | Interesting Internet Sites | Moving On: Changes in Institutional Leadership | New Members | Re-Assessing Full Members

FOREWORD

Networking and Linking paign (see page 27), together with other important organisations: the world organisation of Family Doctors (Wonca), Global Health through Education Training and Service (GHETS), and the European Forum for Primary Care (EFPC).

In developing this action, the co-operation with GHETS has been utmost important. GHETS provided a lot of support in the press-communication strategy.

Dr. Jan de Maeseneer

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The 15by2015 initiative also gives a direction to our organisation: linking with other organisations and networks - as pointed out by De Maeseneer - but also to focus on primary care as the most distinctive of our educational origins characteristic in 1978. The reorganisation of the educational process was recognised then as a necessity if we were to focus on community-oriented primary care. Tradi-

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Dr. Fernando Mora

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Jan de Maeseneer | Secretary General Email: jan.demaeseneer@ugent.be

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According to Goodwin (2004) a network is “any moderately stable pattern of ties or links between organisations or between organisations and individuals, where those ties represent some form of recognisable accountability (however weak and often overridden), whether formal or informal in character, whether weak or strong, loose or tight, bounded or unbounded�.

The Network: TUFH exists already decades and is connecting similar-minded people globally to share ideas, form links and work together. In order to strengthen these links, yearly conferences are organised, this Newsletter and Education for Health are written and we have the taskforces, which are interacting more and more through listservs. The most recent initiative in this field has been a listserv in relation to Social Accountability and Accreditation. It would be interesting to exchange our views - for example at the coming Conference in September 2008 - on how weak or strong, loose or tight, bounded or unbounded our links are.. Though, apart from conferences and taskforces, more is needed: not only networking within the organisation but also links with other organisations/networks are important. For example, The Network: TUFH is engaged in the 15by2015 cam-

Reference GOODWIN, N., PERRI, G., PEIK, E. et al.

(2004). Managing Across Diverse Networks of Care: Lessons from Other Sectors Report to the National Coordinating Centre for NHS Service Delivery and Organisation. NHS. www.sdo.lshtm.ac.uk/files/adhoc/ 39-policy-report.pdf

tional organisation of the curriculum based on disciplines - with basic sciences at the beginning, emphasis on teaching rather than learning, and in individual performance over team learning were clearly insufficient, faced with the challenges that primary care poses. Thus innovation in health professions education became a key concept of our institution. Many are the products of our efforts, from problem-based learning to the relevance of linking with all those concerned with the health of individuals and communities, and to the ethical principle of social accountability, to mention just a few. But we have to recognise that this process is so complex that no matter what we do, or how successful we have been, there is always more to do. I would like to point to two areas of interest. Experiences in primary care and linking with service providers and communities have been interesting and relevant in many of the less developed nations, like India, Brazil or Uganda. There should be a more concerted effort to enhance linking of people working in these areas that go beyond our annual conference. This is one of the central purposes of GHETS. It would also be interesting to analyse how much community work and educational innovation have impacted on health professions education world-wide. I think that conceptually there is a large impact, but this has to be reflected on the educational practices. Perhaps we have been limited in our outward reach, in our educational mission, and this is reflected on how some large organisations and groups (like the Global Health Workforce Alliance: www.who.int/workforcealliance/en/) are now where we were many years ago: recounting educational experiences in communities. This calls for increasing and strengthening of our links with our educational counterparts.

At this moment, when the spirit of Alma-Ata is riding again in the world, we have a golden opportunity to regain relevance.

Fernando Mora | Global Health through Education Training and Service (GHETS) Email: fmora5@yahoo.com

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THE NETWORK: TUFH IN ACTION ANNUAL INTERNATIONAL CONFERENCE Every year The Network: TUFH organises an international scientific and networking conference.

The Conference 2008 will be held in Chía-Bogota, Colombia, from September 27 – October 2.

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‘South-North’ Collaboration: Friends of Moi University Establishing and sustaining medical schools in developing countries can be challenging.

Some collaborations between medical schools in developing countries and one or more medical schools in developed countries have been helpful. However, medical schools in developing countries can be vulnerable to the sudden withdrawal of funds (particularly if they have only one partner). In order to effectively shield themselves from withdrawal of support, medical schools in developing countries often participate in a number of parallel independent twinning relationships. This approach poses its own challenges, including the potential for lack of coordination, overlap and duplication of efforts, and conflicting advice.

Consortium of Moi Supporters In 1989, Moi University Faculty of Science (‘Moi’) was established in Eldoret, Kenya, under the direction of the Founding Dean, Haroun Mengech. Mengech helped to ensure that the medical school had a strong community focus and used problem-based learning methods (Westberg, 1999). During the planning phase, Mengech and others approached and received support from three medical schools: Maastricht University Faculty of Health Sciences (‘Maastricht’) in the Netherlands, Linköping University Faculty of Health Sciences (‘Linköping’) in Sweden, and Ben-Gurion University of the Negev Faculty of Health Sciences (‘Ben-Gurion’) in Israel. All three schools belonged to The Network.

Representatives from Maastricht and Linköping first became aware of the support from the other universities during a chance meeting in Eldoret. Wanting to complement and not conflict with each other’s support of Moi, they decided to meet with representatives of Ben-Gurion at the Network’s next annual Conference (Majoor, 1991).

Around the same time, a group of doctors from Indiana University (‘Indiana’) in the US 4

who were interested in international health approached Moi to establish an ongoing working relationship (Voelker, 2004). Upon learning about the institutions in The Network which were working with Moi, the Indiana doctors made contact with Maastricht and agreed to communicate regularly with all the Network partners about activities. This ‘Consortium of Moi Supporters’ has become known as ‘Friends of Moi’ (or ‘Friends’).

Friends of Moi Work Together Since 1991, the Friends of Moi have met every year during the annual Conferences of what is now called The Network: TUFH. The group reviews the activities of all partners during the previous year, and they plan for activities for the upcoming year, paying particular attention to complementing the activities of their partners and avoiding overlaps.

The success of the Friends collaboration has required open communication and effort on all sides. The successive Deans at Moi have nurtured the individual partnerships and coordinated the activities of the Friends.

Each donor has developed its own area of focus, based on its own expertise but balanced by the need to complement the activities of the other schools. This strategy has not only allowed these areas to strengthen at Moi, but has also led to the development of expertise in the Moi staff.

The universities of Linköping and Maastricht have both focused on preclinical education. To deal with this overlap, Maastricht and Linköping have run workshops jointly.

Indiana’s contributions to the clinical education programme appear to have complemented Linköping’s and Maastricht’s contributions to the preclinical programme. This suggests that institutions with different approaches and affiliations can take part successfully in a Friends model.

Conclusion The Friends see their consortium as one of mutual benefit, flowing in many directions, rather than simply as one of donor and recipient institutions. All of the schools have benefited from joint research projects, joint application for funds, student and staff exchanges and an international perspective. While many of these successes might take place through one-onone partnerships, the benefits were multiplied by the inclusion of different schools.

We have found that the Friends model can include institutions offering broad-based support as well as individuals with limited resources. We have also learned that the contributions are most likely to be successful if they focus on the developing school’s expressed needs and complement the activities of other partners.

References MAJOOR, G. (1991). Collaboration Among Institutions Supporting a New School.

Newsletter: Network of Community-Oriented Educational Institutions for Health Sciences, 16, 10.

VOELKER, R. (2004). Conquering HIV and Stigma in Kenya. Journal of the American Medical Association, 292(2), 157-159.

WESTBERG, J. (1999). Making a Difference: An interview of Dr. Haroun K. Arap Mengech.

Education for Health, 12(1), 108-110.

The unabridged version of this article hasbeen published in Education for Health, Volume 20, Issue 1 (May 2007).

Kimberly Oman (James Cook University, Australia), Barasa Khwa-Otsyula (Moi University, Kenya), Gerard Majoor (Maastricht University, the Netherlands), Robert Einterz (Indiana University, USA), Åke Wasteson (Linköping University, Sweden) Email: kimberly.oman@jcu.edu.au

A Cow for a Women’s Prison in Uganda After attending the Network: TUFH 2007 Conference, I remained in Kampala, staying at Hospice Uganda, a non-residential palliative care organisation. Through the Hospice, I met a young English lawyer, Alexander Mclean. Alexander has spent the holidays of his law degree in sub-Saharan Africa, mainly Kenya and Uganda, setting up clinic wings and libraries in prisons. He offered to take me to the women’s prison, Luzira, and I gladly accepted. Having seen prisons in Australia, I was interested to explore conditions in Uganda.

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When I returned home to Australia, I told my mother - a Legal Aid lawyer in Newcastle - about the conditions in Luzira. She and her colleagues decided that they

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Around halfway through the service, a baby started crying in the arms of one of the prisoners. Alexander explained to me that the women who entered the prison

More information on Alexander Mclean and his organisation, the African Prisons Project, can be found at www.africanprisons.com

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I enquired how the children were fed, and Alexander told me the babies were breastfed, but that their diet was so poor that it was very difficult for them to lactate. He explained that the cow was there so that the women had some calcium in their diet.

There was not enough milk for all the women, but at least it helped some.

In June of 2007, a major storm had hit Newcastle, and a coal carrier had been grounded off Nobby’s Beach. The ship remained just off the beach for the next few weeks, until finally being pulled off the reef by four tug boats. It was called the Pasha Bulker. The new Luzira cow was finally named Pasha Bulcow by the lawyers, and is currently providing milk to the mothers of Luzira prison.

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As it was Sunday, the women were awaiting church. Soon, a Catholic group and an Anglican group of outsiders arrived to give the services. The women broke into the appropriate groups and the services began in two large sheds. I attended the Anglican service, which was full of beautiful music and dance, and was so unlike any other church service I have ever seen.

should get in touch with Alexander to help fund another cow for the prison. Over a few months, they raised the money from the criminal defence lawyers of Newcastle, and sent it off to Alexander as a cheque. They held a vote to decide on a name for the new cow.

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pregnant delivered there, and the children remained with their mothers until the mother was released, or in some cases, executed. As the mother in this case clearly wanted to remain in the service, I offered to take the baby outside and quieten her.

I held the baby girl for almost thirty minutes, and she barely moved in that time.

She whimpered a few times, and tried to open her eyes, but she was very listless and non-responsive. When the service ended, her mother came outside to me. She was 19 years old, and had been in prison for four months. She did not know when she would be released, and she had no family to care for her or the child. She begged me to take her baby with me back to Australia, to look after her and give her opportunities. I did not know what to say.

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On a Sunday morning, I met Alexander and his father at the prison, and after being given clearance, we entered the prison grounds. It was very different than what I had expected. Both prisoners and guards were all women, but there were many children around the prison as well. The grounds were not, as I had anticipated, a Victorianstyle block of concrete, but rather long dormitory blocks with corrugated tin roofing, and a few other buildings in a similar style (including a kitchen which had a roof but was otherwise mostly open to the elements). Between the buildings was gravel and grass, and prisoners seemed to be sitting around in groups unless they had specific duties. There was also a cow wandering the grounds.

Pasha Bulcow being officially handed over to Luzira prison

Barbara Cameron | Student, Faculty of Medicine, University of New South Wales, Australia Email: barbasha@gmail.com

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THE NETWORK: TUFH IN ACTION ANNUAL INTERNATIONAL CONFERENCE

BOOK REVIEW

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Effective IPE: Development, Delivery and Evaluation

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The Conference in Colombia in Brief • When: September 27 - October 2, 2008.

• Where: Chía-Bogota, Colombia (in collaboration with the Facultad de Medicina, Universidad de La Sabana).

• Theme: Adapting Health Services and Health Professions Education to Local Needs: Partnerships, Priorities, and Passions.

• Goal: To analyse and discuss how health systems, services and health professions education adapt and readapt to the local needs of populations according to the historical, political and cultural influences they receive over time.

• Tracks throughout the Conference: educational track, research track, and Spanish track.

• Key-note speakers: - Dawn Forman, United Kingdom and Betsy VanLeit, United States of America - Strategic Leadership in Interprofessional Education: Perspective from around the World.

- Valda Ford, United States of America - The Role of Cultural Competency in Developing and Sustaining Partnerships, Priorities and Passions.

- Wim Van Lerberghe, Belgium - Primary Healthcare since Alma Ata. - German Zuluaga, Colombia – topic still to be announced.

• Post-Conference Excursions: - Visit the Arhuaco native groups at the village of Nabusímake in the Sierra Nevada de Santa Marta. During this three-day trip participants will have the chance to receive the message from the Arhuaco about their ecologically sustainable perspective of health, integrated to their traditional cultural practices and their effort to link it to the national health system organisation.

- Visit the village of Agua de Dios during a oneday trip, where participants will have the chance to experience how the country has evolved overtime in its socially organised response to patients with Hansen disease.

• Conference website: www.the-networktufh.org/conference

Book Review of: Effective Interprofessional Education: Development, Delivery and Evaluation Authors: Della Freeth, Marilyn Hammick, Scott Reeves, Ivan Koppel & Hugh Barr ISBN-13: 978-14051-1653-4, 206 pp.

The major objective of the book Effective Interprofessional Education is to discuss and illustrate the development, delivery and evaluation of effective interprofessional education in both the healthcare and social service arenas. This book is written by authors who are well-respected in interprofessional education, including Hugh Barr from Britain.

Although the authors state that they intend to reach a diverse audience that includes teachers, practitioners, administrators and funders, the book is probably best targeted for health professions educators whether in the academic or community setting.

The book is divided into three sections with multiple chapters in each section. Section I includes a discussion of the fundamentals of interprofessional education and a definition of ‘effectiveness’. Section II focuses on the development and delivery of interprofessional education, while Section III concentrates on evaluation. Throughout the book there are practical real world examples and case studies from a variety of healthcare and social service settings. Although the authors are from Britain, they have attempted to use case studies from other parts of the world. The authors’ treatment of the subject matter is comprehensive. The multiple case studies are useful for illustrating the content of the text. The information is up-to-date with references to current peer-reviewed literature and important textbooks on interprofessional education. In the Foreword of the book, John Gilbert from Canada characterises the book as a ‘workbook’ for anyone involved in collaborative learning. Section III on evaluation will be particularly helpful for educators and practitioners who wish to evaluate their interprofessional educational initiatives. The section on evaluation also includes a brief discussion of the issues associated with measurement reliability and validity.

Effective Interprofessional Education is well written and easy to read. The organisation of the book into three sections helps the reader navigate through the content. The information is logically presented, beginning with the definition of interprofessional education, followed by a discussion of the development and delivery of interprofessional education and ending with the important topic of evaluation. Although there are multiple contributors, the book reads in a very coherent manner.

If educators, administrators or practitioners are looking for a ‘how-to’ practical book, this will serve their purpose. It will aid healthcare and social service professionals in the development, delivery and evaluation of interprofessional educational strategies.

This review has been published before in Education for Health, Volume 20, no. 1, 2007.

Wendy Rheault | Dean, College of Health Professions, Rosalind Franklin University of Medicine and Science, USA Email: wendy.rheault@rosalindfranklin.edu

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).

Interprofessional Education and Practice

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The Service User While the IPE taskforce has a specific focus, there are substantial overlaps of interest with other taskforces focused on particular groups of service users e.g Care of the Elderly, and Women’s Health. In addition, the delivery of integrated service is an issue for the IPE taskforce and for specific areas of health e.g. Public Health, and Primary Care. For this reason this taskforce is interested in collaboration with other areas of The Network: TUFH in order to encourage and enable im-

Implementation of Interprofessional Education / Community and Work-Based Education A variety of learning and teaching approaches are relevant here, amongst them problem-based learning, collaborative enquiry, and continuous quality improvements (Barr, 2003) and also case-based learning (Lindquist et al., 2005). “Practice-based learning is seen as essential and can take many forms; observational study, shadowing, cross professional placements and experience on training wards” (Barr, 2003). The timing of interprofessional education continues to be a topic of discussion as is the issue of the importance of embedding or not embedding uniprofessional identity before engaging with interprofessional learning.

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The importance of multiprofessional (now seen as interprofessional) learning and education for health professionals was emphasized in 1988 by the World Health Organization (WHO, 1988) in their statement Learning Together to Work Together for Health and this

Evaluation of studies which focus on such interprofessional learning experience have been gathered by Freeth et al. (2002), Barr et al. (2005) and Hammick et al. (2007). Much of the interprofessional education discussed within these studies is carried out within the workplace and is not accredited by a college or university. The benefit of explicit relevance to practice can also be gained through placement experience within a multiprofessional team and also through a joint placement experience within a programme leading to professional registration.

The increased involvement of service users and carers in the design and implementation of education programmes for health professionals is a feature of interprofessional education in the UK and has been addressed in the recent UK Department of Health project Creating an Interprofessional Workforce.

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Learning Together to Work Together 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 lack of operation of functional links between agencies has led to a failure of service and increased risk to service users. The inability of multiprofessional teams to communicate has also led to a failure to respond to the needs of service users effectively (Conway & Macmillan, 2003).

The link between multiprofessional and interprofessional learning experiences and enhanced collaborative ability within a multiprofessional team or between agencies has yet to be fully evidenced, but examples have been identified which indicate a change in practice which is sustainable following structured interprofessional learning experience within a multiprofessional student population e.g. (Dickinson & Carpenter, 2005).

provement in service design and provision, through improvements in interprofessional learning and improved integration of services and care provision.

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Mission of IPE Taskforce To enhance the quality of interprofessional education, learning and practice by drawing together experience(s) from the international context.

drive has been repeated by other legislative and policy requirements in several different countries.

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The taskforce Interprofessional Education (IPE) changed its title from multiprofessional to interprofessional in order to emphasize the importance of structured learning with, from and about different professions, by comparison with simply sharing a learning environment.

The term ‘multiprofessional’ is used in the paper to denote a team, training ward or student group which contains representation from a number of professions.

The international context in which the IPE taskforce functions recognises a number of different models of community and workbased education, ranging from a joint placement between, for example, social work and community nursing students as part of pre-registration education to a uniprofessional community-based experience within a medical education programme. There is an op7

THE NETWORK: TUFH IN ACTION POSITION PAPER

portunity here for Network: TUFH members to learn from each other about the advantages of these different models and to enable an expansion of joint placement and work-based learning where appropriate to the development of uniprofessional and interprofessional skills, competencies and understanding.

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The strengths of a joint placement experience have been recognised as having an impact on both students and supervisory staff, who gain cross/interprofessional understanding. Community service learning is acknowledged to be a valuable extension of community-based education for health professionals (Mpofu, et al., 2004) Enabling Students to Work Interprofessionally Part of the above depends on the interprofessional learning ethos being seamless across university contexts and during the practice learning experience. A synergy should ideally be achieved between the interprofessional experience in the practice learning environment and in the campus/university context.

Effective interprofessional learning (IPL) depends on clinicians and educators being adequately prepared for their role as facilitators during classroom and practice learning opportunities (Reeves, 2002; Ponzer et al., 2004). Within the UK, practice teacher preparation is influenced by professional bodies, is often delivered uniprofessionally and does not necessarily address interprofessional learning and teaching. Many courses do not provide follow-up support. This arrangement reinforces professional boundaries, fails to prepare practice teachers to support practice-based IPL and does little to alleviate the isolation staff may feel. What is now needed are some role models to encourage IPE development.

Clinical teacher preparation is similar in Australia. In most courses there is little collaboration between professions or acknowledgement that students from different professional groups are learning in the same 8

environments, but advances are being made to change this. However, there are some examples of good practice. There is a commitment to interprofessional practice by the professional bodies in many universities in New Zealand. Therefore where interprofessional learning exists, collaborative education occurs and professionals learn together as well as focus on speciality practice.

Modelling of collaborative practice by practitioners from different professions is also an excellent positive driver for student interprofessional development as is the delivery of key curricular and skills areas by members of a different profession e.g. delivery of clinical skills teaching to medical students by nurses.

The multiprofessional training wards run in both the UK and in Sweden enable students from different professional programmes to be guided by professions other than their own (Fallsberg & Wijma, 1999; Fallsberg & Hammar, 2000).

You can read the unabridged version of this Position Paper at www.the-networktufh.org/ publications_resources/positionpapers.asp References BARR, H., KOPPEL, I., REEVES, R., HAMMICK, M. & FREETH, D. (2005). Effective Interprofessional Education: Argument, Assumption & Evidence. Oxford: Blackwell.

BARR, H. (2003). Unpacking Interprofessional Education in Interprofessional Collaboration. Ed A. Leathard Brunner-Routledge.

CONWAY, J. & MACMILLAN, M. (2003).

Quality Health Care Delivery: Implications for Multiprofessional Learning. The Network International Conference. Towards Equity in Education, Training and Health Care Delivery. October 2003, Newcastle, Australia.

DICKINSON, C. & CARPENTER, J. (2005).

Contact Is Not Enough: An Intergroup Perspective on Stereotypes and Stereotype Change in Interprofessional Education.

The Theory-Practice Relationship in Interprofessional Education. Occasional

paper 7. The HE Academy Health Sciences and Practice subject centre. Ed Colyer, Helme and Jones.

FALLSBERG, M.B. & WIJMA, K. (1999).

Student Attitudes Towards the Goals of an Interprofessional Training Ward. Medical Teacher, vol 21: 6, 576-81.

FALLSBERG, M.B. & HAMMAR, M. (2000).

Strategies and Focus at an Integrated, Interprofessional Training Ward. Journal of Interprofessional Care, vol. 14:4, p 337-51.

FREETH, D., HAMMICK, M., KOPPEL, I., REEVES, S. & BARR, H. (2002). A Critical Review of Evaluations of Interprofessional Education. UK Learning and Teaching Support Network (LTSN) Centre for Health Sciences and Practice, Occasional paper 2.

HAMMICK, M., FREETH, D., KOPPEL, I., REEVES, S. &Â BARR, H. (2007). A Best Evidence Systematic Review of Interprofessional Education. www.bemecollaboration.org/beme/pages/ reviews/hammick.html LINDQUIST, S., DUNCAN, A., SHEPSTONE, L., WATTS, F & PEARCE, S. (2005). Case-Based Learning in Cross-Professional Groups - The Design, Implementation and Evaluation of a Pre-Registration Interprofessional Learning Programme. Journal of Interprofessional Care, 19(5) 509-520.

MPOFU, R., DANIELS, P. & ADONIS, T.A. (2004). Student Perceptions of Community Service Learning Experiences in Community Health Services. The Network International conference Overcoming Health Disparities: Global Experiences from Partnerships between Communities, Health Services and Health Professional Schools. October 2004 Atlanta US. World Health Organization (1988). Learning Together to Work Together for Health. Report of a WHO Study Group on Multiprofessional Education for Health Personnel. The Team Approach Technical Report Series 769.

Geneva: WHO. Dawn Forman, Jill Thistlethwaite, Katie Cuthbert, Isabel Jones, Marion Jones | On behalf of the IPE taskforce Email: dawn.forman@btinternet.com

IMPROVING HEALTH HEALTH AUTHORITIES

What Would I Change if I Were Minister of Health?

This column took me a while to write. The truth is, the US healthcare system is unique, brilliant, and fundamentally flawed all at the same time. If you are wealthy and have a heart attack, you probably could count yourself lucky to have it in any major US city.

However, if you are an average citizen trying to meet the basic health needs of your family, and maybe even prevent a heart attack, there are better places to be. I should point out that we technically do not have a ‘Minister of Health’ in the USA, so this column will assume I was the US equivalent.

satisfied patients and better health indicators (Macinko et al., 2003). Additionally, states within the USA that have a greater supply of primary care physicians, but not specialists, have lower mortality rates (Shi et al., 2003).

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How would I try to increase the nationwide percentage of primary care providers? This is a question not easily answered. I would start by creating rewards for medical schools that produce higher percentages of primary care physicians, and support the expansion of state run physician-assistant and nursepractitioner programmes. I would also ask states to set up taskforces that would creatively encourage the recruitment and development of future primary care providers, in ways that worked for their state.

Continued attempts at tinkering with

References MACINKO, J. et al. (2003). The Contribution of Primary Care Systems to the Health Outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970-1998. Health Services Research, 38:831.

SHI, L. et al. (2003). The Relationship between Primary Care, Income Inequality, and Mortality in the United States, 19801995. Journal of the American Board of Family Practice, 16:412.

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Perhaps my father summed it up best, when he said “If you go to a shoe store, they sell you shoes”. Well, the USA’s healthcare system is structured to promote and utilise specialty care. Even the training of residents, the post-graduate level physicians in the USA, promotes the training of specialists. Medicare, a public funding source, pays hospitals to help subsidise the training of physicians, and the subsidy is linked to the hospital’s level of inpatient, but not outpatient service.

Reimbursement for work done by medical providers also heavily favours invasive procedures.

I do not think simply increasing the number of primary care providers in our country would magically solve all our healthcare challenges, but it would strategically change the debate. A provider workforce more based in the viewpoint of primary care would serve as a stronger voice against those with purely financial interests, specifically the insurance and pharmaceutical industries. Perhaps then, the USA would be ready for a rethinking of the priorities of its healthcare system. In the meantime, there would be more stewards to pursue the multitude of possible communitybased solutions.

Who knows, maybe the newly powerful alliance of primary care providers would find they did not have that much to change that their increase in numbers did not already take care of.

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At the time of writing this, the leading Democratic hopefuls for the 2008 presidential election are playing with ideas that keep private insurances in the loop for any comprehensive healthcare overhaul, while many Republican opinion leaders are responding by stoking Cold War era fears of ‘communism’ and ‘socialism’. In this environment, what could I do that would make a fundamental difference? I have an idea, but its implementation would be a work in progress: I would make it my number one priority to increase the number of primary care providers.

The USA has a lower percentage of primary care physicians (about 35%) than other Western nations and Canada, where the percentage usually hovers around 50%. The number of primary care providers has some interesting correlates. Nations with higher primary care orientation tend to have more

Dr. Daniel Waldman

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We all know that the USA is alone in being the only industrialised Western nation without a national health insurance programme a safety net that ensures basic healthcare needs are met. The US also has health indicators such as infant mortality and life expectancy that trail countries that are nowhere near as wealthy. Why is this? That is a complex question, for a different day. It is important though, to understand that there are many parties with vested interests in the direction of the healthcare debate.

Medicaid and Medicare reimbursement to reward quality primary care might serve as a competitive incentive for private insurances to keep pace. Finally, I would start a major information campaign to educate the public, in hopes that future caps on the numbers of specialist training spots would receive public support.

Daniel Waldman | Staff Physician, Department of Family and Community Medicine, School of Medicine, University of New Mexico, USA Email: dpwaldman@salud.unm.edu 9

IMPROVING HEALTH WOMEN’S HEALTH

HIV/AIDS in Sudan

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The lower status of women in society, especially in the developing world, makes them socially vulnerable and an easier target for the spread of HIV/AIDS. The product of this vulnerability is the disregard of the possible different prevention methods provided and acknowledged by the Government and the people. It is clear that women need various options when it comes to these methods; the current ones are insufficient.

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Women in Sudan have less access to education, with almost half illiterate, or have completed only basic or primary learning.

This reality has changed over the past years, and more women are now enrolling in different educational institutes. Generally speaking, women in Sudan are bound to their homes, and they experience a lower social status in their marriages. They are not involved in policy making and they lack economical dependence, relying on their spouses financially. The concept of gender has a direct relationship with HIV/AIDS. Men have more power and more rights than women. They have more access to education and employment to make money.

Socially, they can go out, have more access to information and are more decisive on issues regarding sexual activities. This ideology of false power holding needs to be changed in order for both sexes to equally prevent themselves against HIV/AIDS. I carried out a study in Khartoum, Sudan, in three regions, each containing numerous women who differ in thinking, behaviour, education and lifestyle. My main objective was to find out how much they knew on HIV/AIDS: what the disease is, how it is transmitted and what are the various prevention methods. Secondly, I wanted to know their perspectives on the current HIV/AIDS policy and whether it is suitable or should be changed. I also interviewed policy makers from the Government and NGOs, seeking their ideas on this issue.

I wanted an explanation on why there was a rapid increase in HIV/AIDS statistics.

The Sudanese women involved in the research are aware of the existence of HIV/ AIDS. However, their knowledge regarding related aspects is rather low. Respectively, 41% and 37% of the women did not know any symptom of STDs and HIV/AIDS. Main modes of transmission were identified correctly, although still 10% think a mosquito bite can transmit HIV. As a means of prevention, most women mentioned the use of clean needles. The most important mode was unprotected sexual intercourse, which was mentioned by just 32%. Only 79 women knew about the male condom and most of them believed it was a contraceptive method more than it was a prevention method for HIV/AIDS and other sexually transmitted diseases. The best ways to inform women according to the respondents are seminars, lectures and videos.

Secondly, the influence of the Islam is shown here; religious awareness and good morals are the second best way!

As for policy implementation, it seems that the Government shows a lack of funding and the HIV/AIDS issue is not on top of the list, since the Government already has to deal with the conflicts in the south and in Darfur. The other problem is programme implementation and the unclear Government structure. There needs to be a better co-operation among all players on the field to yield a better outcome. The Sudanese NGOs need to formulise their implementation structure and harmonise with the other organisations so as to know what each is doing.

Different changes are necessary for the short and long term. The identification of the needs compared with current policy showed that the current one is not sufficient for women. The interviews with women

showed a lack of knowledge, and conversations with policy makers showed that more structure is needed. Women need more empowerment in defending their rights in the different prevention methods and the concept of stigmatisation should be changed to help people understand that HIV/AIDS does not affect ‘bad people’ only.

In conclusion, I would like to repeat what a wise man said to me concerning transformations that needed to occur in Sudan: “The lower you come, the higher the changes”.

Selma Ali El Sadig | Student, Faculty of Medicine, Ahfad University for Women, Sudan Email: selma667@hotmail.com

Women need more empowerment in defending their rights in the different prevention methods and the concept of stigmatisation should be changed to help people understand that HIV/AIDS does not affect ‘bad people’ only.

Nutritional Status of Children of Women Sugar-Cane Farm Workers Under-five malnutrition is high in the Siaya District, Kenya: stunting (47%); underweight (30%), and wasted (7%) (Bloss et al., 2004).

Early cessation of breastfeeding in a resourcepoor environment leads to chronic malnutrition, morbidity and mortality (Coutsoudis and Bentley, 2004). Maternal incomegenerating activities add to household income, but often decrease mother’s time for child-caring, leaving care-giving to relatives (Pierre-Louis, 2007).

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Throughout a decade, Amany Refaat (Professor, Community Medicine, Suez Canal University, Egypt, arefaat@ ismailia.ie-eg.com / a.refaat@scuegypt. edu.eg) fought the medicalisation of FGC using different interventions.

Recently Prof. Refaat has published a report on this work: Combating the Medicalisation of Female Genital Cutting in Egypt: Steps on the Long Road for Its Eradication.

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Rosebella Onyango / School of Public Health and Community Development, Maseno University, Kenya Email: rosebella.onyango@googlemail.com

Female Genital Cutting (FGC) in Egypt FGC is a harmful banned cultural practice in Egypt, which showed increased medicalisation of its practice in the last decades. Meanwhile, the prevalence of the practice had declined from an estimated 88% of daughters in 1995 to 70% by 2005 according to consequent EDHS reports. However, medicalisation increased from 55% to 75% for the same period.

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References BLOSS, E., WAINAINA, F. & BAILEY, R.C. (2004). Prevalence and Predictors of Underweight, Stunting, and Wasting among Children Aged 5 and Under in Western Kenya. Journal of Tropical Pediatrics, 50(5):260-270; Oxford University Press.

COUTSOUDIS, A. & BENTLEY, J. (2004).

Infant Feeding: In. (Eds. Michael JG, Margetts, BM Kearney, JM. and Arab, L.).

Public Health Nutrition, Chapter 16: 264282. Blackwell Publishing Company Oxford UK. PIERRE-LOUIS, J.N. (2007). Maternal Income-Generating Activities, Child Care, and Child Nutrition in Mali. Food and Nutrition Bulletin, 28(1):67-75.

The theme for this year’s celebration was Partnering with the media to reach Zero Tolerance to FGM. IAC partners with the media because the media reach a wider segment of the population with powerful and lasting messages. Therefore their involvement in the campaign would likely accelerate reaching the goal of eliminating FGM.

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Results The women worked daily for 10 hours without leave, resulting in early cessation of breastfeeding. They earned 80 shillings per day; inadequate to purchase nutritious replacement feeds. Children <6 months were fed on diluted porridge, while those aged 624 months ate mashed adult foods. Most children (70%) were fed twice a day, while 30% were fed thrice a day. Nutritional status

of the children was poor with 44% underweight, 36% stunted, and 20% wasted.

Many children (56%) had diarrhoea.

Prolonged maternal absence resulted in early cessation of breastfeeding and introduction of inadequate replacement feeds. The children had poorer nutritional status than Siaya District levels.

By ‘Zero Tolerance to FGM’, IAC means that FGM should not be tolerated for any reason, at any time, place or on anybody.

FGM has been recognised as violence against women and girls and coupled with other medical, social, psycho-sexual and economic consequences; the practice should not be allowed to continue under the guise of tradition or religion.

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Cross-Sectional Study Women sugar-cane farm workers in Kenya work for long hours that deprive them of quality time for child-caring. Women-specific issues such as maternity leave, proper daycare centres, equal pay-for-work, and regular medical checks are not addressed by their employers. Occupational health and safety are major issues compromising their health during pregnancy. To determine the duration of breastfeeding among sugar-cane farm workers, and to assess the nutritional status of their children, a cross-sectional study was implemented to determine the feeding patterns of 128 children, aged 3 to 24 months, whose mothers work in sugar-cane farms.

Mothers were interviewed on breastfeeding duration and infant-feeding practices.

Children’s weights and lengths were measured on Salter’s weighing scales and studio meters respectively. Anthropometric parameters of weight-for-age, length-for-age and weight-for-length were used to assess nutritional status.

A 29-year sugar-cane farm worker carrying her nine month-old baby girl.

Standing are boys aged 14 and 24 months. All these children have proteinenergy malnutrition

Female Genital Mutilation International Day on Zero Tolerance to Female Genital Mutilation (FGM) The Inter-African Committee on Traditional Practices (IAC) with its National Committees in 28 African countries and the Group Sections, in 16 countries outside of Africa, observes February 6, 2008 as the 5th anniversary of the International Day on Zero Tolerance to FGM.

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IMPROVING HEALTH HEALTH PROFESSIONS

The Present and Future of the Family Doctor

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To a large extent, Huxley’s Brave New World has become reality. With economic, technical and IT developments, and with increases in numbers, the individuals of the human species have become kind of registered product. These so-called ‘human resources’ are administrated by more or less anonymous authorities and institutions, which are often not compatible with traditional patterns of healthcare.

The traditional family doctor can be trusted to give advice, protect and support the individual patients in their struggle for life and health.

Europe’s social history founded political systems based on social welfare and Health for All. These ideas have been spread by organisations acting globally, like UN, WHO or Wonca.

Administrating these ‘human resources’ - ready to use and productive with high efficiency - requires structures like the medical services, that guarantee availability at minimal cost for application and capacities of maintenance.

The role of the family doctor has changed accordingly to a functioning instrument in a complex social construction. To detect the conflicts of interest that arise, one needs to analyse these phenomena from various view points.

Example One: Survival of the Species The doctor is no longer the highly educated specialist in matters of health, called by the suffering individual patients in their socio-economic micro cosmos, the family.

The doctor is obliged to come, contracted by nothing more than the professional maintenance role within the new socioeconomic system of public healthcare.

Also, the role of the family has changed: the responsibility for health and welfare of its members has been delegated to ‘the 12

public’; mankind forgot about prospective behaviour as one parameter out of several precautionary principles of survival strategy. However, in our ‘developed world’, dissolving patterns of family corporate identity (FCI) and family financed support for family members in need are still to be found in immigrant families with Hispanic, Arabian or Asian background.

Example Two: Economy Welfare and Health for All submitted to public responsibility causes expenses for the society. Private equity is needed, the use of which will be controlled by the donors. Consequently, the following questions will arise: • Will a reduced cost of maintenance of the human resources also reduce follow up costs?

• Do we need those people over age X, who have outgrown the productive period of their lifespan statistically calculated?

• Do we still need all these people consuming health and social services?

• To which extend can we influence the servicing staff, their technical resources and their education to reduce cost?

Example Three: Advocate for Deprived Individuals Individuals are left to themselves fighting loss of mental or physical capacities, their diseases, their pain. What they wish for and need was an independent solicitor (a family doctor), making a stand for their individual needs and achieve the necessary support.

Confronted with today’s reality, we thus have to ask: • Under these circumstances, can family doctors do their job properly and meet the challenges of either side?

• Are education and training focussing on the knowledge, skills and attitude necessary to meet the upcoming challenges in doctor’s professional lives?

The various national health systems have different approaches towards an eco-political solution, but they fail to solve conflicts of interest. We, general practitioners or family doctors, have to find ways to minimise the burden of individual suffering of patients and disabled people. We have to make the best under the economic pressure and with restricted resources left for the social and health sector by economic and politics.

The seed you invest today will be the base of a sustainable social and healthcare system in the future.

Austrian Family Doctors Let me give you an example of a working generalist group practice in the middle of a European city. Following the tradition of Austrian GP/FM doctors since World War II, these family doctors have been educated as ‘solicitors’ for their patients, as ‘freelancers in causa health’ for individuals.

They never lost linkage to basic medical science, and followed up on research and newly designed technical developments.

Another basic strategy has been to work together in a group, and to implement as many skills as possible into the medical services offered at primary care level.

This has led to long time results as: a low rate of hospitalising of patients; a low

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The multidisciplinary trained family doctor will be the effective service provider to cope with the future challenges of health systems. High standards of primary care with highly educated and well trained generalist physicians (‘family doctors’) will create a flexible and stress resistant structure. This may be the only effective and efficient instrument to preserve the traditional European socio-cultural advantages - the European Way - to respect individuality, personal freedom and privacy.

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Equation The following equation will illustrate this concept in a simple way: sustainability is a product and a main parameter to measure efficiency and stability of processes in an

In other words: sustainability means strategic thinking and planning in a time frame for generations: generations of experts produced by the education and training system and generations of implementation of services run by those experts. The seed you invest today will be the base of a sustainable social and healthcare system in the future.

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Well educated and trained staff will be in a much better and independent position, defending erosion of the right on individualism of their patients and to withstand the pressure coming from politics, economy or patients claims. These fam-

rate of unnecessary co-treatment, double diagnostics and multiple level treatment; a low decrease of capita per month treated, despite increasing numbers of service providers in the area concerned.

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These family doctors will be able to decide and act independently to stand up for the needs of their patients; they can be a partner to the top small scaled specialists.

Science x Practice = Sustainability

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environment of complex systems not well known or well described. Biological interactive systems are as complex as socioeconomical and cultural systems are. The parameter sustainability gains importance with the system’s increasing complexity and reflects the ability to resist stressors and/or the ability to use the resources available within the system’s life cycle. If one factor decreases, in consequence the system’s benefit for all is also reduced.

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Active Conclusions It is wise not to forget the roots and the history - if there is no history there will not be any future. The contemplative view of the facts can lead to reflected active conclusions and open an outlook into the family doctors’ future: • A medical education programme, well based on profound scientific knowledge (including various disciplines as physics, chemistry, anatomy, histology, pathology), will overrule so-called holistic education programmes.

• Intensive practical training has to be added to the theoretical education this could be a paid job with increasing taking of responsibility (practical knowledge is supervised learning by doing).

• Specialising in top small scaled fields shows a high dependency on technical equipment (financial investment) and homogenously performed skills.

Therefore, the time spent on specialisations could be decreased dramatically, but the basic practical education should be prolonged and obligatory for all trainees. It should be the basic outfit before further small scaled specialisation and acting bedside in own responsibility is possible.

ily doctors will be able to decide and act independently to stand up for the needs of their patients; they can be a partner to the top small scaled specialists; and specialists will be able to understand their and their patients needs because they have the same roots of basic education.

Communication will become easier, losses in transfer of information will be reduced, and misunderstanding caused by emotional level feelings will be minimised.

Ilse Hellemann | General Practitioner, Medical University of Graz, Steirische Akademie für Allgemeinmedizin, Austria Email: ilse.hellemann-geschwinder@ meduni-graz.at

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IMPROVING HEALTH INDIGENOUS HEALTH

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American Indians and Alaska Natives in Health Careers In many parts of the world indigenous people do not receive high quality healthcare. This is certainly the situation in the US, where American Indians and Alaska Natives and other minorities receive less and lower quality healthcare than the rest of the population. Consequently, American Indians and Alaska Natives have the lowest life expectancies in the US or any nation in the Western Hemisphere, except Haiti. Compared to other Americans, the death rates for American Indian are 400-700 percent higher for diabetes, tuberculosis and other chronic diseases.

One of the reasons that American Indians and Alaska Natives have poor healthcare outcomes is because they are underrepresented in the healthcare work force. Minority physicians, dentists and nurses are more likely to serve minority and medically underserved populations, yet there continues to be a severe shortage of minority health professions.

The American Indians and Alaska Natives in Health Careers website http://aianhealthcareers.org/ is designed to encourage indigenous people to consider a career in the health professions and to provide them with information that can help them explore careers in 11 different healthcare fields. For each of the 11 health careers, the following information is provided on the website: • An overview of the profession and healthcare needs that are addressed by the profession.

• Steps that students need to take in order to enter the profession as well as descriptions of schools and programmes that provide special support for indigenous students.

• Profiles of indigenous students and health professionals, including advice from these people regarding entering their profession.

• Links to resources, such as national health professions organisations, indigenous organisations in healthcare and the health professions, sources of scholarships, and student organisations.

Jane Westberg | Clinical Professor, Family Medicine, University of Colorado, USA Email: jwestberg@mac.com

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OCCUPATIONAL HEALTH

Noise Pollution in Pakistan Noise pollution or sound pollution actually means a sound which irritates or annoys the individual. In other words, it exceeds the standard normal decibel of hearing threshold which leads to stressful sound, thereby damaging the ears and subsequently causing stress factors which lead to elevated blood pressure and irritability. In terms of audiology, sound is measured by a unit called the decibel. The normal speech varies between 60-65 decibels. An increase of three decibel doubles the sound. Heavy traffic sound reaches 90 decibels. A sound wave measuring more than 100 to 120 decibels is equal to a bomb blast sound.

Karachi Karachi is a cosmopolitan city in Pakistan; no less than two million cars, buses, scooters, motorcycles and rickshaws have led to environmental pollution, noise pollution and street congestion during working hours. There are about 300,000 rickshaws in the city without silencers, which cause tremendous noise pollution, both from noise and also carbon and sulphur fumes emitted from the silencer. Loud taperecorders in the coaches will add to noise pollution and cause damage to hearing. Noise pollution is also contributed by the sound of factories, trucks, heavy machines, aircraft sound (the airport is within the premises of the city), fire crackers, loud music, headphones; they can all damage the cochlea.

Impact Noise pollution causes significant health problems, leading to the damage of the hair cells of the cochlea, which can result in irritability, stress and tension. It can even lead to heart problems and high blood pressure. People get tired and have difficulty concentrating. The working potential of the individual is decreased.

Hearing loss occurs in places where sound

is unavoidable. It includes construction workers, farmers, police personnel, fire fighters and musicians. The International Labour Organisation (ILO) does not permit workers working an eight hour shift for more than six months above 100 decibel noise exposure. ILO advices a change of job or place to avoid noise pollution.

The Federal Aviation Administration (FAA) monitors control of noise from airplanes.

They advise airports to be built eight kilometres away from the populated area.

The World Health Organization does not permit constant exposure of 120 decibel for workers.

Control and Recommendations • Noise pollution is not a necessary price to pay for living in an industrialised society. We must reduce industrial noise. We must avoid constant exposure of workers to a noisy environment.

• Training programmes to create awareness through media, seminars and charts.

• Government and private sector to cooperate to conduct awareness programmes.

• Vehicles inspection and fitness teams comprising of private and public sector to allow the vehicle on the road after complete fitness.

• Awareness of school children and college students regarding hazards of loud music and use of headphones.

• Singers and music entertainers should be informed about hearing problems caused by loud music.

Kaleemullah Thahim | Assistant Professor, Consultant Ear Nose Throat Surgeon, Karachi, Pakistan Email: kaleems92@hotmail.com

INTEGRATING MEDICINE AND PUBLIC HEALTH

Policy and Advocacy Integration We must also into Training train residents As we write this article, the resounding an active investigation of current policies. to see what words of one of my Network: TUFH (African) The policies may be structured within the colleagues is triggered. He asked, “What framework of an organisation, agency, clin- aspects of the do you mean when you say ‘Integration ic, hospital, and/or within the local, state, patients’ lives of Public Health and Medicine’?”. As we or federal Government. proceeded to explain to him the current might hinder movement to integrate the concepts and Competencies principles of public health in undergradu- The American College of Graduate Medical their ability to ate and graduate medical curriculum, he Education has restructured the paradigm politely stopped us by asking the simple of residency education to focus on compe- comply with question “Don’t all doctors do that?”. His tencies and outcomes (www.acgme.org/ question informed us that medicine has outcome/comp/GeneralCompetenciesStan the physicians’ once again come full circle, within a system dards21307.pdf, retrieved June 10, 2008). of care, to affect population outcomes and The Systems Based Practice competency treatment plan.

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Advocacy for Expanded Social Services Delayed discharges and subsequent overcrowding of the emergency department

Conclusion The far-reaching impact of resident involvement in advocacy and policy extends beyond the individual patient or the focused clinical experience. The population of people whose healthcare options are negatively impacted by a particular policy may now be positively affected at new levels by physicians. At the academic level, residents who engage in policy development and advocacy, role model their behaviour for medical students to emulate. Physicians are empowered to liberate themselves from the confines of the office and impact policy that may contribute to the well being of not only their patients, but large populations at one time.

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Projects Expanded Pharmacy Hours Patients were frequently admitted to the hospital because their access to medications was limited by restricted hours of the University Pharmacy. After meeting with the pharmacy staff and investigating other indigent pharmacy systems, the residents presented a report to the administration that resulted in the expansion of pharmacy hours.

has a broad impact on hospital function.

By gathering data and learning about the pertinent management issues, residents were able to develop a collaborative effort with the Social Services Department, which resulted in the recommendation to allocate funding to new social worker positions which would help alleviate this situation.

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Advocacy Efforts FM residents in the University of New Mexico’s (UNM) Department of Family and Community Medicine (DFCM) are engaged in an effort to affect healthcare outcomes, not only at the individual level, but at the community level. The FM residents recently began their advocacy efforts under the tutelage of Sally Bachofer and Arthur Kaufman.

Daily, FM residents interact with patients afflicted with ailments and diseases that are associated with or triggered by ecological factors or determinants of health. While generally, we expect that the residents will be skilled in treating or positively affecting the bio-medical aspects of the patient, we recognise that the residents’ education is equally fuelled by training to create change through advocacy and/or policy development. It is not enough to say that the patient is non-compliant or is not following the treatment protocol. We must also train residents to see what aspects of the patients’ lives might hinder their ability to comply with the physicians’ treatment plan. One approach to engaging the FM residents in community change is through

includes two elements that apply to advocacy and policy development: “participate in identifying system errors and implementing potential system solutions”, and “advocate for quality patient care and optimal patient care systems”. The UNM residents have been involved in several initiatives to gain skills and knowledge aimed at fulfilling these competencies. Residents may elect to incorporate the Department of Family and Community Medicine’s Public Health Certificate programme into their curriculum.

Residents are involved directly in policy and advocacy activities during their clinical experiences, both in the hospital and through their continuity clinics. A couple of policy and advocacy projects in which the residents were engaged are outlined below.

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not just individual patients. The simple act of engaging Family Medicine (FM) residents in policy and advocacy is a testament of how we are now revisiting what once was a norm for healers throughout the world.

Sally Bachofer, Lily Velarde, Vanessa Jacobsohn, Amy Clithero, Arthur Kaufman | Department of Family and Community Medicine, School of Medicine, University of New Mexico, USA Email: livelarde@salud.unm.edu 15

COMMUNITY ACTION COMMUNITY INTERVIEW

Community at the Heart

What was your experience with community members, and with which community members was that?

I went for my COBES training to a small village in the south western part of Uganda, called Rugazi. I mostly interacted with mothers, because I was more into children. They were very welcoming, because they acknowledged that they have community problems that they have to solve.

The people who were there before did not give them feedback, so they asked us if we were different. Another problem were the local leaders; they were aware of, but not interested in our meetings. The locals wanted to listen, but the chief felt he heard enough of it. It is difficult to keep the community together when their leader disagrees.

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This interview was conducted with Lydia Nanjula, a medical student at the Mbarara University of Science and Technology in Uganda.

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Were there also students of other disciplines working there, and were there ways to collaborate with them?

Yes, there were. It was a pilot study by our university to do a multidisciplinary elective placement. I was the only medical student in the group. There were two development studies students, a teacher, and me. We were able to collaborate and work on the factors influencing children’s health in that area, giving a broader understanding of the issues in the eyes of a development worker, a teacher, a medical student, to finally come up with a report.

We first chose a topic, then shared roles among the four of us. So if today we were to give a public health talk, and I am in charge, I would be the one to get the community together, prepare the topic and research.

Sometimes students do research in a community. Do you know of an example in which the outcomes of that research had positive results for your community?

Yes, I do. There was a research initiative in that same area. The needs of that particular community were assessed. There was an effort to establish the community component in primary healthcare, and then let the people of the community know that they can better their own health. The community was told to choose their volunteers. These trained workers went back and they taught them to make a tap/jerry can, for hand washing after using the latrine. They also taught them how to conserve firewood.

If you were in a leadership position, would there be anything that you would change concerning the position of students in the community?

I would try to facilitate the students more, to give them food, upkeep money, and transportation (some areas are so far, that you have to exclude them). And to give them a briefing and a workshop before the community placement, so that they know what they are actually up for.

Imagine that you had to choose between community-based and hospital-based.

What choice would you make and why?

I think I would choose community-based.

Because if you tackle health at the community level, you prevent people from getting to the hospital level. If I worked at hospital level, and nothing was done at community level, I would always have a high patient load. But if I went to the villages and told people to just wash their hands; this is something very basic, but it solves a lot when you just prevent diseases through health education.

New brochure Education for Health Education for Health (EfH) seeks/publishes manuscripts that: • address community-based education of health professionals, • address community-based healthcare delivery, • describe and evaluate collaborations between academia and health service organisations designed to promote community health, • address multi- and interdisciplinary approaches to health professions education and service delivery, • address models and systems of education, research, and service delivery that link developing and developed countries.

EfH informs clinical and public health practitioners, educators and policy makers about global approaches to integrating health professions education and health systems. The journal hosts an online forum to debate best ways to ensure equity, quality, relevance and cost effectiveness of healthcare in the developing and developed world, and optimal ways for training health professionals.

EfH publishes original full-length research manuscripts as well as communications on programmes and policy perspectives related to: • community-based education of health professionals, • integration of medicine and public health in practice and medical education, • global health workforce, • multidisciplinary health professions education, • partnerships between health system stakeholders for disease prevention and control.

Submission information: www.educationforhealth.net

INTERNATIONAL HEALTH PROFESSIONS EDUCATION MEDICAL EDUCATION

Teaching for Learning, Learning for Health GOFAR is a comprehensive faculty development resource for all teachers and learners in the health professions. The letters in GOFAR refer to Goals and the broad purposes of medical education; Objectives and the specific desired outcomes that learners should achieve; Framework refers to the structuring of learning experiences to support students in successfully achieving learning goals; Assessment asks to what extent were learning experience and teacher effective; Review poses the question, what should be done differently next time?

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Stewart Mennin | Professor Emeritus, Department of Cell Biology and Physiology, School of Medicine, University of New Mexico, USA; Mennin Consultoria em Saude Ltda, Brazil Email: smennin@gmail.com

Reference ALLAN, J., BARWICK, T.A., CASHMAN, S., et al. (2004). Clinical Prevention and Population Health, Curriculum Framework for Health Professions. American Journal of Preventive Medicine, 2004;27(5):471â&#x20AC;&#x201C;76.

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You can find GOFAR at www.the-networktufh.org > Publications/Resources > Further reading > Teaching for Learning: Learning for Health - Quick Reference Guides for Planning, Implementing, and Assessing Learning Experiences

Please, if you are interested in education of health sciences, in teaching methods and in the integration of education and practice, consider participating actively in this exciting collaborative effort by either submitting materials to PERC, or by downloading approved materials from the PERC site that have been reviewed and posted to the site.

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GOFAR was written and compiled by Stewart Mennin, former Assistant Dean for Educational Development and Research and Professor Emeritus, Department of Cell Biology and Physiology, and by Deana Richter, Director of the Office of Teacher and Educational Development at the University of New Mexico School of Medicine. The website for the Office of Teacher and Educational Development (http://hsc.unm.edu/som/TED) has a wealth of faculty development materials,

GOFAR is also available in Farsi, generously translated by Marzieh Moattari from Shiraz University of Medical Sciences Faculty of Nursing and Midwifery, Shiraz-Islamic Republic of Iran. If you are interested in translating GOFAR into your language, please contact either me (smennin@gmail.com) or Deana Richter (tdevelopment@salud. unm.edu). It is free and meant to be shared. Let us know what you find most useful and what would make it better.

GOFAR it!

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GOFAR represents a synthesis of 25 years of work in health professions education by the Office of Teacher and Educational Development at the University of New Mexico, School of Medicine. It contains practical resources about how people learn, the development and effective use of performance objectives, community-based/ambulatory teaching/precepting, hospitalbased teaching, problem-based learning, lecturing and making presentations, giving feedback, assessing learners and using questions effectively. It contains guides and strategies for assessment and feedback. GOFAR has resources for teachers working in large classrooms, small groups, and one-to-one.

resources, presentations, et cetera. There is a section on the Medical Education Scholars Programme designed to help secure the succession of leadership and innovation in health professions education at the University of New Mexico and a section on residents as teachers.

Prevention Education Resource Centre The Prevention Education Resource Centre (PERC, www.teachprevention.org) is a web-based repository of educational materials related to clinical prevention and population health. PERC is supported by the Association for Prevention Teaching and Research (APTR). The site promotes collaboration across healthcare disciplines, professions, and institutions by facilitating the exchange of teaching resources and connecting educators.

PERC is envisioned to fulfill the identification of accessible relevant syllabi, teaching materials, examination materials, and curriculum evaluation approaches that may be used to teach each of the 19 domains identified in the Clinical Prevention and Population Health Curriculum Framework (Allan et al., 2004) as well as curriculum frameworks developed for introductory undergraduate (college level) public health courses like Global Health, Public Health and Epidemiology. Expected outcomes for PERC include the provision of a searchable web site allowing the user world-wide to identify materials that are relevant to particular domains of the Curriculum Framework, applicable to particular clinical health professions, and allow for utilisation of particular types of teaching methods. The Network: TUFH promotes the Clinical Prevention and Population Health Curriculum Framework as a conceptual and comprehensive source for a systematic analysis of its adaptation to different realities world-wide in underdeveloped and developed countries.

Jaime Gofin | Associate Editor PERC; Director Community-Oriented Primary Care, School Public Health & Health Services, George Washington University, USA Email: sphjxg@gwumc.edu 17

International health professions education INTERPROFESSIONAL EDUCATION

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Collaborating Across Borders In October 2007, the University of Minnesota convened Collaborating Across Borders: An American-Canadian Dialogue on Interprofessional Health Education, the first American-Canadian conference of its kind.

The conference drew 300 people from the US, Canada, UK, and New Zealand for a three-day meeting focused on bridging knowledge, awareness and best practices in interprofessional education (IPE). The University of Minnesota partnered with the Canadian Interprofessional Health Collaborative (CIHC) to design the conference. Conference goals included: showcasing American and Canadian work in IPE; documenting what is and is not working in IPE; making recommendations for policies that facilitate interprofessional collaboration; setting an agenda to promote future continued collaboration.

From among the more than 120 abstracts that were submitted for consideration, conference planners designed seven tracks that paired American and Canadian presenters in order to provide parallel stories of IPE development and outcomes in the two countries. Highlights include: Track 1: Cutting Edge Innovations in Curriculum and Instruction IPE shares the broad goals of building teams of healthcare professionals: increased knowledge of professional roles, communication skills, and learning how to work in teams.

A common concern was addressing ‘education to practice’; the fact that some students do not find interprofessional teams once they are in practice.

Track 2: 21st Century Technology-Enhanced IPE Showcased were a range of innovative learning opportunities, including a web-based learning module that employs educational games, Team Objective Structured Clinical Examinations (TOSCEs), an online case study resembling real-life experiences, and traditional face-to-face courses that integrate an 18

e-learning component. Many presenters noted that flexibility - both in curriculum development and course planning - is key to developing new, interprofessional programmes.

Track 3: Through the Eyes of Students Students have been successful in designing IPE models that have been adopted into the curricula, as well as service-learning experiences outside the curriculum. Examples include: student run clinics, interprofessional policy and case analysis, and pre-health interprofessional courses. Students recommended peer education; progressive curriculum development; support for informal learning; opportunities for research; identifying student leaders; creating IPE clinical experiences; and creating an IPE office that provides support and creates the link to legitimacy, authority, and power.

Track 4: Faculty|Teaching Skills Development Presenters discussed faculty development literature, which shows that clinical faculty serve as role models for trainees and play a key role in the IPE learning environment. The literature also confirms that collaborative practice requires skilled, knowledgeable, interprofessional teachers. However, presenters noted there is little research about the effectiveness of IPE, or about a best practice model for educating clinical faculty about IPE. Track 5: Transformation|Change|Leadership Presenters discussed the merging of technology and learning platforms, such as ‘hybrid’ or blended learning, which blends online and face-to-face instruction. Presenters noted a trend toward devices that are smaller, faster, cheaper and more mobile. They discussed the use of portals to manage, customise, personalise, and make information transportable.

Track 6: Addressing Barriers through Policy Development Several presenters identified the need for further research on IPE’s impact and data that

could be used to communicate that impact to policymakers. Research questions may focus on the association between teamwork and quality of care, essential knowledge, skills, and attitudes for teamwork and collaboration, promotion of IPE through accreditation standards, and the best time in the curriculum to introduce IPE. Track 7: New Models of Care|Communities of Practice Emerging research in new models of care is demonstrating improved patient outcomes, shorter patient stays and improved communication and learning among health professionals and students. The core themes supporting the development and successful implementation of new models of care include: •o rienting new partners and giving them a voice; • designing an atmosphere of respect and informality; • supporting team development by articulating roles, expectations and power; • providing flexibility for students through their learning experiences.

Moving Forward The University of Minnesota has continued its collaboration with Canadian University partners to foster interprofessional health education across its borders. Current efforts include the Journal for Research in Interprofessional Education, expected to launch late 2008.

Collaborating Across Borders II will be held in Halifax, Nova Scotia, May 20-22, 2009.

For more information about the 2007 Collaborating Across Borders conference, please visit www.ipe.umn.edu and click the ‘Collaborating Across Borders’ logo.

Barbara Brandt | Assistant Vice President for Education, University of Minnesota Academic Health Center, USA Email: brandt@umn.edu

Interprofessional Education: A Personal Perspective

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For all professions to learn together for the benefit of the clients and communities they serve, changes have to be made at curricula and professional attitude level. Finally, the willingness to analyse and participate in this process no matter what profession one comes from is the key to the success of IPE.

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More recently, the definitions of interprofessional practice and collaborative practice have been addressed by the WHO Working Groups, of which I am a member. However,

Those who have attempted interprofessional education will agree that challenges include finding a common depth of knowledge, synchronising curricula and timetabling difficulties as well as developing common method of assessment of learning outcomes.

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For IPE to succeed, there should be an understanding of why professionals should learn together. Sharing an anatomy class may be cost effective, but may not produce interprofessional collaboration. The students from different professions have to critically review why they should sit in one class, learn the same material or attend to the same client. In trying to answer these questions, students may discover the amount of overlapping knowledge, both theoretical and practical, coupled with the strength of each professional expertise which they will require to practice collaboratively. In most cases, this overlap of knowledge has kept professionals apart, emanating into professional and protective professional acts, which in some cases do not allow for interprofesional practice. The professional boards often set learning outcomes and competences in line with their international partners without reference to the growing interprofessional practice needed for comprehensive healthcare in underdeveloped countries.

My personal experience is that for IPE to succeed the following should be taken into consideration: development of core courses combining theoretical and practical knowledge; designation of sites for collaborative practice with generic educators or supervisors; the involvement of lay persons, e.g. communities in developing the curricula and student supervision; a generic assessment system for students; analytical teaching methods allowing for sharing of ideas among the different profession.

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Attempts to train generic workers have had little success, and more recently, IPE has been seen as an acceptable alternative since it does not challenge professional identity. IPE requires several approaches, such as more than one profession learning together using the same learning materials, tutors and time tables with the aim of achieving the same goals. The assumption is that there is generic knowledge and skills which each profession should have, without losing professional identity. Further, a

common site for interprofessional clinical practice or a service learning module has to be developed since objectives are seen to overlap more in practice than in theory.

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In Africa and other underdeveloped countries, lack of qualified personnel, limited professional programmes, sparse health facilities, increase of pandemics such as HIV/AIDS and the continuing challenges of poverty as well as political struggles, have forced professionals to work together and to be multi-skilled. Healthcare professions in developing countries have no luxury of specialisation. In most cases, the only available healthcare practitioner may be a nurse who is expected to know about all health needs of clients. The challenge therefore is to equip one health practitioner with all skills required for care of not only one individual, but also of eradicating preventable diseases in partnership with other professionals and lay persons.

Professor Ratie Mpofu

only minority educators have dared to engage in IPE while the rest still wallow in their singular, isolated professional practice. The majority ridicule those who try to look for answers of complex healthcare from a broader interprofessional perspective.

Consequently, the general consensus among those who have accepted IPE as a future reality is that it is still far from solving the real challenges of complex healthcare issues such as mental health, HIV/AIDS pandemic and health promotion in general.

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Interprofessional education (IPE) has been described in as many ways as there are attempts to implement it. The most recognised definitions, particularly for European and Western countries, have been summarised in a report by Della Freeth et al. on A critical review of the evaluation of Interprofessional Education commissioned by learning and teaching Support Network Health Sciences and Practice from the Interprofessional Education Joint Evaluation published in May, 2002. It emphasises shared problem solving and collaborative decision making particularly in complex health problems.

Ratie Mpofu | Dean, Faculty of Community and Health Sciences, The University of the Western Cape, South Africa Email: rmpofu@uwc.ac.za 19

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. Here you will find two of such yellow papers.

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Grassroots Partnership in Vietnam This article describes a model of a community collaboration in which young teaching staff at the Faculty of Public Health, Hanoi Medical University (HMU) learned how to work with grassroots health workers. The objectives of the programme were to build both capacity of teaching staff for working with communities, and capacity of local health workers and volunteers to identify and address local health problems related to social changes.

Courses HMU worked with three communes in a densely-populated, urbanising area near Hanoi, to build a model that supported health staff and volunteers at grassroots level in solving local health problems.

A pool of trainers taught and supervised six staff of the commune health centres and 27 village health workers (VHW). The VHW were the final target for capacity building as well as the link with community members during community diagnosis. The commune staff and VHW learned to identify problems and to collect data (existing and new), to describe and prioritise the problems, and then to look for solutions. They learned by doing in a series of courses alternating with practice periods, in two phases.

During the first course, the VHW collected evidence to identify health problems in their communes, then prioritised and selected topics for action research. During the second course, the trainees developed research plans and quantitative and qualitative data collection tools. They analysed the collected during the third course, when they also wrote reports, including proposed 20

interventions. Stakeholder meetings gave opportunities for community members to contribute their ideas to the plans.

In the second phase the same groups planned one intervention each, using an evidence-based approach and the first phase results. During the six-month implementation period, the HMU teachers and district staff provided supervision, not only to support the VHW and commune health staff but also for their own learning.

Discussion Village health workers in Vietnam are not staff in the health system, but volunteers, although many are retired health staff and all have had training in programmes lasting from three months to two years.

With health staff at the commune health station, VHW constitute a network for primary healthcare activities, both preventive and curative. VHW are in a position to know about health and health problems in their areas, so they should be involved actively in evidence-based planning and management (Moazzem et al., 2004). The history of top-down planning left both commune health staff and VHW passive in problem-solving, even in their own villages. Recent rapid development results in new health problems, so it is important to involve local health staff and VHW to identify local problems and find appropriate and feasible solutions to them. The programme followed the systemic capacity-building model developed by Potter and Brough (2004), based on their experience in the Indian health sector, with support to the four elements of the capacity pyramid: structures, staff, skills and tools.

The other side of the problem was in the medical schools; their teaching staff had little experience of health problems at village level and of how the rapid social changes affect them. The teachers bring students to the community and need to know how to work in a participatory way with the local people responsible for health. To involve the local health staff and volunteers, an appropriate approach and way of working is essential. Key lessons that teachers learned from this pilot programme included the importance of: using participatory methods to create an enabling environment for learning and sharing; understanding differences and similarities between professional and lay definitions and perceptions and exchange of lay and expert knowledge and perception; joint supervision and evaluation between health service, university and community as key tools for empowerment and capacity building on both sides.

References MOAZZEM HOSSAIN, S.M., BHUIYA, A., KHAN, A.R. & UHAA, I. (2004).

Community Development and its Impact on Health: South Asian Experience.

British Medical Journal, 328, 830-833.

POTTER, C. & BROUGH, R. (2004).

Systemic Capacity-Building: A Hierarchy of Needs. Health Policy and Planning, 19, 336-345.

Dr. Luu Ngoc Hoat | Head, Biostatistics Department, Faculty of Public Health, Hanoi Medical University, Vietnam Email: luungochoat@hn.vnn.vn

Embedding Indigenous Perspective in Health Curriculum With the health of Australia’s Indigenous peoples amongst the worst in developed nations, and the health disadvantage of Indigenous Australians so devastatingly apparent, the importance of appropriate training for health professionals has never been more salient.

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Key elements of the strategy included the explicit identification of expected learning outcomes, the streamlining of content/ learning activities within selected units, the

Key elements of the programme included: • the explicit identification of expected learning outcomes and competencies; • the incorporation of Indigenous content and learning activities within a large number of selected units; • the integration of Aboriginal and Torres Strait Islander perspectives within assessment in theory and practicum units; • the development of a purpose-built website and media-based learning resources for use across the faculty and in specific units; and • tutorial and self assessment activities for students to reflect on their learning.

References CAMPINHA-BACOTE, J. (1998). The Process of Cultural Competence in the Delivery of Healthcare Services (3rd ed.). Cincinnati, OH: Transcultural C.A.R.E. Associates.

CROSS, T., BAZRON, B., DENNIS, K., & ISAACS, M. (1989). Towards a Culturally Competent System of Care. Washington, DC: Georgetown University Child Development Centre, CASSP Technical Assistance Centre.

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The Yapunyah Project involved extensive consultation and collaboration with Indigenous staff and health experts in the local Aboriginal and Torres Strait Islander community, and it carefully constructed a core curriculum and associated graduate capabilities. The overall project involved incorporation of Indigenous perspectives across four major undergraduate courses in the Faculty of Health (Nursing, Psychology and Counselling, Public Health, and Human Movements) and one biomedical unit offered by the Faculty of Science. The experience has been a challenging and positive one, and the reforms have been supported by a sustainable framework.

This project took a ‘whole of course’ approach to the development of cultural competency in the health disciplines, and was implemented across first, second and third year units within four major undergraduate courses in the Faculty of Health.

The goal was to move beyond a ‘good citizenship’ model of Indigenous knowledge to one of professional competence in students.

A crucial feature of the Yapunyah Project was the embedding of learning activities, including assessment, within curricula.

Student learning has been impacted positively across 26 units at both undergraduate and postgraduate levels, with over 7,700 students each year enrolled in the units that have been redeveloped to include Indigenous perspectives. The self awareness and personal development that students experience through their engagement in the learning activities of the programme provide a basis for their learning outcomes beyond graduation and into their professional lives. This has been facilitated by the integration of the clinical/practicum environment within the Yapunyah Project, whereby cultural competency is built into clinical units and clinical assessments. The project has also succeeded in enhancing the experience of Aboriginal and Torres Strait Islander students with respect to health courses and creating a positive impact on all graduates’ interest in and opportunities for employment in the area of Indigenous health. The continued and sustained work that has arisen from the Yapunyah project prepares our graduates to be proactive in working to improve the health status of Indigenous Australians.

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The Yapunyah Project was an initiative of the Faculty of Health at the Queensland University of Technology, instigated as a result of ethical, clinical, accreditation, and regulatory imperatives to develop cultural competence in health graduates with respect to Aboriginal and Torres Strait Islander perspectives. The project was guided by earlier reforms in health curricula by the Committee of Deans of Australian Medical Schools and the Royal Australian College of General Practitioners, and by the cultural competence in healthcare delivery models of CampinhaBacote (1998) and Cross, Bazron, Dennis & Isaacs (1989). It was also informed by the cultural safety reforms to health curricula in New Zealand.

development of media-based learning resources within selected units, integration of Aboriginal and Torres Strait Islander perspectives within assessment in theory and practicum units, and self assessment activities for students to reflect on their learning.

The Yapunyah Project reflects an explicit strategy to systematically promote students’ understanding and appreciation of Aboriginal and Torres Strait Islander perspectives and competence in providing culturally safe healthcare to health consumers of Indigenous backgrounds. The project aimed to facilitate the development of professional competencies that are fundamental to the provision of care that promotes optimal health outcomes for Aboriginal and Torres Strait Islander people.

Robyn Nash, Sandra Sacre and Beryl Meiklejohn | Faculty of Health, Queensland University of Technology, Australia Email: s.sacre@qut.edu.au 21

INTERNATIONAL DIARY

Diary 2008 Annual International Conference of The Network: Towards Unity for Health 27 September - 2 October, 2008, ChĂ­a-BogotĂĄ, Colombia 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

Further information: Network: TUFH Office, P.O. Box 616, 6200 MD Maastricht, the Netherlands; tel: 31-43-3885638; fax: 31-43-3885639; email: secretariat@network.unimaas.nl; Internet: www.the-networktufh.org/ conference 1 - 5 October, Melbourne, Australia 2008 Wonca Asia Pacific Regional

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 17 - 21 November, 2008, Kampala, Uganda Improving the Quality of Family Medicine Training in Sub-Saharan Africa. Organised

by Primafamed. Further information: email: primafamed@ugent.be;

Internet: www.primafamed.ugent.be 20 - 21 November, 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 21 - 24 December, 2008, Ismailia, Egypt 10th International Workshop on Human Resource Development in Health Management & Leadership. Organised by Center for Research & Development in medical education & health services, Faculty of Medicine, Suez Canal University (FOM/ SCU), Ismailia, Egypt. Further information: email: CRDMED@ismailia.ie-eg.com; Internet: crdmed.tripod.com

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Post-Conference Excursions: October 3, 2008: Health Centre Aqua de Dios October 3 - 5, 2008: Valledupar - Sierra Nevada de Santa Marta

Conference - A Celebration of Diversity.

Organised by Royal Australian College of General Practitioners and World Organization of Family Doctors (WONCA).

Further information: email: wonca2008@meetingplanners.com. au; Internet: www.wonca2008.com

Diary 2009 1 - 4 March, 2009, Johannesburg, Republic of South Africa Wonca African Regional Conference Family Medicine in the African Context.

Organised by World Organization of Family Doctors (WONCA). Further information: Internet: www.globalfamilydoctor.com/ conferences/conferences.asp 15 - 19 March, 2009, Ismailia, Egypt 23rd International Workshop on Community-based Education Incorporating Problem-based Learning, Innovative Approaches. Organised by Center for Research & Development in medical education & health services, Faculty of Medicine, Suez Canal University (FOM/

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SCU), Ismailia, Egypt. Further information: email: CRDMED@ismailia.ie-eg.com; Internet: crdmed.tripod.com 25 - 29 May, 2009, Washington DC, USA Global Health Conference. Organised by the Global Health Council. Further information: email: conference@globalhealth.org; Internet: www.globalhealth.org/conference 5 - 8 June, 2009, Hong Kong, China Wonca Asia Pacific Regional Conference Building Bridges. Organised by World Organization of Family Doctors (WONCA).

Further information: Internet: www.wonca2009.org

15 - 26 June, 2009, 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

STUDENTS’ COLUMN STUDENTS’ SPEAKERS CORNER

Community Mental Health Education in Nigeria I just concluded an insightful ten-week posting in psychiatry. I gained a panoramic view of mental health and some knowledge of how the attitudes, beliefs and practices of individuals in the local community affect the concept of psychiatry.

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Mental Healthcare Programmes The earliest account of community

It is important to note that community psychiatry involves the education of people in the community, preventive measures, therapy, rehabilitation and support of the mentally ill and those convalescing.

There is therefore a need to create mental healthcare programmes and at the same time involve individuals in the community in its initiation. Apart from community mental health education, the need to establish population-based treatment and care is also very vital.

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This may be attributed to the poor knowledge of mental health due to inadequate mental health education. The community

Gap Over the years more focus has been placed on community and family health education with mental health education being neglected. This reality has created a wide gap between attitudes and practices towards improving the general body health and that of mental health. It is therefore important that we scientifically educate the community on good mental health. At the same time they need to understand that apart from genetic predispositions to mental disorders, we are all predisposed to a decline in our mental health; it should not be attributed to cultural phenomenon and perceived enemies in their locality. There is hence a necessity to integrate this in various organised healthcare programmes.

psychiatry and community mental health education in Nigeria was in 1954, when a notable doctor, Professor Adeoye Thomas Lambo formed a diurnal hospital system around a psychiatric hospital, Aro-Abeokuta (during that period they did not have the infrastructure or manpower for the mentally ill) where the individuals in the community allowed patients to stay in rented rooms in their houses where they were treated and in exchange the villagers were given water and free healthcare services. This initiative was reported to have shown an effective enhancement in the mental health of the patients, improved prognosis and reduction in stigmatisation.

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A brief story: a fellow medical student of mine was on her way to the psychiatric hospital when she decided to hail a cab going via that route. She was then asked by the cabman where specifically she wanted to be dropped off and when she mentioned the hospital the cabman blatantly refused to take her there.

easily accepts issues on general body health while matters on mental illness are treated with rejection. The first point of call for most of these members of the community in the care/treatment of mental illness is traditional/spiritual healers, due to lack of proper understanding together with the traditional belief that the sources of mental health problems are spiritual. This approach usually prevents early detection of the factors that contribute to the illness. It also delays initiation of prompt and effective therapy.

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Stigmatisation The perception of psychiatry varies from community to community. Generally, mental illness is still being perceived as being spiritually related in developing countries like Nigeria. It is reported that about 70% of the population of Nigeria reside in rural communities. Lack of understanding and knowledge about mental health by the community contributes largely to the stigmatisation of practitioners (psychiatrists, other health workers, medical students in psychiatry posting) in the field of psychiatry as well as the patients.

Queens Medical Centre

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The concept of mental health is integrated into the WHO (1986) definition of ‘health’ or ‘wholeness’ of an individual, which states that “Health is a state of complete physical, mental and social well being and not merely the absence of disease or infirmity”.

Hence, when considering the general wellbeing of individuals in the community there is no need to fragment the health of their body from their mind, as they both constitute the total state of health of any individual.

Igwilo Ugonnaya Ugochineyre | SNO African Representative, College of Health Sciences, Igbinedion University, Nigeria Email: chinyerehumphrey@yahoo.com 23

STUDENTS’ COLUMN STUDENTS’ SPEAKERS CORNER

Network: TUFH Institutions Welcome Maastricht Students

Why did I choose Sudan? I finished a Master’s degree before, so I had already done a thesis in the Netherlands. I wanted to try to do the same in a foreign country.

Actually, I planned to go to a country like England or another European country. But then the university offered me an opportunity to go to Sudan. What to do? It seemed it was not possible to go to England unless I arranged everything myself, which would take too long. Since three other students were going to Sudan as well, I assumed this was a good second option. Then the others decided not to, so I was by myself.... I still decided to go: off to Sudan!

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A Maastricht Student at Ahfad University for Women, Sudan April 2007 was an exiting month! It was the month I would leave to Sudan to work on a research for my Master Thesis in Health Policy, Economics and Management.

I had also completed a Bachelor in Health Sciences and a Master in Health Education and Promotion, all at Maastricht University.

My study concerned a cross-sectional survey regarding HIV/AIDS prevention policy for Sudanese women. HIV/AIDS is increasingly affecting girls and women world-wide. The first case of HIV in Sudan was diagnosed in 1986 and since this diagnosis, the prevalence in Sudan has been rapidly increasing.

It is really important to change this rising pattern now to prevent bigger problems from occurring in the future.

I hope my thesis helped to change this. My problem statement was: To what extent can the policy for HIV/AIDS prevention for women in Sudan be improved? I formulated short- and long-term recommendations: the political commitment has to be improved by emphasizing the impact of HIV/AIDS in Sudan, testing for HIV, and using protective measures during sex should become more anonymous. Furthermore, the Government

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Ms. Annemarie van der Kolk with her supervisor Dr. Mohamed Moukhyer should involve the community to get greater insight into their needs. In the long-term, a climate of openness concerning sexuality and related matters should be encouraged.

This approach might change opinions on sex and use of condoms. Islam is an important factor, since this religion has a big impact on people’s beliefs and behaviour policy making. This religion should be intertwined with HIV/AIDS prevention.

This last recommendation on integration of Islam is a very important one. During my stay I got insight in this religion and the way it impacts daily life. It was very interesting to live with a Sudanese family. I still remember the first time I was in the room and suddenly everyone got up, grabbed a prayer mat and started to pray!

The research itself was quite difficult. It happened several times that I managed to make an appointment with someone and travelled for an hour in a bus without air-conditioning (degrees up to 50ºC!). When I arrived at the institution and asked for the person I would have an appointment with they replied: “No, he is not here, we do not know of any appointment...”. You have to be very patient and persistent. But although it was hard, I did manage to write my research report.

After three months of many, many spoons of sugar (they like sweets a lot!), busy markets, incredibly crowded bus stations, several death experiences due to crazy traffic, interesting conversations regarding religion and a lot of sunshine I travelled back home.

I gained many experiences and will certainly never forget this country!

Annemarie van der Kolk | Student, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands Email: annevdk@hotmail.com

Geriatric Depression Care in Rural Illinois Because of a change in the medical curriculum at Maastricht University, the Maastricht Faculty of Medicine (now Faculty of Health, Medicine and Life Sciences) was in need of more off-campus clinical and research opportunities for their 6th year medical students.

During the Network: TUFH Conference in Australia, we started to talk about sending some of those students to the College of Medicine at Rockford, University of Illinois, USA. Our students do not have a research requirement; in their senior year they have

several electives, so a lot of the time they are away from Rockford. We always have a number of research projects, but not always a lot of students around. Therefore, it was handy for us that Maastricht students could help us with the projects; and we helped them gain experience.

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I think a strength of students coming to Rockford is that it is very easy for us to put them in contact with doctors and patients, so they can actually go out and collect their own data.

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As a 6th year Dutch medical student, I went all the way to Rockford, Illinois for my research participation. My research

Lieke Vogels / Student, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands Email: liekevogels@hotmail.com

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Michael Glasser | Associate Dean, Centre for Rural Health Professions, College of Medicine at Rockford, University of Illinois, USA Email: michaelg@uic.edu

Finishing my research project was my main goal in Rockford, but another reason to choose for Rockford was the fact that I always wanted to experience the American way of life. And I certainly did! I shared my apartment with a medical student. This made it very easy to integrate with other medical students and local people. I was the only exchange student at the College of Medicine, so everybody was really interested and willing to help. All people I met have been very generous and I have made some precious friendships. I have even been a bridesmaid at a friendâ&#x20AC;&#x2122;s wedding!

This made my stay in the US a wonderful experience.

Ms. Lieke Vogels

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I think a strength of students coming to Rockford is that it is very easy for us to put them in contact with doctors and patients, so they can actually go out and collect their own data. At other universities the research might be more clinical; ours is clinical in a way, but also social and behavioural. They actually get to know people, and they get to know how the healthcare system works and how it effects the people that are using that system.

Throughout this experience, I have realised that management of geriatric depression in rural areas in the US remains an area of concern, as there is poor access to mental healthcare. Although more than 20% of the US population lives in places defined as rural, only 9% of all physicians practice in these communities. Better recruitment of psychologists and counsellors in rural regions is needed to improve depression care. Furthermore, the results of the study strongly support integration of mental healthcare in primary care practices. This approach is quite similar to the change you see in the Netherlands; an increasing amount of family physicians share the office with psychologists.

J U LY

Lieke Vogels came in October 2007, for the 18 week research participation. It is important to have 18 weeks; you need this time.

We did a project on what primary care doctors know about and how they treat depressions in older people. Ten years before that, a colleague and I had done a survey of rural doctors in Illinois, to find out how they treated depression in older people. It would be useful to conduct a survey on that population 10 years later.

Lieke and I are writing a paper now to publish her study findings. We have analysed the results and now we are writing a paper so we can submit it to a US peerreviewed journal.

project was on the assessment and treatment of depression in older adults in rural Illinois. I grew up on a farm in a small rural community in the Netherlands, and geriatric medicine has always drawn my attention; therefore, this project was perfect for me. Rural medicine gets special attention at the University of Illinois in Rockford.

There is a special programme for rural medical students, so it was the perfect location for this project.

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Member and organisational News Messages from the executive committee To learn more about the personal beliefs, motivation and goals of our EC Members, we have invited Ian Cameron to share his thoughts with us.

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EC Intelligence: Ian Cameron In April 2008 the Australian Government held a 2020 Summit. The planners invited 1000 people who were described as Australia’s brightest and best, to spend an unfunded weekend discussing what Australia should look like in 2020, and what needed to be done to get there. Streams included such areas as productivity, governance, social inclusion, creativity, health, rural communities, Aboriginal and Torres Strait Islander peoples, security, and the economy.

I was honoured to be one of those selected to attend.

In many ways it reminded me of a Network: TUFH Conference. There were few plenaries, and those few addressed some of the bigger issues. Our groups focussed not on what was wrong, but what was needed.

The thoughts were diverse and often ‘out of the square’. Like a Network: TUFH Conference, it had no defined ending, but left participants and the Government with a plethora of thoughts for the future. It was fun.

One of the great strengths of The Network: TUFH has always been this inclusion and sharing of thoughts, without anyone pushing their thought as a single path to make the system work. The Network: TUFH recognises and celebrates diversity. From its beginnings in academic-community partnership, it has acknowledged that health changes will largely come from outside the health sector, but that we all have our role to play and to share. However, The Network: TUFH has for many years concentrated on the education side of development.

The merging of The Network with TUFH gave exciting possibilities to the new organisation in moving beyond an academic focus to being more inclusive of others in 26

health systems, and at all levels including policy makers, practitioners and health organisations, as well as academics and community. I think that since the merger, we have not taken full advantage of the opportunities offered by the inclusion of TUFH, and we still have a chance to maximise these opportunities.

Recently I was talking with a wise and eminent doctor about rural health workforce. He had also been involved for many years in Aboriginal health and in general practice education. While we talked he asked me “where did we go wrong?” And we have gone wrong. Our rural health workforce throughout the world is small and declining. Yet our education and training effort and expertise are increasing. Reflecting on his question, I think it in many ways parallels the directions that are open in The Network: TUFH. Our focus on education has helped to equip a potential health workforce for their future, but we sometimes have neglected the work environment they may go into. This is where I think a greater uptake of the TUFH elements will add immense value.

For me the future of The Network: TUFH combines more of the same actions with more concentration on health systems. The conferences are marvellous; often the thought of the next one is what helps to keep me going. We need to add to that the wider partnership theme. This has already been happening with closer ties to collegiate organisations including Wonca, the Wonca Rural Working Party and the Wonca Africa regional group. The recent co-signed editorial in the British Medical Journal on vertical health funding is a great example.

The ongoing relationship with GHETS is another.

Dr. Ian Cameron The Network: TUFH is widely known, but we could be better at letting people know how we do things. This particularly applies to future funders of Network: TUFH activities. I think that a short published strategic plan that includes what we do, who we do it with, how we do it and how it is funded would be of immense value in adding to our profile.

All these strategies are framed in a context that it is the people involved who make The Network: TUFH what it is. We need to continue to acknowledge the vision and leadership, the participation and work of all our people from Conference attendees to the Secretariat. We need to support the students and hopefully keep them within the Network: TUFH community as they graduate and move into their own work.

And we need to ensure that the Network: TUFH community remains one that cares, shares, develops and is enjoyable.

Ian Cameron | Executive Committee Member; CEO NSW Rural Doctors Network Email: icameron@nswrdn.com.au

TASKFORCES

15by2015: Quality Healthcare for All The Network: TUFH is one of the organisations involved in the 15by2015 campaign. The campaign has been officially launched with the publication of an editorial in the British Medical Journal on March 1, 2008 ( De Maeseneer et al., 2008. Funding for Primary Healthcare in Developing Countries. 336:518-519).

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Dr. Elmusharaf has been relevant to the advancement of health in his community, in different areas including medical education, medical students’ activities, health service delivery, health researches and community charity work. He established and led many students and medical organisations and conducted workshops and training courses concerning leadership developing programme. He organised and participated in more than 30 medical trips to rural areas of Sudan, which included medical students training, charity medical services, health education and promotion and small projects implementation, which was of grate value.

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Please sign our petition in support of improving the primary healthcare around the world: www.15by2015.org

During the General Meeting in Kampala, Uganda in September 2007 the 2nd TFA was presented to a very honoured Dr. Khalifa Elmusharaf from Sudan. Dr. Elmusharaf, a 32-year old medical doctor, has been an active participant and contributor at the Network: TUFH Conferences; he was a member of the Poster Evaluation Committee; he was also national coordinator of Sudanese participants in Australia; in Vietnam he was a member of the Conference Evaluation Committee, and he won the Best Poster Award; in Belgium he organised and co-facilitated a workshop titled Practical skills for students and young health professional to setup community projects; he is an active member of Evaluation Committee of the Women and Health taskforce; he presented also several posters.

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Primary healthcare cuts across diseases in a systemic way. Investing in improving the quality of primary healthcare (infrastructure, human resources and equipment) is a broad-based and sustainable investment that should be accessible and affordable for all. For example, if good primary healthcare were available in the 42 countries accounting for about 90% of child deaths world-wide, 63% of these deaths could be prevented. The most prevalent health care problems in developing countries are respiratory illnesses, diarrhoea and complications of labour and delivery. These can and must be treated within the same primary healthcare framework that deals with diseases such as malaria, tuberculosis and AIDS.

The TFA honours a person/organisation/institution/group for outstanding contributions to The Network: TUFH. The award consists, apart from a certificate, of an economy ticket to travel to a future Network: TUFH Conference (to be filled in within three years from the year of award), space in the Newsletter and a world-wide announcement through our hlt-net Alert.

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The positive news is that financial support to improve healthcare in developing countries has increased seriously in the last years, about 26% between 1997 and 2002. However, the vast majority of this aid was allocated to disease specific projects (vertical programmes) rather than to broad-based investments (horizontal programmes) such as primary healthcare services. Vertical programmes improve healthcare, but only for small groups of people with specific diseases. Some people receive good care, others remain untreated because there are no doctors, nurses or medication available.

Furthermore, salaries of healthcare providers working for donor-funded vertical programmes are often two to four times that of equally trained Government workers in primary healthcare. This induces an internal brain-drain (loss of well-trained people where they are most needed) where local healthcare workers move from their work in health centres and hospitals to the better paid projects of donor organisations.

Tribute to…

At the occasion of the Network: TUFH’s 25th anniversary, the Executive Committee installed the Tamas Fülöp Award (TFA).

Tamas Fülöp, who was in a leadership role at WHO Headquarters in Geneva at the time, took the initiative to establish The Network in 1979.

J U LY

15by2015 is a campaign calling for all major global health donors to allocate 15% of all their grants towards strengthening the primary healthcare system of the country they are working in. The target date is the same as with the globally known and used eight millennium development goals: 2015. With 15by2015 we want to specifically target healthcare and make you and all influencing stakeholders aware of an adequate strategy to improve healthcare. Quality healthcare - accessible and affordable - is a right for all; most everybody agrees on this, but the way to reach this is not always clear.

Dr. Khalifa Elmusharaf was awarded with the 2007 Tamas Fülöp Award

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Member and organisational News TASKFORCES

Mini-Grants Supporting Women and Health Learning Package

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Global Health through Education, Training and Service (GHETS) awarded in 2007 a total of $10,000 towards mini-grants (each is no more than $3,000) to support the use of the Women and Health Learning Package (WHLP). Each year, the grant proposals are reviewed by the Women and Health Taskforce. In 2007, the taskforce chose four recipients who submitted innovative plans for approaching women’s health topics through a variety of different avenues: In Uganda, GHETS funded Sarah Kiguli to increase knowledge regarding reproductive health among undergraduate medical students, who will in turn work with women in the surrounding areas. This project came about from Sarah Kiguli’s observations of the trend of pregnancy among many single female students during their medical training along with the lack of stand-alone services for women.

Sarah Kiguli sees the need to promote preventive messages in order to decrease the risk of unwanted pregnancies and STI’s. As a result she plans to use a variety of media, such as workshops and talk shows, to increase reproductive health knowledge, while also directing skits and role-playing in order to empower young people with the communication skills for approaching these issues.

Rogayah Ja’afar of Malaysia has identified a similar need to promote curricula surrounding women’s health at health professional schools as well as NGOs. After taking part in the drafting of a formal educational module on women’s health at a meeting several years ago, she hopes to incorporate the WHLP as a key component of this curriculum and to expand its scope to the national level. These efforts will culminate in a National Work28

shop for Promoting Women’s Health Learning for Malaysian Health Professional Students scheduled for next year.

In South Africa’s Gauteng province, Todd Maja has recognised the need for health education curricula to be developed among youth care centres in order to address the increasing number of youth engaging in risky behaviours.

By conducting workshops among healthcare providers and students serving as peer educators from these health centres, Todd Maja will help to develop learning modules tailored to the specific health problems of local youth.

Ultimately these modules, derived from the WHLP, will be implemented by staff at several different youth centres.

Lastly, in Nigeria Godwin Aja aims to use church-based women support networks as a means for promoting the use of the WHLP. Churches provide opportunities for training non-professionals on behaviour change and promoting health among local communities.

Godwin Aja will orchestrate a two-day workshop that will allow for discussion of many WHLP topics via interactive activities such as drama features, essays, storytelling, and poster presentation. Along with disseminating knowledge, GHETS is hopeful that this workshop will create a sense of partnership for increased awareness on women’s health issues among churchbased networks as well as arm individuals with the necessary skills for facilitating further workshops in the future.

Jessie Rothstein | Global Health through Education, Training and Service (GHETS), USA Email: jdr@ghets.org

New Taskforce: Social Accountability and Accreditation The new taskforce is chaired by Robert Woollard, Canada (woollard@familymed.ubc.ca), and Charles Boelen, France (boelen.charles@ wanadoo.fr).

Its aim is promotion of social accountability principles and methods with aims: • to orient education, research and health service activities of educational institutions to better respond to people’s priority health needs; and • to develop relevant evaluation and accreditation standards and processes.

The taskforce objectives are: • to create awareness and interest for social accountability in universities and health professional schools at international level; • to organise educational activities related to the definition and measurement of social accountability; • to elaborate standards reflecting social accountability; • to suggest tools and mechanisms to assess social accountability; • to collect data on status and progress of social accountability in universities and health professional schools; and • to conduct experiments in using standards, assessment tools and mechanisms for the purpose of accreditation.

Projects Related to Care for the Elderly Molly Eriki from Uganda (jajjashome@ mildmay.or.ug) reported on an innovative programme in Uganda, in which grandparents are care givers of children with AIDS. â&#x20AC;&#x2DC;Clubs for Grandparentsâ&#x20AC;&#x2122; were set up in 14 of the 80 districts of Uganda. NGO funding was used to hire volunteer coordinators who recruit volunteers identified by local healthcare centres and parish officials to run these clubs. The clubs typically support 40 to 50 grandparents each week.

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The Network: TUFH taskforce on Elderly Care and the Network: TUFH taskforce on Interprofessional Education will jointly plan and run a session at the next Network: TUFH Conference in Colombia in 2008. Elderly Care taskforce members are invited to participate in planning the session by contacting Larry Chambers and Dawn Forman (dawn. forman@btinternet.com) (leader of the taskforce on Interprofessional Education).

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The Help Age Ghana long-term care home and a few veteran homes are the only facilities, and therefore virtually all older adults must stay at home when they become frail and more dependent. As more and more city dwellers spend time at work, they have less time to care for their homebound parents and/or grandparents.

Joan Basigira from Uganda (registrar@ med.mak.ac.ug) had observed that care of the elderly is not a topic presently covered in the undergraduate curriculum of the Makere Medical School. Medical students now must participate in the Community-Based Education Service (CBES) component of their programme, where they conduct a community environmental scan focusing on prevention and health promotion. Some exposure to care of the elderly may arise but this is not emphasized by the CBES. Students also are involved in the palliative care hospice in Kampala that includes outreach home visits.

The School of Medicine is presently conducting a review of the undergraduate medicine curriculum. As Registrar, Joan will recom-

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At present, the students may be exposed to care of the elderly in their clerkship, and there is an opportunity in the family medicine residency programme for residents to focus on geriatrics.

In her teaching hospital, a geriatrics clinic is offered one day of each week. In September 2007, an outreach centre/clinic for older adult outpatients was offered and medical students (house surgeons/interns) participate in these clinics. The plan is to expand these clinics to include health promotion and disease prevention.

Larry Chambers from Canada (lchamber@ scohs.on.ca) outlined projects of the Elisabeth Bruyère Research Institute (EBRI). The EBRI website provides brief overviews of its research programmes that cover care of the elderly, including the cardiovascular health awareness programme (www.chapprogram. ca), palliative care, CanDRIVE (a research programme to improve clinical decision-making related to keeping older drivers driving), primary care, and TAFETA (keeping people independent in a friendly home environment through the use of technology). Larry reported that the EBRI is producing and evaluating on-line e-learning resources that focus on interprofessional patient-centred collaborative care and palliative care through the humanities. The EBRI is a member of the newly established Ontario Seniors Health Research Transfer Network (SHRTN) (www.shrtn.on.ca).

Through the support of librarians, knowledge brokers and the health and aging research institutes/centres in Ontario, caregivers of older adults participate in SHRTN local implementation teams, SHRTN communities of practice, the SHRTN annual assembly to exchange ideas, connect people, and promote use and production of research.

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Akye Essuman from Ghana (akyessuman@ yahoo.com) outlined his interest in home care for older adults in his practice and his desire to see care of the elderly be a learning goal for medical students in his medical school.

Suman Gadicherla from India (sumanamogh@gmail.com) reported on Indira Gandhi National Open University, School of Health Sciences offering post graduate diploma courses, which is of one year duration, for medical graduates i.e. to those who have completed their MBBS and are practicing medicine. This course is offered in distance education mode and the school is one of the study centres where the enrolled participants come for contact programmes, about four spells of one week each.

mend that care of the elderly be part of the undergraduate medicine curriculum.

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A number of activities are offered at the clubs, from skills training in care of children to poetry writing and healthcare. Healthcare sessions at the club are followed up with home visits by nurses, teachers, physicians, religious leaders and social workers. Students including medical nursing and social work students regularly have placements attached to the clubs. With the early success of these clubs, Molly pointed out that this programme should be offered in the other 66 districts in Uganda.

Akye plans to work with his colleagues in his family practice to find ways to provide home care for the older adults in their practices.

This approach will also create learning opportunities for undergraduate medical students.

Larry Chambers | Taskforce Care for the Elderly Email: lchamber@scohs.on.ca 29

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.

WONCA 8th International Rural Health Conference, Nigeria, February 2008 Three hundred members attended - the majority from Nigeria - dynamic and ebullient and welcoming. Sadly, rumours about security deterred visitors from outside. But Calabar appeared well ordered, organisers ensured security and there was no sense of threat. The Organising Committee was chaired by Ndifreke Udonwa and the Scientific Committee by Victor Inem. They and their teams of workers overcame all challenges.

Mutually Supportive Relationship WONCA and The Network: TUFH are seeking a mutually supportive relationship. This partnership was discussed by the Rural Health Working Party, chaired by Ian Couper from Witwatersrand University, South Africa.

I was asked to represent The Network: TUFH.

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Frontline Medicine: From Natural Disasters to Daily Care

The organisations have different aims but share common ground in rural communitybased medical education and commitments to primary care. They are jointly seeking discussion at the World Health Assembly for: • the HARP initiative (Health for all Rural People), and • the 15by2015 initiative to ensure by the year 2015 that 15% of vertical programme funding be allocated to strengthening integrated local primary care systems.

WONCA proposed to The Network: TUFH that the relationship be developed as follows: • Consultation will continue at the Northern Ontario School of Medicine International Conference: Community; Medical Education in the North (ICEMEN) in Sudbury Ontario, June 8 to 14, 2008: http://normedsps.lakeheadu.ca/ icemen/default.aspx • WONCA Rural Health members will

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attend the Network: TUFH Conference in Colombia for further discussion in September: www.the-networktufh.org/ conference • A joint workshop at the WONCA Rural Health World Conference in Crete in 2009 (www.ruralwonca2009.org) will plan for a joint full meeting in 2011.

Remembrance The conference opening ceremony and celebratory dinner were marked by the remembrance of the contribution to general practice of two historic figures in the early development of general practice in Nigeria.

The first was S.IE. Emoke, of this very region, one of the first Nigerian trained practitioners. The second was C. Andrew Pearson of the Wesley Guild Mission hospital, who was a leader in establishing of this training.

Pearson’s son Bryon presented the album of his fathers’ photographic record of those early beginnings, to remain permanently in Nigeria. He reminded me I had spoken about McMaster at the 1979 launching conference. The first day of the Calabar conference was rich with seminars, training sessions and presentations on the main theme and on wide ranging topics. The day closed with an outdoor evening reception at University of Calabar Teaching Hospital.

Okoyong On the second day we were bussed to the rural community of Okoyong. Here my keynote address, Lessons from Community-Based Education in Five Continents, was held in brilliant sunshine, the PowerPoint invisible.

Pictures were in words and action. Fifteen graduates of Ilorin were in the audience.

Three I had taught 30 years ago! Discussion to and fro became part of the talk, verifying my account. Who needs technology? We were greeted by the Paramount Chief, an

The Network: TUFH is being represented at meetings and conferences all over the world: • Geneva Health Forum 2008, May 2008, Switzerland. Represented by Jan de Maeseneer.

• Global Forum on Human Resources for Health, March 2008, Uganda.

Represented by Sarah Kiguli.

• WONCA 8th International Rural Health Conference, February 2008, Nigeria.

Represented by John Hamilton.

• Bellagio Conference on Expanding Frontiers in Medical Education, September 2008. Represented by Abraham Joseph.

• Global Health Council’s 35th Annual International Conference, May 2008, USA. Represented by Jan de Maeseneer and Pertti Kekki.

anaesthetist. Then moved to the old home of Mary Slessor, an early missionary, much revered in this area to which she brought Presbyterian ministry, healthcare and protection for newborn twins who were believed to be evil. And then we got down to serious exchange with the community at the village meeting house, with speeches, music, singing and dancing. The officers of the Rural Health Working Party and Chris van Weel (President of WONCA) were robed and inducted as Chiefs, followed by more singing and dancing.

The working party returned the compliments of the elders by proposing that a fund be raised to repair and update the clinic. A cultural evening in Calabar and a thoughtful visit to the Museum of Slavery closed the day.

The Network: TUFH should look forward to working with WONCA Rural Health.

John Hamilton | Professor Emeritus, Department of Medicine and Public Health, Faculty of Health, The University of Newcastle, Australia Email: jha06187@bigpond.net.au

ABOUT OUR MEMBERS

A Passion for...

The passion of Paul Akmajian, Marketing and Outreach Officer, School of Medicine, University of New Mexico, USA: A famous Argentine teacher of mine once said, “You don’t find the tango. The tango finds you.” Well, the tango found me and it became a major passion of mine.

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It is said that to become an expert at something (anything) requires doing it for ten years or 10,000 hours. Looking back over my ten-year tango journey, I can say that I have probably become an expert, but I also know how much more I still have to learn. It is difficult now to conceive of even a week going by without dancing two or three times. Tango has taken me to unexpected places, and in the process I have made lots of friends and become part of a network of people all over the world who share my passion…and speaking of that, I have heard there is some good tango in Bogotá!

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Argentine Tango itself has a fascinating history, going back perhaps as far as 150 years, with the form we are familiar with evolving in Argentina and Uruguay just before the beginning of the 20th century. The very first musicians and dancers were most

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The answer is complex and mysterious, but I think the best explanation I can give is that it combines so many things I love into one activity: nice music, hugs, a bit of theatricality and spontaneity with a physical challenge. Combined with that you have a unique opportunity to connect deeply - to become one - with another human being for the three minutes of a song.

As the century progressed, immigrant dockworkers from Italy, Germany and elsewhere in Europe arrived in Argentina in great numbers. Living in the poorer barrios (neighbourhoods), they brought their own music and instruments, and through mixing with the residents of the nearby black barrios, the tango was born.

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So exactly what is it about the tango that hooks people? How is it that someone like me, who had never done any couple dancing per se and never even thought of myself as a good dancer, became addicted to and adept at a dance so intricate and complex as the Argentine Tango - that now I am even teaching it to others?

likely Afro-Argentines and Afro-Uruguayans who originally came over as slaves.

They brought with them African rhythms such as the candombe, and later, via Cuba, the habanera. These two rhythms form the earliest origins of the milonga; a dance predecessor of the tango.

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Little did I know then that this was just barely the beginning, and that it would take years and many miles more on the

dance floor to get even close to mastering the dance. Nor did I fully realise then how it would change me and how far it would take us, how many wonderful people we would meet and wonderful times we would have.

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At first, as we struggled through those early classes, it was maddening and frustrating. This was social, couple dance requiring that I lead every step. Many times I decided that this was it; I was quitting.

I just was not going to get it. Yet, something kept me coming back… Perhaps the sweet, sad, nostalgic sounding music, the social interaction, the wonderful feeling of embracing your partner and moving around the floor, or just simply moving your body to music. Little by little, with time, I gained confidence and finally reached a point (after more than a year!) to ‘think’ less and ‘feel’ more. As the vocabulary of the dance became part of my body memory, I had fewer tango ‘crises’ and I was able to relax and enjoy it more.

‘You don’t find the tango. The tango finds you.’

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It all began rather innocently in 1998, when my wife and I decided to try to get out of the house more and we started taking some swing dance lessons. They were quite fun, and one day through a casual conversation with a friend, the idea of branching out and trying tango lessons came up. My initial reaction was “Tango!?”.

It seemed very old fashioned and exotic….

I knew virtually nothing about it and questioned whether or where we would ever get the chance to dance it outside of classes.

Nevertheless, we signed up for a six-week class series, and my amazing tango journey began.

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Member and organisational News

The Network towards unity for health

ABOUT OUR MEMBERS

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Newsletter Volume 27 | no. 1 | July 2008 ISSN 1571-9308 Interesti ng Internet Si tes The Network: TUFH Interactive - Recommended Internet sites www.the-networktufh.org/publications_resources/interactive.asp The Higher Education Academy Subject Centre for Medicine, Dentistry and Veterinary Medicine www.medev.ac.uk International Physicians for the Prevention of Nuclear War, European affiliatess www.ippnw-europe.org American Indians and Alaska Natives in Health Careers http://aianhealthcareers.org International conference in UK: The Future of Primary Healthcare in Europe www.futureofprimarycare.com/?opt=0 The International Council of Nurses (ICN) calls the world’s attention to the increasing violence against women, particularly in areas of conflict www.icn.ch/waa_UNambassadors.htm Primafamed; An institutional network for the development of family medicine and primary healthcare in Africa www.primafamed.ugent.be/index.html

Moving On: Changes in Institutional Leadership The Secretariat received information about changes in leadership with the following Network: TUFH members. We have listed the names of the former and new (Vice-) Deans/ Directors for you: • Dr. Hernando Matiz Camacho, Escuela Colombiana de Medicina, Universidad El Bosque, Bogotá, Colombia has been replaced by Dr. Miguel Ruiz Rubiano, medicina@unbosque. edu.co • Dr. Jayaprakash Muliyil, Christian Medical College and Hospital, Bagayam, Vellore, India has been replaced by Dr. Anand Job, prince@cmcvellore.ac.in • Dr. Bernard Groosjohan, Faculty of Medicine, Catholic University of Mozambique, Beira, Mozambique has been replaced by Dr. Josefo Ferro, josefoferro@yahoo.com.br • Dr. Mayuree Vasinanukorn, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand has been replaced by Dr. Somchai Suntornlohanakul, somchai.su@psu.ac.th • Prof. Michael Olanrewaju Padonu - mopadonu@yahoo.co.uk - has been appointed to the post of Provost of the College of Health Sciences, Igbinedion University, Nigeria 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 2102: Faculty of Health, The University of Newcastle, Newcastle, Australia.

Silver Full Member Up to 2013: School of Medicine, Moi University, Eldoret, Kenya.

Silver Full Member

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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 • School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana • Faculty of Medicine, University of Medical Sciences & Technology, Khartoum, Sudan Associate Members • Steirische Akademie für Allgemeinmedizin, Medical University of Graz, Graz, Austria • Health Training Institute, Alli Causai Foundation, Ambato, Ecuador Individual Members • Dr. Tayyab Hassan, Hospital University Science Malaysia, Kota Bharu, Kubang Kerian, Malaysia • Drs. Klaas Bart de Raad, Máxima Medical Centre Eindhoven, Eindhoven, the Netherlands • Ms. Ntsakisi Eustacia Furumele, Faculty of Health Sciences, University of Limpopo, Polokwane, Republic of South Africa • Ms. Julie Sierra, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA