THE NETWORK TOWARDS UNITY FOR HEALTH
VOLUME 28 | NUMBER 01 | JUNE 2009
NEWSLETTER LETTER
MARCH 8, 2009 was the time that we celebrated the international Women’s Day. On March 8, 1910, there was special attention for better working conditions for women in the textile industry, and for women’s right to vote. Nowadays, most women are allowed to vote, but there are still plenty of other rights to be fought for: equal payment and equal career opportunities is one; the right for a woman to decide herself what happens to her body is another. 100th
IN THIS ISSUE, AMONG OTHERS: Violence: A Social Determinant of Health 03 Becoming Interprofessional at Kobe University, Japan 07 Clinical Officers in Africa 18 Connecting Health Research in Africa and Ireland 20 Network Alumni: A Unique Experience 30
In almost every Newsletter we pay attention to women and health. Also in this edition: read about the female community health volunteers in Nepal, the no-scalpel vasectomy as effective and safe substitute to female sterilisation, and the training modules regarding women’s health (e.g. on breast cancer, female genital mutilation, and unsafe abortion). On behalf of the all-women editorial team of the Network: TUFH Newsletter (including our language editor): girrrrl power! Marion Stijnen and Pauline Vluggen Editors
In the Newsletter we refer to The Network: Towards Unity for Health as The Network: TUFH.
06 09
CONTENTS 03 Foreword Violence: A Social Determinant of Health 04 The Network: TUFH in Action 04 Annual International Conference Collaborative Partners: Nepal and UK | The 2009 Conference 05 Book Review One Who Has Gone Out, Has Come Back and Sees With New Eyes 06 Education for Health Education for Health: An ‘Insider’s’ Account 07 International Health Professions Education 07 Interprofessional Education Becoming Interprofessional at Kobe University, Japan | Forever Young - The 1988 WHO Report on Teamwork in Health | “Things Are Moving Towards IPE, But It Takes Time to Change…” 11 Accreditation and Quality Assessment External Influences in Training of Health Personnel 12 Yellow Papers Parallels in Healthcare Evaluation and Educational Assessment 13 Medical Education SHEIL A@AMEE 2009 14 Distance Learning PREVIEW: Problem-Based 16 Improving Health 16 Women’s Health No-Scalpel Vasectomy: An Urban and Rural Area Scenario 17 Rural Health The Importance of Safe Water Supply and Proper Storage of Drinking Water 18 Health Professions Clinical Officers in Malawi | Clinical Officers in Kenya | Clinical Officers in Uganda 19 Health Research Using Art to Understand Medical Conditions | Connecting Health Research in Africa and Ireland 21 Care for the Elderly Perceptions of Sexual Practices and Problems among Geriatrics 22 Community Action 22 Female Community Health Volunteers in Nepal 23 Students’ Column 23 Students’ Speakers Corner SNO Kenya Activities on World AIDS Day 2008 | STUFH: Students Towards Unity for Health | Student Member Editorial Board EfH 24 International Diary Diary 2009-2010 26 Member and Organisational News 26 Messages from the Executive Committee General Meeting 2009, Jordan 28 About our Members Training Modules | Network Alumni: A Unique Experience | Re-Assessing Full Members | New Members | Tribute to… | Primary Healthcare Resolution Adopted in Geneva! 32 Introducing Members Styrian Academy for General Practice and Family Medicine 32 Interesting Internet Sites
FOREWORD
Violence: A Social Determinant of Health sonal violence (e.g. intra-family violence, child neglect) and structural violence (e.g. unequal access to healthcare for socially vulnerable groups such as undocumented immigrants, or adverse environmental living conditions experienced by socially marginalised groups).
Prof. dr. Jan De Maeseneer
N U M B E R 0 1 | V O L U M E 2 8
Recently, we have seen the emergence of new forms of co-operation. One is ‘SouthSouth’-co-operation. Here, expertise in developing countries is shared through networking among institutions in countries with similar socio-economic resources and history. In this way, development is less dependent on ‘experts’ coming from the North. The Primafamed network in Africa - which focuses on training of family physicians and primary healthcare workers - may be an example (www.primafamed.ugent.be).
N E W S L E T T E R
Encouraging students to be more sensitive toward justice in international health is not only a matter of theory, but also of practice.
Within The Network: TUFH, there is an important movement of students from and to developing countries, seeking to gain expertise on the relation between development and health. This student exchange can lead later to international co-operation, focusing on strengthening the local capacity for healthcare. Within The Network: TUFH, the SNO is a vehicle to stimulate international exchange through students. This contribution to international co-operation, understanding and peace is one of the essential strategies of The Network: TUFH.
2 0 0 9
Health-threatening violence comes in many forms; not only physical, as in war, but psychological and structural as well. Healthcare providers confront this on a daily basis: per-
Academic health centres are beginning to take a stand against various forms of violence. Recently, the chancellors of the Flemish universities in Belgium called attention to the plight of undocumented people and refugees and the consequences of their living conditions to their health. Faculties in different parts of the world have taken responsibility for teaching students about the consequences of international conflicts on health, and the role of physicians in war conditions. Increasingly, ‘international health’ appears in health science curricula. The topic ‘human rights and health’ is discussed by staff and students. Social inequalities in health are debated and researched.
Prof. dr. Arthur Kaufman
J U N E
In December 2008 and January 2009, over 1.300 Palestinians were killed in the Gazastrip. The Lancet (www.thelancet.com) recently published a series of scientific publications, documenting the impact of this war and of the permanent occupation of the Palestinian territories on the Palestinian health and health system. Since January 2009, poverty has increased and almost half of the Palestinians are dependent on food donations. Moreover, the social cohesion that contributes to the Palestinian social structure and health system is under pressure and has weakened. The situation in Palestine exemplifies how violence threatens health. In Darfur, continuous violence leads to devastating health problems such as serious infections, malnutrition, and major depression. Today, conditions in Darfur are direr, after the president of Sudan ordered the NGOs to leave the region. In Zimbabwe, a humanitarian catastrophe grows as a consequence of an incompetent and corrupt Government, leading to a cholera-epidemic growing to 3.500 new cases every week (www.azg.be). And physicians and other health professionals from Western countries have participated in torture in wars in Iraq and Afghanistan.
Structural violence has a broad origin and can be related to such varied causes as political acts, social conditions, or some religious beliefs. Female circumcision of 12-year old girls in Northern Nigeria can result in painful urogynecologic function and complications during pregnancy. Broadcasting of unscientific and prejudicial statements about HIV/AIDS by religious and political leaders may threaten the health of populations. Confrontation with direct and indirect forms of violence puts physicians and healthcare providers in front of difficult choices: scientific knowledge is no longer sufficient, but there is a need for a broader reflection, taking into account context, ethical issues and societal commitment.
Jan De Maeseneer and Arthur Kaufman | Secretary General, The Network: TUFH, Belgium; Former Secretary General, The Network: TUFH, United States of America Email: jan.demaeseneer@ugent.be; akaufman@salud.unm.edu 3
THE NETWORK: TUFH IN ACTION ANNUAL INTERNATIONAL CONFERENCE Every year The Network: TUFH organises an international scientific and networking conference. The Conference 2009 will be held in Amman, Jordan, on October 10 - 15.
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 8
J U N E
2 0 0 9
Collaborative Partners: Nepal and UK The Network: TUFH provides many opportunities for meeting international colleagues from diverse health related backgrounds. At Ghent, Belgium, in 2006, colleagues from Kathmandu University Teaching Hospital, Dhulikhel, Nepal and the University of Derby, UK established the beginnings of a new partnership through the networking opportunities promoted by the conference philosophy. The sharing of expertise and culture is seen by both universities as an essential component for growth and innovation, not just within university life as a whole, but more specifically in their health training programmes. In 2008, the University of Derby sponsored a senior lecturer from Nursing and Healthcare Practice to visit Nepal as a member of an international teaching team, Partnerships in Medical Education. This visit involved delivering teaching sessions to undergraduate and postgraduate nurses at the School of Nursing, Nepalgunj, Kohalpur, as well as meeting nursing and teaching colleagues at Dhulikhel.
Mrs. Liz Day and Dr. Chet Raj Pant Concurrent to the visit, Kathmandu University Teaching Hospital invited the University of Derby to respond jointly to a call for proposals for the Development of Partnerships in Higher Education project (British Council, Nepal). In principle, both universities have agreed to submit a joint proposal, with Kathmandu University Teaching Hospital as the lead institution. The project aims to contribute to improving maternal health through an evaluation of the current health education programme delivered by student nurses undertaking a four-week placement in the community.
The Network: TUFH provides many opportunities for institutions throughout the world to strengthen their health networks and develop international partnerships to consolidate and diversify their business, whether it is health practice or education. It is hoped that international engagement and support for the network will continue to grow. Chet Raj Pant and Liz Day | Associate Dean, Kathmandu University Teaching Hospital, Nepal; Assistant Head of Subject for Nursing and Health Care Practice, Faculty of Education, Health and Sciences, University of Derby, United Kingdom Email: crpant@yahoo.com; e.day@derby.ac.uk
The 2009 Conference During October 10-15, 2009 The Network: TUFH will organise its annual Conference in collaboration with the Faculty of Medicine, University of Jordan. This Conference will be held in Amman, Jordan. The theme of the Conference is Achieving Quality in Health Care: Challenges for Education, Research and Service Delivery. After the Conference (October 16, 2009) you can participate in the following PostConference Excursion: Mu’tah University, Karak, Jordan.
4
The Dean of Kathmandu University Teaching Hospital welcomes not only the prospective of collaboration in relation to curriculum development and research activity, but also future opportunities for the continuing professional development of teaching staff with the University of Derby.
Conference site: www.the-networktufh.org/conference Programme: www.the-networktufh.org/conference/ programme.asp Registration: www.the-networktufh.org/conference/ registration.asp Abstract submission (for Thematic Poster Sessions): www.the-networktufh.org/conference/ abstractchoice.asp
Proposal submission (for Mini-workshops or Didactic Sessions): www.the-networktufh.org/conference/ abstractchoice.asp
BOOK REVIEW
One Who Has Gone Out, Has Come Back and Sees with New Eyes Book review of: Suffering and Healing in America: An American Doctor’s View from Outside Author: Raymond Downing ISBN 1-84619-130-0, 121 pp.
0 1 | V O L U M E 2 8
In the next section, Downing first discusses the medicalisation of prevention. He then takes a look at the examples of
This review has been published before in Education for Health, Volume 21, no. 2, 2008).
N U M B E R
Several chapters explore health. The first asks what most contributes to health. The reader must consider where healthcare priorities are and should be. Paradigms explores how the prevailing paradigms of intrusion and balance impact healthcare beliefs and actions. The third chapter, Hubris, reminds us of the lessons of Aescalapius, Promethius, and the largely forgotten Charon. The final chapter, Ethics, explores the conundrums that result when ethical dilemmas and decisions are coopted by legal interpretations and interventions.
In the first chapter on healing, Treatment, Downing raises questions of cost and what money can buy. Family Medicine reflects on this American specialty of the 60’s. He argues that the specialty is confronting a number of crises: identity (who Family Physicians are), vision (what they do), financial (how they will get paid and control costs), methodological (how the discipline ‘knows’), and ethical (how they relate). This is a strong critique, and I would argue that the crises described apply not only to Family Medicine, not simply to primary care and not solely to American medicine.
N E W S L E T T E R
The themes of this book are illustrated with stories, all well told. Downing is a student of the humanities, and he encourages further learning.
In the final section on culture, the first chapter reminds us that we cannot really see our own culture until we stand outside of it. The chapter on Learning teaches the reader that ‘international health’ must be a two way street. The ‘first world’ cannot save the ‘third world,’ but we can learn much from one another. The final chapter is entitled Poverty. Dr. Downing sees the world through a Christian lens which may bother some readers, but the important lesson - that everyone has something to give, has something to teach, and has value equal to anyone else - transcends any single faith tradition.
2 0 0 9
Dr. Downing covers the themes of health, suffering, healing, prevention and culture. He begins his introduction with the story of his father who never learned to swallow pills (which is to say, he never fully accepted the tenets of American healthcare). From this personal and local story, he moves to his experience in Africa. He helps the reader understand the perspective of one who has gone out, has come back and sees with new eyes.
malaria, HIV and heart disease, so that the reader can consider the complex issues of disease control efforts in opposition to eradication strategies and physician efforts in contrast to health system endeavours.
J U N E
Raymond Downing practiced medicine in Africa for a decade. The contrast between healthcare in the US and in Africa motivated him to pen his personal reflections in a series of essays. Ultimately, his Department Chair, Dr. Greg Blake, challenged him to address this question: “what did my African experience have to say about American healthcare?”.
The section on suffering begins with a chapter exploring the question of physician-assisted suicide. Downing discusses the difference between pain and suffering. He defines suffering as how one bears physical, emotional and spiritual pain and argues that one of the tasks of medicine is to be with those who suffer. The first of two Chronic Disease chapters explores how physicians disagree. Medicine has evolved from clinical diagnosis to symptom relief to impacting the morbidity and mortality of chronic diseases, but the quantitative impact of our preventive strategies and the resultant dependence they foster on the ‘medical system’ must be critically questioned for both the ‘third world’ and the ‘first world’. The second Chronic Disease chapter explores Downing’s observation “that the search for magic bullets is upstaging the attempts to treat the sickness of society” (p. 55). He challenges us to consider, in context, what Thabo Mbeki said about HIV in 2000 (for which he was dismissively criticised): that an organism or an etiology is but one small part of the challenge of disease.
Judith Gravdal and Morris Goldberg | Book and Electronic Media Review Editor EfH; Chair, Department of Family Medicine - Programme Director, Family Medicine Residency - Advocate Lutheran General Hospital, USA Email: jgravdalmd@gmail.com 5
THE NETWORK: TUFH IN ACTION EDUCATION FOR HEALTH
Education for Health: An ‘Insider’s’ Account
The electronic era of the journal had just started. Prior to this time, potential authors could still submit their papers in hard copy format only. Now they were being asked to submit in electronic format also. One of Hill’s major successes was getting the journal indexed in PubMed/Medline. This was a significant step that brought a higher level of recognition and esteem to the journal. Its immediate effect was an increase in the number of submissions to EfH.
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 8
J U N E
2 0 0 9
When I started working for Education for Health (EfH) 10 years ago, March 1999, we had an almost completely new team: the new editor Hilliard (Hill) Jason, who would become my big mentor; two associate editors: Jane Westberg and Gerard Majoor; and me, the journal secretary. Hill also added a group of 70 new peer reviewers, many of whom continue to review for the journal today. They have come a long way with us!
When Ronald (Ron) Richards took over EfH editorship from Hill, we had a team of four associate editors: Jane Westberg, Jan van Dalen, Pertti Kekki and Noel Juban; Maud Senden moved into the position of journal secretary; and I became Ron’s ‘right hand’ in the new role of managing editor of the journal. In 2002, when The Network was changed into The Network: Towards Unity for Health, Ron was faced with the challenge to ensure that this major organisational change in The Network: TUFH be reflected in the journal. Ron, before he retired, recommended that the EfH editorship be handled by a team of two co-editors who would share the workload - since the workload of an editor cannot be underestimated!
6
This, in fact, is what happened. Michael Glasser and Margaret Gadon came on board in 2006 as the first team of coeditors for the journal. In 2007, Margaret Gadon was succeeded by Donald Pathman, who became Michael’s new ‘teammate’. I must say, we have a strong team! In addition to the co-editors and me, the group now also includes our five associate editors - Jane, Jan, Pertti, Noel, and Robert (Bob) Woollard - and Angelique van den Heuvel, our journal secretary. At the time of the transition to co-editors, the mission statement of the journal was also changed. It now reflects the broader role of The Network: TUFH, incorporating an emphasis on linkages between academic institutions and communities to improve health and healthcare delivery. The year 2007 was an important one for the journal. It was a time of major change! EfH was launched as an open access e-journal, making its content freely available to a global audience. This shift also required that authors submit their articles online. Getting our issues published nowadays has become a multi-continental event, with our co-editors in America, the journal office in Europe, and the ‘publisher’ in Australia. In reflecting on EfH, one of the things I have come to value most, and which has not changed in all of the 20 years of the journal’s existence, is the fact that EfH strives to provide inexperienced authors especially those from developing countries - with a forum to practice the skill of scientific writing and to get their work published. While striving for a high standard, we do tend to be more patient than most journals and work harder to encourage our authors, especially those in the non-Eng-
Mrs. Marie-Louise Panis
lish-speaking and developing parts of the world. The value of a paper is sometimes buried deep within, under layers of less than fluent English, poor structure, and vagueness. I’m always very happy when we are able to ‘salvage’ such a paper that most likely would have been rejected elsewhere. I feel privileged to be working for EfH. I have come in contact with so many wonderful people from all over the world. As Hill Jason once wrote: “The authors, reviewers and editorial board members associated with EfH are genuinely exceptional people. They share a vision and a commitment that is inspiring” (Jason, 2001). I have had 10 very good years with the journal. I hope to add several more Reference JASON, H. (2001). Editor’s Notes. Education for Health, 14(3), 347-349. This is an abbreviated version of an article that has been published in the May edition of Education for Health.
Marie-Louise Panis | Managing Editor, Education for Health Email: efh@network.unimaas.nl
INTERNATIONAL HEALTH PROFESSIONS EDUCATION INTERPROFESSIONAL EDUCATION
Becoming Interprofessional at Kobe University, Japan
| V O L U M E 2 8
Information on our IPE/L programme, including videos of workshops, seminars and some lectures, can be accessed at the website of Kobe University Interprofessional Education for Collaborative Work Centre (KIPEC) via: http://kobe-equiv.net/www/kipec
0 1
In the year, students undertake interprofessional clinical practice, in interprofessional teams, at the patient/user level. This clinical practice component is now being developed. The plan is that in 20102011 this will be scenario-based Problembased Learning. All going well, this clinical practice will be conducted in clinical institutions with co-operation of patients in 2011-2012. Medical students will have more interprofessional clinical practice in their 5th and 6th year.
Future Directions Developing good evaluation methods is important as it will identify the students’ and the programme’s strengths and weaknesses. These will inform the tasks ahead of continuously developing our IPE/L programme further. Masters of Science and Doctoral courses and research are currently being developed in the international health department of our graduate school, particularly the new International Activity for Health Course.
N U M B E R
In the first year students learn interprofessional basics in an introductory subject
4th
Extra-curricular activities, such as a student Interprofessional Work Day and seminars and workshops held in an Interprofessional Work Week, offer faculty and students additional opportunities to become interprofessional. Especially 2nd- and 3rd-year medical students are encouraged to participate, because they do not have IPE/L in their curriculum then. These ongoing activities also disseminate knowledge and skills to educators from Kobe University and other educational institutions and professionals in clinical practice.
N E W S L E T T E R
The IPE/L programme is now in its 4th year. It was enforced with a reformed curriculum in the 2007-2008 academic year. Student learning in this IPE programme is interactive, experiential-based and includes clinical practice and stresses patient-centred care. It is predominantly conducted in interprofessional group settings. There is some participation of people with disability and patient-groups, because we regard the healthcare users as team member.
The importance of collaborative practice and its education have been widely reported globally and nationally. At Kobe University, however, we have an additional local perspective. Kobe is, unfortunately, best known for the Great Hanshin-Awaji Earthquake which occurred in the early morning of January 17, 1995. Our experiences with providing healthcare services after this earthquake, and after other natural disaster nationally and internationally, have provided another impetus for developing IPE/L. Students’ learning is applied to healthcare provision in international and disaster healthcare in their 2nd and 3rd year.
Students practicing communication skills with a person with aphasia
2 0 0 9
IPE/L at Kobe University Our IPE programme evolved from the first pilot-classes in 2002, which introduced collaborative working to undergraduate nursing students. We now have an IPE programme that is fully integrated into the four-year undergraduate curriculum for the Faculty of Health Sciences (nursing, medical laboratory technician, physical therapy, and occupational therapy) and into the six-year curriculum in the School of Medicine (medical doctor). To express the central role of students we add ‘/L’ to IPE to stress that the IPE programme is about the students’ Learning.
and in the subject Modern Medicine and Bioethics. Thereafter, they experience interprofessional work in an early exposure clinical practice. Students acquire communication skills and work on issues related to safe medical services, ethics and so forth. The group work includes the use of images and metaphors, such as menus to express team work. Generally, these presumed to be inexperienced first-grade students demonstrate understandings of the role of one’s own and other professions, position of the patient (patient-centred teams), team-processes (i.e. influences of status and hierarchy) and so forth. The early exposure clinical practice includes students from Kobe Pharmaceutical University.
J U N E
In Japan, the Ministry of Health, Labour and Welfare started promoting chi-mu iryou or ‘team-treatment’ in the 1980s. Although the term ‘team-treatment’ was neither defined, nor its practice explained, it was promoted to encourage high quality healthcare provision. For 10 to 20 years not much changed in healthcare education, but recently more and more Japanese universities and colleges are incorporating it in their curricula. At the Faculty of Health Sciences at Kobe University we are at the forefront of developing Interprofessional Education (IPE). This article introduces our IPE programme as an illustration of developments in Japan.
Yuichi Ishikawa | Dean and Professor, Kobe University Graduate School of Health Sciences, Japan - Board Member InterEd Email: yishikaw@kobe-u.ac.jp 7
INTERNATIONAL HEALTH PROFESSIONS EDUCATION INTERPROFESSIONAL EDUCATION
Forever Young The 1988 WHO Report on Teamwork in Health
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 8
J U N E
2 0 0 9
Over 20 years ago, October 12-16, 1987, a group of people met together at WHO headquarters in Geneva to compose a position paper on Multiprofessional Education, which was published in 1988 entitled Learning together to work together for health (WHO, 1988). The six key members were from Sweden, Nepal, Egypt, the Philippines, Mexico and Tanzania, supported by representatives from Switzerland, France, Austria, Canada and Australia.
8
Today, the term Interprofessional Education, defined as “occasions when two or more professions learn with, from and about each other to improve collaboration and the quality of care�, would be used. But in my view, that is the only outdated component of a truly remarkable document, which contains so much deeply insightful material, it should be recommended reading for anyone involved in the healthcare field. For those of you with the available time, I would suggest reading the 72 page report at least twice. But given the fact that this is unlikely for many people these days, I have prepared a summary of the key points, which all remain valid. I have used the term Interprofessional Education (IPE) in place of Multiprofessional Education. The introduction outlines the primary goal as the improvement of individual and community health through effective collaboration and teamwork, i.e. interprofessional practice. Healthcare needs suitably trained people designed to work effectively in a team, with responsiveness to community needs. IPE is clearly stated to be a means to this goal, not an end in itself, (although the report intriguingly suggests it may provide a way of primary health introduction into a country or area, with the potential to reorient health systems), but reliable evidence of its strengths and weaknesses is lacking. Decision-linked research (i.e.
sites where collaborative health teamwork is particularly useful, such as deprived or underprivileged areas. A balanced range of real life problems is needed, which might be found using the epidemiological characteristics of a specific community.
Prof. dr. Peter Baker research focused on identified needs requiring informed decisions) is needed to determine its value and practicality, its undetermined effects on later professional practice and quality of care (this being made difficult by its marginal status, lack of measuring instruments or assessment criteria and the need to distinguish its impact from that of other factors). The key issues of when IPE should be introduced, and how much is needed, remain unresolved. One of the most important recommendations for implementation is the use of authentic workplace environments with real situations needing teamwork, recognition of the unique role and contribution of each team member and active participation by learners. Ideally, these settings should be suitable for research into team practice and teamwork training to further encourage student learning. Learning activities should be progressively staged in terms of complexity. Education and practice need to be mutually beneficial and strengthening, and IPE teachers should be involved in service provision. They should also be specifically trained in its delivery, evaluation and learner assessment. Community involvement in healthcare tasks and IPE learning objectives is also important, and wherever possible, there should be a focus on undertaking it at
One of the main issues targeted by the report is the lack of professional and team profiles as a prerequisite for curriculum design for both monoprofessional and interprofessional education programmes, with the latter also requiring identification of the different components of effective teamwork. General team functions should be segmented into specific components to develop a profile for each team member, to determine team learning activities and teamwork competencies. These will then comprise a mix of shared (e.g. promote and support community involvement) and variable (e.g. wound care undertaken by different team members according to need or availability) tasks, with specific ones for each individual according to prior professional training and experience. An explicit description of all healthcare team tasks also greatly assists in defining the professional profile of each category of healthcare worker, again divided into general functions and specific roles. It is also necessary to determine specific ways in which IPE increases the ability to solve problems, both individually and as team members, and improves healthcare quality. Conflict resolution, negotiation of roles, leadership, supervision, ethics, coordination, integration, communication, motivation, psycho-social skills are all integral components. Health promotion or maintenance, family support, community structure, employment status and leisure activities are also important factors requiring consideration in training and practice.
Peter Baker | Head of Rural Clinical School, School of Medicine, University of Queensland, Australia - Board Member InterEd Email: p.baker@uq.edu.au
| V O L U M E 2 8
The report also includes what I felt was a nice ‘cheat sheet’ for the introduction of IPE, which I would like to include by summarising below: • Justify it. • Develop implementation strategies. • Form group of enthusiasts. • Obtain high level support. • Gain stakeholder consent. • Continuous teacher training. • Improve administration. • Select suitable IPE problems. • Identify workplace training sites. • Determine professions involved. • Draw up professional profiles of types of health personnel the institution
Reference WORLD HEALTH ORGANISATION (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.
0 1
I have presented just a brief journey through a report filled with interesting stories and anecdotes from all over the world about collaborative healthcare activities. If you do find the time, it really is well worth reading, or perhaps re-reading.
N U M B E R
The report highlights the difficulties of maintaining IPE, with lack of money or commitment cited as key factors, coordination of curricula with workplaces often problematic, and factors such as fear of loss of professional identity acting as constraints. At an administrative level, promotion of team approaches also need to coordinate educational planning with health services, supported by intersectoral linkages wherever possible, with properly established jointly agreed criteria for quality in both healthcare and education. It is also important to look at the cost-benefit ratio of IPE as compared to traditional monoprofessional training models, and ensure its benefits are not wasted through lack of interprofessional practice within the healthcare system.
N E W S L E T T E R
expects to educate together. • Design student learning activities, including sequencing and preparation. • Identify resources needed. • Determine structure of student groups. • Evaluate learning outcomes and programme quality. • Review. • Manage change. • Promote IPE concept at all levels.
2 0 0 9
Given that economic, cultural, social and physical environment factors affect health, sectors other than health may be needed in healthcare teams, particularly in developing countries (intersectoral): agriculture, animal husbandry, food, industry, education, housing, public works, water supply, and communications. These should be coordinated through high level Government agencies.
J U N E
I HAVE PRESENTED JUST A BRIEF JOURNEY THROUGH A REPORT FILLED WITH INTERESTING STORIES AND ANECDOTES FROM ALL OVER THE WORLD ABOUT COLLABORATIVE HEALTHCARE ACTIVITIES. IF YOU DO FIND THE TIME, IT REALLY IS WELL WORTH READING, OR PERHAPS RE-READING.
9
INTERNATIONAL HEALTH PROFESSIONS EDUCATION INTERPROFESSIONAL EDUCATION
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 8
J U N E
2 0 0 9
“Things Are Moving Towards IPE, But It Takes Time to Change…”
10
The fourth international conference All Together Better Health (ATBH) IV took place in Sweden on June 2-5, 2008 (www. alltogether.se). The conference was hosted by Karolinska Institutet in Stockholm and the Health University in Linköping and focused on Development and Progress in Interprofessional Education and Practice. During four days more than 400 professionals from all over the world came together. They listened to keynotes, took part in workshops, seminars, short communications and poster sessions, all with Interprofessional Education (IPE) and Interprofessional Learning (IPL) as common topics. Four themes were presented: changing panoramas, the impact of IPE, IP communication: patient safety and quality improvement, and cost-effectiveness and evaluation of IPE. Tackling the Themes Invited keynote speakers focused on different ways of tackling the themes. Here are some examples: Quoting Mats Brommels, Karolinska Institutet, Sweden: “In professional services like healthcare, knowledge develops through specialisation. Specialisation gives rise to new groups of experts striving to establish themselves as professionals within a protected field. The development of knowledge and technology in healthcare results in an increasing fragmentisation of its professional structure. This change is not only creating new professions - it also requires professionals to adjust and proactively develop their skills to meet new requirements and organisational settings. The fragmentisation will emphasise the need for co-operation and communication among service providers and professionals alike. Professionals need to learn together how to best adapt to and thrive on these
changes which reshape their working environment”. Quoting John Gilbert, Canadian Interprofessional Health Collaborative: “The international movement toward interprofessional education for collaborative practice has developed rapidly over the past ten years. As curricula have emerged, so has the need to build a set of competencies that reflect interprofessional education and practice”. Quoting Yvonne Steinert, Mc Gill University, Canada: “Faculty members clearly play a critical role in the teaching and learning of IPE and they must be prepared to meet this challenge”. Quoting Hans Rosling, Karolinska Institutet, Sweden: “Professions are a curse to healthcare”. Overcoming Differences It could be fruitful to remind ourselves that the IPE concept indirectly connects to CP Snows’ famous lecture in Cambridge 50 years ago, where he argued that it was time to overcome the separation between the two cultures at the universities science and humanities. Little has happened during the last 50 years…. Yet IPE works in the same direction and strives to overcome differences by working together and hence get a better understanding of each other. IPE does not want to diminish the importance of each profession - quite the opposite, studying and working together with others gives a better understanding and insights in the own profession. Returning to their commitment in the 80s Learning together to work together for health - WHO recently organised Global Study Groups on Interprofessional Education and Collaborative Practice in order to present a
Mrs. Sari Ponzer (General Secretary of the conference) and Mrs. Ester Mogensen (right) at the All Together Better Health IV conference framework for action on this theme. WHO has recognised the importance of IPE and collaborative practice as an innovative approach that also could help tackle the challenge of global health workforce. A general meeting with the Global Study Groups convened in Stockholm in connection with the ATBH conference. The global perspective thus became one of the most important issues during the conference. Going back to fragmentisation, maybe the most provocative IPE/IPL concept is the idea of learning together with others. It can be a challenge to the professional ego: if I am a professional, why do I need to and what can I learn with and from other professions? Some have described the process of IPE as a kind of bereavement and loss of professional identity: if I have to learn together with others my sense of professionalism is taken away from me. Others point out the enrichment: IPE gives you a double profession - both a personal and an interprofessional identity. Intense Scandinavian and European networking in NIPNET (Nordic InterProfessional Education Network, www.nipnet. org) and EIPEN (European Interprofessional Network, www.eipen.org) has contributed to a better understanding of the need for collaboration and to fruitful contacts over borders. Things are moving towards IPE, but it takes time to change… Ester Mogensen | Senior lecturer, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden Email: ester.mogensen@ki.se
ACCREDITATION AND QUALITY ASSESSMENT
External Influences in Training of Health Personnel A vast experience in training health person-
individual-oriented health practices (López
nel (THP) in Latin America relates to public
and Blanco, 2007).
health policies (PHPs), focusing particular
ning of the last century; • curriculum disintegration in sets of basic, clinic, social, and behavioural sciences;
attention on strengthening national identi-
The traditional Latin American comprehen-
ty and trainees’ comprehensive education.
sive THP has been seriously hindered by
PHPs impact institutional programmes
control processes that place the responsibil-
through academic processes, administrative
ity of THP’s professional orientation and
Conclusions
procedures and recently, through standard-
accountability in systems of accreditation
• There is a close relationship between
ising evaluation, professional certification,
and certification external to the teaching
international and national economic and
and accreditation changes which had subor-
institutions and outside State control.
dinated the relevance of PHPs, science and
• neglecting of the education advances of the 1960-1990 decades.
social situations, PHP, and THP.
ONCE NATIONAL AND LOCAL PUBLIC HEALTH POLICIES ARE FORMULATED, THEY IMPACT TRAINING HEALTH PERSONNEL CURRICULA.
• There is asynchrony between PHP and THP.
reformed curricula for new students and
Policy Changes
JARILLO, E., ARROYAVE, G., & CHAPELA. C.
their readiness for professional practice.
Through the processes of evaluation and
(1997). La práctica profesional, las
technology for THP curriculum development. Below you will find three aspects of these changes.
Even when adapted to national and local esses), overall international trends and oripolitical situations, impacting national and local PHPs (Jarillo et al., 1997). Once national and local PHPs are formulated, they impact THP curricula. However, PHPs impact professional practice change at least asynchrony between the introduction of the
accreditation away from States’ control. • Resulting THP curricula privileges individualistic and curative practices suitable for market necessities. • These changes neglect the advances of THP achieved particularly in the 19601990 period. References COMAEM. Visión 2005. Retrieved April 10, 2009, from www.copaes.org.mx/ directorio/marcos_referencia/mcomaem.pdf
N U M B E R
one decade after its formulation, due to an
through systems of evaluation and
N E W S L E T T E R
entations emerged from socio-economic and
ticularly in Mexico, has been achieved
2 0 0 9
necessities (in the search of harmonic proc-
and structure in Latin America, and parJ U N E
Direction and Impact
• The imposition of THP curricula’s contents
políticas internacionales de salud y el
tional Latin American THP had moved to a
diseño curricular en medicina de la
Training
model based in a homogenising pattern of
UAM-X. In: Berruecos, L., La construcción
|
During the last four decades PHPs and THP
contents and orientations, which in fact has
permanente del Sistema Modular. México:
responded to the prevalent economic situa-
grown to become the only valid referent for
tion in Latin America, to overall internation-
the institutions in charge of THP.
V O L U M E
de salud en México. La reestructuración
developments. In the last decade and until
COMAEM’s (Mexican Council for the
neoliberal. In: Jarillo, E., Guinsberg, E.
present time, the economic changes leading
Accreditation of Medical Education) criteria
(Eds.) Temas y Desafíos en salud colectiva.
to a globalisation of national economies
and guidelines for an accountable medical
Buenos Aires: Lugar Editorial. 21-48.
have displaced the State as main economy
teaching programme show:
and policy regulator on behalf of the market.
• the individual and curative retrogress Edgar Jarillo, Maria Del Consuelo
In Latin America, an example of that dis-
necessary to accomplish market ends;
placement expresses in the decreasing State
• programme objectives focusing on com-
mandate in providing public services to the
petences without elaborating on their
Care Department, Collective Health PHD
population; lack of maintenance and expan-
epistemological basis;
programme, Universidad Autonoma
sion of public education and healthcare
• inclusion of technical and scientific novel-
systems; and a retrogress from collective- to
ties with a flexerian logic of the begin-
2 8
al policies, and to scientific and technologic
UAM-X. 467-486. LÓPEZ, O., & BLANCO, J. (2007). Políticas
0 1
accreditation described above, the tradiEconomy, PHP and Comprehensive
Chapela, Addis Abeba Salinas | Health
Metropolitana-Xochimilco, Mexico Email: asalinas@correo.xoc.uam.mx 11
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 one such yellow paper.
Parallels in Healthcare Evaluation and Educational Assessment
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 8
J U N E
2 0 0 9
The measurement of performance is remarkably comparable for both healthcare services delivery and for institutions delivering educational programmes. Assessing the environment, the process of delivering the services, and the impact those activities and contexts have upon the recipient of the services follows a similar methodology.
12
The American University of Armenia’s (AUA) College of Health Sciences (CHS), like all AUA’s educational programmes, was established to impact the economic sector that it represents. In addition to developing an educational programme based on unique structural characteristics and efficient operational approaches, the CHS has played a substantial role in pioneering healthcare quality assurance programmes in Armenia. This experience in healthcare quality assurance provided AUA a template for its nascent internal efforts to establish an ongoing programme of educational effectiveness assessment. From its inception, the CHS was involved in the development of quality assurance in its educational and programmatic activities. Examples of the College’s contribution to quality assurance through education and healthcare services delivery include (American University of Armenia, 2007; Centre for Health Services Research and Development American University of Armenia, 2007): • Creating two required courses in healthcare management and evaluation with a strong emphasis on quality assurance, and ensuring concepts and methods of evaluation and quality are incorporated across the curriculum. • Fostering a number of integrative stu-
dent thesis projects that focus on issues of quality and evaluation. • Developing and adapting quality assurance instruments and systems of assessment in Armenian and Russian. • Translating and publishing An Introduction to Quality Assurance in Health Care by Avedis Donabedian. This provided a compendium of concepts and approaches based on a lifetime of scholarship. Currently, it is the major text available in the Armenian language on the subject and is used by professionals at the Ministry of Health as well as at the various levels of health services. The book was later published in English by Oxford University Press (Donabedian, 2003). • Leading a multi-year programme to develop systems of performance evaluation at the Nork Marash Medical Centre that now serves as a model for such programmes in Armenia and its region. The CHS has engaged in a parallel set of activities, the continuous process of educational assessment. The Master of Public Health programme has been planned and evaluated on a yearly basis by a group of faculty and alumni. The CHS also benefitted from external assessments by its European counterparts through the Public health Education European Review (PEER) process of the Association of Schools of Public Health of the European Region (ASPHER). Buoyed by this experience, AUA implemented a university-wide educational effectiveness assessment system and subsequently sought accreditation. In 2007, accreditation as an institution of higher education was conferred by the Western Association of Schools and Colleges, a US accrediting body (Western Association of
Schools and Colleges, 2007). Today, as a result of its educational programme and its research activities grounded in quality assurance, the CHS has developed into a major resource of healthcare research as well as health professions’ evaluation in Armenia and its region. Potential Applications The last section of this article presents approaches and findings that evolved from our background in epidemiology and assessing the healthcare system. Several common denominators have emerged that characterise institutions with good quality of medical care, and will positively inform educational effectiveness assessment. These include: • Keep good records The presence within the institution of good quality medical records that accurately document healthcare transactions and evaluations is at the core of assessment. In doing so, a university needs a system that evaluates the completeness, validity, and reliability of its records. In hospitals and large clinics the Medical Records Librarian is in charge of overseeing the quality of the records. In a university, the Registrar needs to have a broader mandate to oversee the quality of academic records at all levels. • Create a culture of learning Since the late 1960s, teaching hospitals have fared better than non-teaching hospitals with respect to assessments of the quality of medical care provided (Wennberg, 1984). Although it is difficult to isolate the ‘active ingredient’ that improves quality of medical care in teaching hospitals, probably the competitive involvement of students, interns, and residents may account for much
0 1 | V O L U M E 2 8
References AMERICAN UNIVERSITY OF ARMENIA (2007). College of Health Sciences: Academic Mission and Program. Retrieved
Haroutune Armenian (President, American University of Armenia), Vahé Kazandjian (Adjunct Professor of Health Policy & Management, Johns Hopkins University Bloomberg School of Public Health), Michael Thompson (Assistant Professor of Public Health Sciences, University of North Carolina at Charlotte; Adjunct Assistant Professor, American University of Armenia) Email: methomp1@uncc.edu
N U M B E R
The development of a culture and system of quality assurance and performance improvement in a university environment can be a source of important scholarly research in its own right. At AUA we are in a position to test many of these quality assurance/educational effectiveness concepts and ideas in both a transforming healthcare system and in a new university environment, which are both historically and culturally different from their Western counterparts. We hope that the solutions that we develop here will be of relevance to a vast region of the World.
N E W S L E T T E R
• Establish surveillance/sentinel event systems Surveillance and monitoring of adverse outcomes and events - often called the nervous system - is a core system in health services. Thus, whether it is the monitoring of communicable diseases and cancer in public health,
• Define an appropriate peers/benchmarks Evaluation in health services is dependent on the comparative method developed first by Pierre Charles Alexandre Louis in early 19th century Paris (Morabia, 1996). Over the past two centuries, this has evolved into sophisticated systems of within and between healthcare institutional comparisons. At AUA, our comparison groups are not within the country but halfway around the globe. This gives us better targets to aim for, but also raises questions, at times, about our relevance to the local institutional environment.
23 October, 2007, from www.aua.am/ aua/masters/info3.htm. CENTER FOR HEALTH SERVICES RESEARCH AND DEVELOPMENT AMERICAN UNIVERSITY OF ARMENIA (2007). Centre for Health Services Research and Development, College of Health Sciences, American University of Armenia. Retrieved 23 October, 2007, from http://auachsr.com DONABEDIAN, A. (1980). Explorations in Quality Assessment and Monitoring Vol 1. The Definition of Quality and Its Assessment. Ann Arbor, Michigan: Health Administration Press. DONABEDIAN, A. (2003). An Introduction to Quality Assurance in Health Care. New York: Oxford University Press. KAZANDJIAN, V. A. (1997). The study of forests and ecosystems: how to grow better trees: a commentary on performance evaluation and improvement strategies in health care. Journal of Evaluation in Clinical Practice, 3(3): 235-238. MORABIA, A. (1996). PCA Louis and the birth of clinical epidemiology. Journal of Clinical Epidemiology, 49: 1327-1333. TRIBUS, M. (1982). Deming’s Way. Report for the Center for Advanced Engineering Study. Cambridge, Massachusetts: Institute of Technology. WENNBERG J.E. (1984). Dealing with medical practice variations: a proposal for action. Health Affairs, 3(2): 6-32. WESTERN ASSOCIATION OF SCHOOLS AND COLLEGES (2007). Accredited Institutions of Higher Education. Retrieved 23 October, 2007, from www. wascsenior.org/wasc
2 0 0 9
of this effect. At a university, the involvement of students needs to go beyond the classroom. Students should be engaged in research and development projects and have a formal role in improving the quality of these projects and be more actively and formally involved at all levels of university operation.
or nosocomial infections and deaths in a hospital, the same principles of surveillance apply: surveillance and monitoring systems must feed into investigation systems. The capacity to investigate poor outcomes and processes is the critical step that will identify the determinants of adversity and will hopefully lead to interventions and improvements in the institution. Similarly, at a university, we need to go beyond simple and episodic surveillance and monitoring of outcomes. We need to have an ongoing system that investigates the outcomes of education and leads to change where adverse outcomes are found, and affirmation and resolve where positive outcomes are found.
J U N E
WE NEED TO HAVE AN ON-GOING SYSTEM THAT INVESTIGATES THE OUTCOMES OF EDUCATION AND LEADS TO CHANGE WHERE ADVERSE OUTCOMES ARE FOUND, AND AFFIRMATION AND RESOLVE WHERE POSITIVE OUTCOMES ARE FOUND.
13
INTERNATIONAL HEALTH PROFESSIONS EDUCATION DISTANCE LEARNING
PREVIEW: Problem-Based
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 8
J U N E
2 0 0 9
PREVIEW (Problem-based Learning in Virtual Interactive Educational Worlds) is a JISC (Joint Information Systems Committee) funded project to deliver Problem-based Learning (PBL) for students on healthcare courses via the virtual environment Second Life. PBL has become a central learning approach in many curricula, but the collaborative style of learning is threatened by the movement towards more self-directed and distance learning. Furthermore, virtual world environments offer new possibilities for the ways in which PBL can be delivered. For these reasons, PREVIEW aims to investigate, implement and evaluate the use of virtual worlds to create and deliver immersive, collaborative PBL tutorials. The project has been running since January 2008, and eight PBL scenarios have been developed and tested for paramedic students at St George’s University of London (SGUL) and Health and Social Care students at Coventry University, both in the UK. The scenarios are set up on each University’s Second Life island, with different environments to put the scenarios into relevant contexts; whether it is a high street, a night club, or a care home. Students and teachers on these courses have little or no experience with the Second Life1 environment. Tailored orientation has been set up on each University’s island to provide users with all the basic skills they need to take part in the scenarios. It provides interactive activities to make the training process more enjoyable and effective, and has an accompanying written training guide. ‘Imitation’ scenarios have also been developed to provide students with an opportunity to practice interacting with the scenarios before their PBL sessions begin. 14
A street scene in Second Life
Paramedic Scenarios The four scenarios developed at SGUL for paramedic students are based on widely used resources known as virtual patients: online, narrative-driven cases that test students’ decision-making skills and their ability to apply their knowledge to realistic scenarios. The scenarios adhere to the Medbiquitous virtual patient (MVP) specification2, meaning that they can be interoperable between any platform that adheres to the MVP specification - whether it be within a virtual world, or through a web browser. This also means that these cases can be authored in the same way that any virtual patient case is authored at SGUL, and all the scenarios can also be accessed via the web. All the scenarios start with a dispatch call, as they would in a real life situation. Students have to assess the scene, decide where to park the ambulance, and whether to call for back up. All decisions throughout the scenario are discussed and made collaboratively within their PBL groups. As with virtual patient resources, the scenario adapts to reflect the decisions the students have made. Throughout the scenario they can ask the
patient questions, or carry out various observations and assessments of the patient. The patient in these scenarios is represented through a mannequin that is programmed to respond to certain interactions the students’ avatars may make. The paramedic students also receive an equipment box, stored in their Second Life inventory. This lists all the equipment that a paramedic would routinely have available to them in real life. At any point they can drag an object out of their inventory, and click on it to select the possible options. Another set of decisions must be made around the most appropriate time and way to transfer the patient to hospital. All the scenarios end with the hand over at hospital, in which the students summarise the case on a note card that then gets posted to their tutor. Health and Social Care Scenarios The Health and Social Care scenarios at Coventry are based on face-to-face PBL scenarios, which have been specifically designed for use in Second Life. There are four scenarios, which are all set in a care home context. Students are provided with a brief introduction to each scenario
and given background information about their role. For example, they might be told they are the management team of the home, which is facing a crisis and it is their job to formulate a strategy based on the information they receive.
This article was originally published in 0I, the newsletter of the Higher Education Academy Subject Centre for Medicine, Dentistry and Veterinary Medicine, www. medev.ac.uk medev.ac.uk.
More comprehensive feedback on our testing days and findings of the project so far can be found on the project website.
For more information, or to get involved with testing the scenarios, contact skavia@sgul.ac.uk
www.medbiq.com/std_specs/specifications/ index.html
2 8
Trialling the Scenarios The scenarios have been trialled with students on both courses. Feedback received
2
V O L U M E
For more information about the PREVIEW project, please visit www.elu.sgul.ac.uk/ preview/blog/ or the YouTube channel www.youtube.com/user/PreviewProject
1 secondlife.com
|
The other two scenarios are based around artificially intelligent nonplayer characters (NPCs), which are also known as chat bots. The chat bots, which are built around a mark-up language called AIML, take on roles within the scenarios such as a regional manager, and the students have to interact with them to learn more about the situation. The students use what they have learned from the NPCs as a basis for discussion in their groups, and to help them develop a strategy for the problem they have been presented with.
0 1
National Workshop October 23rd 2008, PREVIEW and our partners within the JISC Emerge Community held a National Learning in Immersive Worlds Workshop. This was a free, one-day event hosted at Coventry University’s Technocentre. The workshop featured a range of real world and virtual sessions and was streamed into Second Life throughout the day.
N U M B E R
Emily Conradi, Sheetal Kavia, Luke Woodham and Terry Poulton | St George’s University of London, United Kingdom; Maggi Savin-Baden | Professor of Higher Education Research, Coventry University, United Kingdom Email: skavia@sgul.ac.uk
N E W S L E T T E R
from the testing days has proved invaluable in improving the scenarios, and in better understanding the process of working and collaborating within the Second Life environment. Further testing days were scheduled over the summer, before the scenarios were embedded within the curricula for the 2008-2009 academic year.
2 0 0 9
Two of the scenarios are based around machinima videos. A machinima is a film made within a virtual environment using virtual actors, in this case Second Life. Students watch the machinimas, which convey information about the scenario, and then begin making a strategy in their PBL groups based on what have they seen. Interactive objects throughout the virtual setting offer additional information and help to set the scene for the scenarios.
Virtual paramedic training J U N E
To provide a realistic context, a virtual care home called The Cedars has been developed in Second Life on the Coventry University island. Most of The Cedars remains the same for all four scenarios, but the office space and some of the interactive objects change depending on the scenario being used. This is done via a holodeck, which allows Second Life objects to appear and disappear at the touch of a button.
15
IMPROVING HEALTH WOMEN’S HEALTH
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 8
J U N E
2 0 0 9
No-Scalpel Vasectomy: An Urban and Rural Area Scenario India was the first country in the world to launch the National Family Planning programme in 1952 (Park, 2000). Since then, there has been predominant female participation in gaining acceptance for Family Planning (FP) methods (Government of India, 1995). They have been the mainstay of the FP programme, and have been targeted for sterilisation. Female sterilisation accounts for 96%, while male sterilization account for only 4%, as per Population reports (1997). No-Scalpel Vasectomy (NSV), the most effective contraceptive method with practically no side-effects/complications, is more effective than oral pills or injectable contraceptives (No-Scalpel Vasectomy, 2009). This programme was offered to men on a voluntary basis under the Family Welfare programme (Li Shunquiang, 1998). Compared to female sterilisation, NSV can reduce surgery costs by 25% (Billions and billions of people, 1998). Objectives and Methodology To know the: • extent of awareness and practice of different FP methods among women in the reproductive age group, with special emphasis on NSV; • reasons for non-acceptance of NSV as a permanent FP method among women who have not yet adopted permanent FP method. A cross-sectional study was done during April-June 2003; 200 urban and 240 rural women belonging to the reproductive age group were interviewed, using a pre-tested semi-structured questionnaire at urban and rural health centres respectively. Results The majority of the women were Hindus (87%); from nuclear families (89.7%); about 78.3% had ≤ 2 children. The husband was the main decision maker, both in the urban and rural area. Interestingly, the mother-in-law still continued as a deci16
sion maker regarding FP. Tubectomy was the most common FP method they were aware of (90.9%), both urban and rural women. At least 98.4% of the females had heard of at least one FP method. Similar results were seen in a study conducted in Nepal (Tuladhar & Marahatta, 2008). The commonest known temporary method was oral pills (68.9%), followed by intrauterine devices (IUD) (66.6%). Among the permanent methods, tubectomy was the most popular method, being accepted in 20.3% urban and 28.1% rural population. This is below the national average (37.3% tubectomy users) as per NFHS3 reports (National Family Health Survey, 2005-2006). Vasectomy has been practiced among less than 2% of couples, in accordance with NFHS-3 reports. IUD was the most common temporary method used among women. About 38% of the urban and 32.9% of the rural women did not use any form of contraceptive. Condoms were used by 5.2% of the couples, in line with NFHS-3 reports. There was no significant difference between the rural and urban population regarding awareness of NSV. Only 13.5% of the urban and 12.1% of the rural women was aware of NSV. Only 3.6% was aware of advantages of NSV. When asked about the perception of women who had not adopted any permanent FP method, none of them were willing to accept NSV in the future. Mass media alone was an important source of information among urban (44.4%) and rural (51.7%) women. For 12.8% information was provided by the healthcare worker, which needs to be strengthened. The commonest reason stated for nonacceptance was that NSV affects the working capacity of men and their sex life. Conclusion and Recommendations The awareness and practice level of NSV is
poor among both urban and rural women. Myths and misconceptions regarding NSV prevail, which needs to be addressed. To popularise NSV, the following is needed: more satisfied client testimonials; increasing men’s access to reproductive health information and services through ‘special clinics’ and ‘work place programmes’. References GOVERNMENT OF INDIA, MINISTRY OF HEALTH AND FAMILY WELFARE, DEPARTMENT OF FAMILY WELFARE (1995). Family welfare programme in India, year book 1995-96, table A-4; 24. LI SHUNQUIANG (1998). No Scalpel Vasectomy Techniques. NATIONAL FAMILY HEALTH SURVEY, INDIA, 2005-2006 (2009). NFHS-3 Fact sheets. www.nfhsindia.org/factsheet.html Accessed on the 29th of April, 2009. No-Scalpel Vasectomy (2009). http://mohfw.nic.in/dofw%20website/ family%20welfare%20programme/nsv/ intro.htm Accessed on the 6th May, 2009. PARK, K. (2000). Park’s tet book of Preventive and Social Medicine. Jabalpur: Banarsidas Bhanot publishers, 16th edition. Population reports of 1997. TULADHAR, H., & MARAHATTA, R. (2008). Awareness and practice of family planning methods in women attending Gyne OPD at Nepal Medical College Teaching Hospital. Nepal Medical College Journal: 10(3): 184-191. Update, Billions and Billions of people, international family planning perspectives; 1998, 24(4); 154. Lalitha Krishnappa1, Ramesh Masthi2, Ashwath Narayana2, and Gangaboraiah Bilagumba2 | Associate Professors, 1MS Ramaiah Medical College Bangalore and 2Kempegowda Institute of Medical Sciences, India Email: lalithakgs@yahoo.co.in
RURAL HEALTH
The Importance of Safe Water Supply and Proper Storage of Drinking Water Makerere University - College of Health Sciences in Uganda is a centre of innovation in health professions education. With the introduction of the PBL curriculum - as one of the first in Africa - the institution has revolutionalised the medical training programme with Community-Based Education and Service (COBES).
• holding group discussions. Our group discussions brought attention to the proper definition of safe water, enlightened them on consequences of drinking unsafe water, assured them of the benefits of drinking safe water, and taught them - firsthand - how to make their water safe for drinking.
| V O L U M E 2 8
Our method was simple and the community members participated in: • conducting health education on water treatment and safe water storage, • demonstrating water treatment by use of chlorine powder, • demonstrating proper boiling procedures, • conducting health education on water treatment and safe water storage, • making clay pots with taps for safe water storage as opposed to jerry cans that can be used for any other purpose,
The project was tailored to suit the understanding of the villagers and the methods used were locally generated. A local NGO continues to provide free supply of the chlorinating tablets. This will ensure that there is continuity and self-sustainability of the project. The local leaders promised to sustain the project.
0 1
Student and community member demonstrate filtration of lake water
N U M B E R
Our effort to break down our message into a form that the villagers could identify with, encouraged the villagers to listen and adhere to the principles that we taught them.
N E W S L E T T E R
Records at a nearby health centre indicated an increasing surge of sanitationrelated diseases, the most common being non-bloody diarrhoea, dysentery and schistomiasis. This problem was largely attributed to massive use of unsafe water, as observed by group members during home visits and interaction with community members. Another contribution to this disease burden was poor latrine coverage, which had stagnated at about 50% in the entire district for the preceding three years.
Our goal was to reduce the prevalence of diarrhoeal disease due to consumption of contaminated water by the village members. Specifically, we sought to raise awareness on the importance of safe water supply and proper storage of drinking water. We also sought to demonstrate this.
2 0 0 9
Nsinda Fishing village is situated along the shore of Lake Victoria in the Mayuge district. The site was selected because of its reliance upon surface water for drinking and the practice of storing such water under unhygienic conditions in the home. There are about 150 inhabitants and 30 homes in the village.
Student demonstrates storage of boiled/chlorinated water in model clay pots with tap for dispensing
J U N E
COBES is a programme that allows students to visit rural areas in groups for at least one month annually, and to participate in health promotion in the area. The 1st year is for introduction into the community, the 2nd for community diagnosis and the 3rd for project development. During the 4th year, the groups implement self sustainable projects in these areas. The goal of these projects is to create mutually beneficial interaction in which the students improve skills in community mobilisation for health promotion, and the community members get health education and public health intervention.
Denise Lwamafa | Student, College of Health Sciences, Makerere University, Uganda Email: kyommey@yahoo.com
17
IMPROVING HEALTH HEALTH PROFESSIONS
Clinical Officers in Africa
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 8
J U N E
2 0 0 9
Clinical Officers in Kenya The public healthcare system of Kenya is organised in a pyramidal way with six levels: from the numerous community health workers at the community level, to referral hospitals at the top of the pyramid. The public health sector provides only half of the healthcare services. The remaining half is provided by private, mission and NGO healthcare services. The core healthcare staffing consists of nurses, clinical officers and doctors, supported by other auxiliary staff. The cadre now known as clinical officers (COs) in Kenya has evolved over a period of approximately 70 years: it began as an apprenticeship training leading to someone called a ‘dresser’, to that of certified COs (nurses trained in diagnostic skills), to the current diploma level training. The cadre is now legally recognised through the Clinical Officers Act of 1989, which also powers the Clinical Officers Council to licence and maintain standards in the practice of COs. In 2007 Kenya had 2,150 COs working in public facilities. Training programmes have been developed over time to enable COs to specialise in fields like Anaesthesia,
Clinical Officers in Uganda A Medical Clinical Officer (MCO) is a health worker who provides promotive, preventive, curative and rehabilitative health services within health facilities and their catchment areas. MCOs form the backbone of the frontline healthcare providers in Uganda. They are easily deployed country-wide in health facilities in remote rural areas where the majority of Ugandans live, and where medical doctors are reluctant to work.
18
Paediatrics, Ophthalmology, ENT, and Dermatology. The Government, as well as faith-based organisations and the private sector agencies, engage in the training of health workers. Currently, the numbers of COs graduating are steeply increasing. COs have always been visualised as front-liners who attend to patients at out-patient departments and community health centres. They play an important role in deciding who to manage and who to refer. The main challenge for the cadre is defining a CO in relation to a doctor. Difficulties in demarcation have resulted in a congested COs’ curriculum. Further career progress is a major problem, with little possibilities to progress in clinical sciences beyond higher diploma level - a situation which has forced many talented COs out of their clinical profession into alternative career options. Previously, there were many expressions of rivalry rather than collaboration between doctors and COs. A more general issue that pertains to all midlevel health workers in Kenya is the limited deployment and low remuneration in the public sector. Research into actual performance of COs
The objective of this article is to provide an overview of the training, roles and challenges faced by MCOs in Uganda. The Ministry of Education three-year diploma curriculum in Clinical Medicine and Community Health is utilised. Pre-clinical subjects are mainly covered in the first and second years, while the clinical subjects are covered in the third year. The practical aspects include conducting a community diagnosis, health centre management, some community health activities, and hospital clinical clerkship.
Clinical officers learning stitching in Kenya is very limited. The evidence available suggests that they do well in the management of common illnesses and that patients are satisfied with their performance. On the other hand - and this is seriously affecting their role as primary healthcare workers - prevention and health promotion competencies appear insufficient. Reuben Waswa and Marianne Darwinkel | KMTC Coordinator Skillslab Expansion; VVOB Advisor Skillslab Expansion | Kenya Medical Training College, Kenya Email: rwaswa@yahoo.co.uk; mariannedarwinkel@yahoo.com
In management, an MCO manages resources in the health facility and health services provided within the catchment area. In community health, (s)he plans, implements, monitors and evaluates primary healthcare services, including conducting research. In clinical care, (s)he manages common health conditions, refers patients/clients, identifies/reports notifiable diseases, and takes appropriate action on medical legal conditions. The training is mostly theory-oriented, tutor-centred, classroom-based, and clin-
The composer Maurice Ravel
0 1 | V O L U M E 2 8
Adamson Muula | Department of Community Health, College of Medicine, University of Malawi, Malawi Email: muula@email.unc.edu; adamsonmuula@yahoo.com
N U M B E R
hospitals in the country. The fact that a CO’s position in the healthcare hierarchy is intermediate - i.e. lower than medical doctors or physicians and degree-level registered nurses, but higher than medical assistants and some nurses cadres and equal to diploma-level nurses can be a source of tension. The COs are a cheap source of labour when they provide services that are traditionally offered by doctors. However, they may not be recognised for such a role, “because they are still clinical officers”. Similarly, for the services that medical assistants (MAs) can provide, the MAs sometimes feel the COs receive better recognition for the same services that they can ably provide. And in the case of nurses, the CO is often better recognised than any nurse cadre, bringing resentment among degree-level nurses. While the solutions to these and many other tensions may be complex, if at all, one thing that is clear is that COs are a critical component of the Malawi healthcare system. Their roles, however, will need to be continuously defined and refined, especially as the number of medical doctors in Malawi improves.
N E W S L E T T E R
Clinical Officers in Malawi The Malawi health system is heavily dependent on clinical officers (COs) for the delivery of clinical services. Clinical services are the backbone health professional cadres for the delivery of in-patient and out-patient (ambulatory) care, surgical services especially in relation to ophthalmic, caesarean sections, orthopaedics and administration of anaesthesia. Ophthalmic, anaesthetic and orthopaedic clinical officers receive an additional 18 months specialisation training to be qualified. The COs are the leading clinician cadre in private for profit, private not-for-profit (especially denominational), public or Government-owned health facilities. Clinical research projects in Malawi (national and international), especially in rural areas, find clinical officers useful in providing clinical services which are part of the research, but also ancillary-non research care. Malawi’s COs have three years of college education at two facilities: the Malawi College of Health Sciences (a Governmentowned and-operated training college) and the Malamulo College of Health Sciences (owned and operated by the Malawi Union of the Seventh-Day Adventists). However, both institutions receive Government grants. Following the three years of formal college education, the COs undergo a oneyear internship at large district-level hospitals or at any of the four regional referral
Alex Kampikaho | Director, Medicare Health Professionals College, MACHSU School of Clinical Officers, Uganda Email: alex.kam@live.com
USING ART TO UNDERSTAND MEDICAL CONDITIONS The relationship between art and the artist’s health is a frequent topic, mostly concentrating on composers. Earlier this year, BBC Radio 4 broadcasted a series of programmes on composers’ states of health and the effect on their musical work. Some years ago, the Royal Society of Medicine ran an event bringing together musicians, psychotherapists, psychologists and psychiatrists to take a much more forensic look at this topic; it allowed the audience to share a composer’s experience at a level much deeper than just musical appreciation. The centre piece of the event was an examination of Ravel, with special reference to his Bolero. Some years before he composed the Bolero, Ravel had suffered an accident; he had slipped while leaving his carriage, fell badly and hit his head on a curb. Nothing untoward seemed to happen for several years. Then suddenly he found he had forgotten how to swim. He began to suffer more and more memory lapses regarding daily activities, and the symptoms became progressively worse in a manner very similar to short term memory loss. He began to exist only in the immediate present, but with no wider cognitive impairment. Crucially, he lost the ability to predict what would happen next, a condition caused by the nature of brain injury. The Bolero has an extraordinary structure, whereby the listener - even on first hearing - can always predict what will happen next in the music. It is the musical equivalent of not needing a short term memory for artistic appreciation. The work placed Ravel back in a world he himself could predict and control one moment to the next; a desperate plea to be able to return to the world he had lost through his brain injury.
2 0 0 9
mortality in Uganda. There is a great need to review the curriculum and adjust it in most aspects in order to enable MCOs to do their work more effectively and address the health needs of most Ugandans.
J U N E
ical care biased, without emphasis on the desired community-based education, research and services. As professionals, MCOs in Uganda are weakly organised in associations, and tend to be overlooked and undermined by medical doctors. As frontline health workers, MCOs are expected to have significant effect on health. However, they are not allowed to carry out emergency surgery and cannot, for example, significantly reduce maternal
19
IMPROVING HEALTH HEALTH RESEARCH
Connecting Health Research in Africa and Ireland
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 8
J U N E
2 0 0 9
Strengthening health system research capacity in Africa can be challenging. There is a dire need to increase research capacity in Africa. The Connecting health Research in Africa and Ireland Consortium (ChRAIC) was formed in response to this need. The project intends to strengthen research capacity in Ireland and Africa through partnership strategies and a global approach. PhD Scholarship The PhD scholarship programme in health system research for Africa is one of the components of this project. This scholarship attracted over 160 applicants in 2008, and I was one of the three successful applicants. The curriculum component of this PhD programme is coordinated by the Royal College of Surgeons, National University of Ireland in Galway and Trinity College Dublin, along with the University College Cork. It offers taught modules in Population Health, Individual Health, Health Systems, Health Policy, Health Informatics, Evidence Synthesis & Clinical Trials, Applying Research Methods, Qualitative Data Interrogation, Handson Data Analysis with STATA, Health Economics & Econometrics, and Social Determinants of Health. These programmes have provided me with a firm foundation and strengthened my capacity to conduct health systems research. African Countries The research partners in ChRAIC work closely with senior policymakers in each of the countries. In February 2009, my supervisor Dr. Diarmuid O’Donovan, Dr. Elaine Byrne (the ChRAIC programme coordinator) and I were invited by the University of Medical Sciences and Technology to visit my home country Sudan to gain an overall view of 20
how the health systems operate in Sudan. During that visit we built up good links with the National Minister of Health and senior officials at federal and state levels. In addition, it helped me to explore the priorities and to shape my PhD research proposal. In the same vein, in April 2009, ChRAIC sponsored the three PhD students - including me - to attend a workshop in Uganda. It was a meeting of programme partners, together with senior representatives of national Ministries of Health, and global policy makers from the six different African countries. Engaging policy makers in the ChRAIC project from the early stage on, has been recognised as enhancing the capacity to apply research evidence in policy making. Programme Researchers from several institutions and countries comprise a long-term partnership for capacity building for pro-poor health research in Africa. Included are: three Irish institutions (Royal College of Surgeons, Trinity College Dublin, and the National University of Ireland Galway), researchers from six African countries (Lesotho National University of Lesotho; Malawi Malawi College of Medicine; Mozambique - Eduardo Mondlane University; Sierra Leone - University of Sierra Leone and Medical Research Centre; Sudan University of Medical Sciences and Technology and University of Juba; and Uganda - Makerere University), and one NGO (Malaria Consortium) The aim of this partnership is to summarise the existing research and knowledge gaps on health systems’ capacity, and to conduct research that will strengthen health systems in Africa in order to serve the poor more effectively. In addition, this project coordinates a doctoral pro-
Dr. Khalifa Elmusharaf in Ireland gramme, assesses and strengthens the partners’ research capacity, and strengthens research into policy links. The focus is on three components of the health system: governance, human resources for health, and access and equity. The programme will contribute to achieving three of the Millennium Development Goals: the reduction of child mortality rates, improving maternal health, and controlling HIV/AIDS, malaria and other infectious diseases. Conclusion In conclusion, this innovative programme will strengthen the health research capacity of individuals, as well as institutions. Long-term collaborations between Irish and African researchers will identify opportunities, develop common interests, and produce the research needed for effective health policies in Africa. Khalifa Elmusharaf / PhD student, National University of Ireland Connecting health Research in Africa and Ireland Consortium Email: khalifa_elmusharaf@yahoo.com
CARE FOR THE ELDERLY
Perceptions of Sexual Practices and Problems among Geriatrics Most studies on sexual behaviour in Africa - especially Nigeria - have focused on young people and adults, with limited attention paid to the elderly. There is a dearth of information about elderly persons’ reproductive health challenges, including sexual dysfunction, and their involvement in risky sexual activities. The goal of this study, therefore, was to determine the perceptions of sexual practices among the elderly in Nigeria.
(80.8%) were the main reasons for engaging in extra-marital sexual relationship. A majority (68.8%) of the participants were of the view that having sex with a virgin could serve as immunity against sexually transmitted infections including HIV; those who held this view comprised 65.1% males and 34.9% females. More than half of the males (56.4%) and females (66.7%) agreed that indulgence in sexual intercourse has a healing effect on the elderly.
N U M B E R 0 1 | V O L U M E 2 8
By contrast, an overwhelming majority (98 = 92.5%) of the females reported that menopausal changes in women caused their major sexual problems and dysfunctions. In addition to the menopausal changes, which included inadequate vaginal lubrication (30 = 73.2%), a few of the respondents (77 =
N E W S L E T T E R
Sexual Problems and Dysfunctions The findings from the survey (see Table 1) show respondents’ sexual dysfunction since they attained the age of 65 years. 238 People (59.5%) identified lack of sexual interest. This sexual problem was reported by 113 (60.1%) males and 95 (39.9%) females. Similarly, a majority of the males (112 = 89.6%) reported that the major sexual dysfunctions among the male respondents were early ejaculation and erectile dysfunction, compared to fewer females (13 = 10.4%) who reported that their partners also experienced the same sexual dysfunction.
2 0 0 9
The study, which was descriptive and cross sectional in design, consisted of 400 male and female geriatrics aged 65 years and above, who were selected using a six-stage sampling technique. The participants’ mean age was 71.8 (± 6.7) years. Slightly more than half, (50.5%) of them were males. A total of 76.2% males and 12.6% females had their last sexual intercourse in the two years preceding the study. A total of 25% of the participants had had sex with persons other than their spouses since they attained the age of 65 years. Among this subgroup that had extra-marital sex, very few (6.8%) used a condom. More males (5.3%) than females (1.5%) had used a condom during their last episode of extra-marital sex (p<0.05). The low level of condom use was attributed to the belief that a condom is not necessary (34.5%) and the perception that a condom is not meant for the elderly (50%). Death of a spouse (78.5%) and loneliness
Conclusion and Recommendation Risky sexual practice among the elderly is a growing public health problem. The Government has significant roles to play. This study shows that elderly persons are still sexually active at old age, while some engage in risky sexual activities. In addition, the sexual perception is relatively negative; this misperception may be due to knowledge inadequacies and, if not properly addressed, may adversely affect their sexual health. Moreover, a majority reported lack of finance, loneliness and separated home as responsible factors. It is therefore suggested that intervention strategies be urgently implemented; they would aim at providing socio-economic support, including appropriate geriatric education to improve their sexual reproductive health. Without urgent measures to enable elderly people to protect themselves, development efforts will be in jeopardy. Investing in elderly is one of the most costeffective interventions to achieve both the International Conference on Population and Development Declarations and attainment of the Millennium Development Goals.
J U N E
Table 1
19.3%) reported lack of sexual drive and sensitivity. Among those who experienced this condition, were more males (40 = 51.3%) than females (38 = 48.7%). A sizeable proportion (106 = 26.5%) however, reported painful sex as sexual problem. The breakdown shows that painful sex is more prevalent in females with a larger proportion (98 = 92.5%) than very few males (8 = 7.5%). Furthermore, few (50 = 12.5%) identified inactive and non-performance; there is a slight difference among gender.
Odor King | Programme Officer Research, Women and Adolescent Reproductive Health, Sure Health Organisation, Nigeria Email: odorking001@yahoo.com 21
COMMUNITY ACTION
Female Community Health Volunteers in Nepal People make a difference in their own lives as well as in other lives. An important example involves the women residing in the Himalayan Kingdom of Nepal.
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 8
J U N E
2 0 0 9
World-wide scientific studies have shown that vitamin A supplementation has a great impact on the reduction of child mortality and morbidity. Two studies conducted in Nepal demonstrated this as well, and also showed a one-third reduction of child mortality among Nepalese children with improved vitamin A status.
22
It is well known that vitamin A supplementation is the most cost-effective of all child survival programmes. Even the poorest country can afford and get maximum health benefits. Health planning and concerned authorities realised that Nepal, being a vitamin A deficient country, would greatly benefit from vitamin A supplementation. But health planners struggled getting a health package to the more than 3.5 million children under 5 years in Nepal, whose poor vitamin A status needed to be adequate. This health package consisted of biannual supplementation of vitamin A and vitamin A rich foods; deworming the children and promoting the selective components of public health care (PHC) such as immunisation, and reducing incidence of acute respiratory infections and diarrhoea diseases. The health package needed to be delivered to each household, but the existing PHC system was inadequate, unable to accomplish the existing network of PHC because of: • its rudimentary and fragmented network, • low morale of paramedics and their frequent absence from work, • weak supervision from supervisors, and a • wide gap between communities and healthcare providers because of poor performance of Government health institutions.
Realising that with their efforts more than one-third of their children’s lives could be saved, mothers came forward to take this challenge. They formed a mothers’ group in each Village Development Committee (VDC) and selected their representatives to bridge the gap between the healthcare providers and communities. These representatives were called Female Community Health Volunteers (FCHVs). Initially their participation was limited to 27 of the 75 districts of Nepal. Today, FCHVs participate throughout the whole country. There are 48.000 FCHVs who actively participate in their communities by assisting PHC services throughout the country. They are provided basic healthcare training by health personnel. FCHVs are fully responsible for distributing vitamin A supplementation and deworming drugs to the country’s 3.6 million children. Last year alone, they distributed a total of 0.46 million cycle of oral pills; 1.5 million of condoms; 0.84 million of oral rehydration solution packets. They also detected and treated one million pneumonia cases. Their contributions were nearly 50% of those served by all the health institutions. They are supported by mother groups, teachers, students, social workers and health personnel. Tables 1 and 2 show the differences between the indicators before and after the participation of FCHVs in terms of process indicators and health status indicators. Their work has been widely recognised, both inside and outside the country. The FCHV’s participated child and mother programme has been most successful and ranked top among all the programmes of the Ministry of Health and Population. Since their contribution to the health programme is entirely voluntary, each VDC has initiated a FCHV Endowment Fund for their benefit and welfare. So far, 710 of 4.000 VDCs have established an Endowment Fund.
Table 1
Table 2
HEALTH PLANNERS STRUGGLED GETTING A HEALTH PACKAGE TO THE MORE THAN 3.5 MILLION CHILDREN UNDER 5 YEARS IN NEPAL Chet Raj Pant | School of Medical Sciences, Kathmandu University, Nepal Email: crpant@yahoo.com
STUDENTS’ COLUMN STUDENTS’ SPEAKERS CORNER
SNO Kenya Activities on World AIDS Day 2008 “How wonderful it is that nobody needs to wait a single moment before starting to improve the world”. Anne Frank The 1st of December 2008 was World AIDS Day (WAD). The Kenya chapter of the Student Network Organisation (SNO) successfully hosted a commemorative event at Moi University, Kenya. In line with the WAD theme, the event aimed to highlight the importance of young people being actively involved in the HIV/AIDS response, and to increase HIV/AIDS awareness among youths in Kenya.
0 1 | V O L U M E 2 8
Robbert Duvivier | Member Editorial Board Education for Health, the Netherlands Email: robbertduvivier@gmail.com
For us it is important that students are confronted with other worlds outside their world as a medical helper. We feel that it sharpens the experience and broadens the frame of mind. Both the participating students and the children are very enthusiastic, and they provide a lot of new ideas for future projects.
N U M B E R
to provide students with more opportunities to learn the principles of academic writing and scientific publishing. We strongly encourage and invite students from all health disciplines to submit their work to EfH. So, if you are one of the students presenting work at the upcoming Network: TUFH Conference in Amman, please consider writing an article for EfH! I know firsthand that writing a scientific article is a daunting task. Therefore, EfH supports prospective authors in this process. We will explain this initiative in more detail in the upcoming issue of EfH. Keep an eye on the journal as we will be announcing more exciting opportunities for students soon!
Currently, we have two projects running. Students can become the homework coach of a child from a migrant family. Every week, the students visit the family and play educative games with the child, in order to exercise the Dutch language in a pleasant way. Secondly, students can drop in at the paediatric clinic when they have a free moment, and read a book with or to a sick child. This way, students can perceive the hospital from a different view.
N E W S L E T T E R
Job Siekei Mogire | SNO Chairperson, Kenya Email: jobsiekeimogire@yahoo.com
The enthusiasm and idealism of many Conference participants was contagious. The students felt that this unique experience had broadened their horizon, and they wanted to give others this opportunity too. The student organisation STUFH was born: Students Towards Unity for Health. STUFH is a small organisation that aims to bring medical and other students in touch with the less fortunate in their own society through voluntary work, in order to stimulate social consciousness.
2 0 0 9
STUDENT MEMBER EDITORIAL BOARD EFH The Network: TUFH has always been strongly committed to including students in its activities, and to stimulate participation at the annual conferences. Education for Health (EfH) is now following this course by including a student in their Editorial Board: a unique move for a scientific journal. My name is Robbert Duvivier and I am currently in my fourth year of Medicine at Maastricht University, the Netherlands. I have always had a keen interest in health professions’ education and I have had the opportunity to be involved not only with the practical aspects but also with educational theory, policy and research. This background led to participation in The Network: TUFH and recently my involvement in EfH. I am grateful for this unique opportunity, and for the warm welcome from the editors. Together, we aim
The main day event attracted over 500 college level youths to the day-long youth oriented-activities. The Moi University Vice-chancellor gave insightful opening remarks, after which a thematic youthfocused film dubbed Transit (produced and supplied by MTV) was screened. This film was followed by stimulating performances by invited youth groups. Three short speeches delivered by youth leaders closed the main plenary session. Ten behaviour change communication booths were run by trained youth counsellors, serving youths seeking individual counselling on personal matters.
STUFH: STUDENTS TOWARDS UNITY FOR HEALTH In 2005, eight medical students from Ghent University, Belgium were selected to take part in the annual Network: TUFH Conference in Vietnam.
J U N E
The overall objectives underlying all these initiatives were to disseminate basic facts about HIV/AIDS; stimulate dialogue on factors aggravating the epidemic; promote healthcare-seeking behaviours for prevention, care and support; emphasize the need for behaviour change, perceived personal risk of HIV infection and responsibility for safe practices.
On the 30th of December 2008, 40 youth leaders converged at Moi University School of Medicine for a one-day advocacy training workshop, hosted by SNO Kenya.
Julie Kips | Board Member STUFH Medical student, Ghent University, Belgium Email: julie.kips@ugent.be 23
INTERNATIONAL DIARY
Diary 2009-2010
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 8
J U N E
2 0 0 9
2009 29 August - 2 September, 2009, Malaga, Spain AMEE Conference. Organised by the International Association for Medical Education (AMEE). Further information: email: amee@dundee.ac.uk; Internet: www.amee.org 16 - 19 September, 2009, Basel, Switzerland Wonca Europe 2009 - The Fascination of Complexity: Dealing with Individuals in a Field of Uncertainty. Organised by Swiss Society of General Medicine, World Organization of Family Doctors (WONCA). Further information: email: a.studer@schlegelhealth.ch; Internet: www.congress-info.ch/wonca2009/home.php Annual International Conference of The Network: TUFH 10 - 15 October, 2009, Amman, Jordan International Conference on Achieving Quality in Health Care: Challenges for Education, Research and Service Delivery. Organised by The Network: TUFH and the Faculty of Medicine, University of Jordan. Post-Conference Excursion: October 16, 2009: Muâ&#x20AC;&#x2122;tah University, Karak, Jordan 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 24 - 27 October, Grenoble, France International Conference: Expected Outcomes and Competences of Health Professionals - How to Transform Educational Institutions, Programmes and Processes. Organised by the International Francophone Society of Medical Education (SIFEM). Further information: email: infos@sifem2009.org; Internet: www.sifem2009.org 24
25 - 28 October, Ottowa ON, Canada 16th Annual Canadian Conference on International Health - Health Equity: Our Global Responsibility, organised by Canadian Society for International Health. Further information: email: 2009ccih@csih. org; Internet: www.csih.org 2 - 6 November, 2009, Maastricht, the Netherlands Advanced Courses in Medical Education: 1) Research; and 2) Assessment in 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: 31-43-3885611; fax: 31-43-3885639; email: she@oifdg.unimaas.nl; Internet: www.she.unimaas.nl 6 - 11 November, 2009, Boston MA, USA AAMC annual meeting. Organised by Association of American Medical Colleges (AAMC). Further information: Internet: www.aamc.org/meetings
email: she@oifdg.unimaas.nl; Internet: www.she.unimaas.nl 20 - 24 December, Ismailia, Egypt 11th International Workshop on Human Resource Development in Health Management & Leadership. Organised by Centre for Research and Development in Medical Education & Health Services (CRD), Faculty of Medicine, Suez Canal University (FOM/ SCU). Further information: email: crdmed@ ismailia.ie-eg.com; fax: +2-064-3209448; Internet: http://crdmed.tripod.com
2010 27 - 30 January, New Orleans LA, USA 35th Annual Conference - Establishing Continuing Medical Education as a Pathway to Better Patient Care. Organised by Alliance for Continuing Medical Education. Further information: email: acme@acme-assn.org; Internet: www.acme-assn.org
7 - 11 November, 2009, Philadelphia PA, USA APHA annual meeting. Organised by American Public Health Association (APHA). Further information: email: comments@apha.org; Internet: www.apha.org/meetings
7 - 11 March, Ismailia, Egypt 24th International Workshop on Community-based Education Incorporating Problembased Learning (Innovative Approaches). Organised by Centre for Research & Development in Medical Education & Health Services (CRD), Faculty of Medicine, Suez Canal University (FOM/SCU). Further information: email: crdmed@ismailia.ie-eg. com; fax: +2-064-3209448; Internet: http://crdmed.tripod.com
26 - 27 November, 2009, 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: 31-433885626; fax: 31-43-3885639;
25 - 26 March, 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. 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 June - 2 July, Maastricht, the Netherlands Summer Course: Expanding Horizons in Problem-Based Learning in Medicine and Health Sciences. Organised by School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University. 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
N U M B E R 0 1 | V O L U M E 2 8
6 - 10 November, Denver CO, USA American Public Health Association (APHA) Annual Meeting. Organised by American Public Health Association (APHA). Further information: email: karla. pearce@apha.org; Internet: www.apha.org
N E W S L E T T E R
5 - 10 November, Washington DC, USA Association of American Medical Colleges (AAMC) Annual Meeting. Organised by Association of American Medical Colleges (AAMC). Further information: www.aamc.org
2 0 0 9
1 - 5 November, Maastricht, the Netherlands Advanced Courses in Medical Education : 1) Research and 2) Assessment in Medical Education. Organised by School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University. 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
It is possible to add events to this International Diary from behind your computer. Information inserted in our website database (www.the-networktufh.org) will be automatically included in the International Diary of the Network: TUFH Newsletter.
SHEILA@AMEE 2009 Prior to the AMEE 2008 conference, the School of Health Professions Education International League of Alumni (SHEILA) organised its first preconference workshop which focused on Self-Directed Learning (SDL). Because of the enthusiasm it raised among the attendees, who found the presentations and interactive discussions inspiring, helpful and motivating, it was decided to continue this lead and to organise another workshop in advance of the AMEE 2009 conference. During the last meeting, change management came up as one of the key issues that SHE alumni are dealing with and therefore the annual theme for 2009 was easily chosen. More specifically, the workshop (30 August, 2009) will centre on Change Management in health professions education, with a special focus on the work of Grol et al. who is an internationally respected researcher on implementation strategies and change management. In this context questions arise, such as: how to plan and give shape to the process of implementing new (educational) concepts?, how to deal with resistance? and how to get political support for your ideas? Building on the concepts developed by Grol et al., an answer to these questions is sought. The workshop will be opened by two alumni of the Master of Health Professions Education (MHPE), Takuya Saiki and Hanan Al Kadri. They will present and share the lessons they have learned in the ambit of change management. The meeting will be chaired by MHPE alumna Jolien van den Houten.
J U N E
30 - 31 August, Pisa, Italy International Conference: The Future of Primary Care in Europe III. Organised by European Forum for Primary Care. Further information: www.euprimarycare.org
18 - 19 November, 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. 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
This workshop is open exclusively to all students and alumni of the School of Health Professions Education (SHE). For more information, please send an email to she@oifdg.unimaas.nl 25
MEMBER AND ORGANISATIONAL NEWS MESSAGES FROM THE EXECUTIVE COMMITTEE
General Meeting 2009 Jordan
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 8
J U N E
2 0 0 9
The Network: TUFH will organise its annual international Conference this October in Amman, Jordan. In conjunction with the Amman Conference, we will also organise our Biennial General Meeting (GM) for all Network: TUFH members and others interested in our organisation. At this GM, Executive Committee Members and a new Chair will be elected.
26
For Full and Associate Members (who have voting rights), the GM and election procedure is an outstanding opportunity to have a voice in who will become part of the Network: TUFH leadership and in other important issues. We therefore encourage our Full and Associate Members to send a delegate (or delegates) to the GM and international Conference in Amman, Jordan. Individual and Honorary Members are of course equally welcome, but they have no voting rights. The first session of the GM is scheduled for Sunday October 11 and the second session on Thursday October 15. Updated information about the GM is also available at: www.the-networktufh.org/conferences/generalmeetings.asp Elections Executive Committee and Chair One of the seven members of the Executive Committee (EC) will reach the end of his 1st term of four years. This is Mohamed Moukhyer (Sudan). EC Members are eligible for a 2nd term of four years. Mohamed Moukhyer has informed us that he will stand for reelection.
Ian Cameron (Australia) is midway his second term of four years. The five remaining EC Members - Denise Donovan (Canada); Dawn Forman (UK); Bishan Swarup Garg (India); Sarah Kiguli (Uganda); and Francisco Lamus Lemus (Colombia) - are midway their first term of four years. The Network: TUFH has three ex-officio members: Michael Glasser (USA) and Don Pathman (USA) - co-editors of Education for Health: Change in Learning and Practice - and a representative of the Student Network Organisation (SNO). As a member of The Network: TUFH, it is your prerogative to nominate candidates for membership of the EC. There will be vacancies for: • EC membership (the Eastern Mediterranean seat - see explanation above with Mohamed Moukhyer); • Chair - Rogayah Ja’afar (Malaysia) will end her term of four years. The Chair is not eligible for a 2nd term. We encourage you to stand for election or to nominate candidates for these vacancies. Constitution The Constitution of The Network: TUFH says: • Officers (relevant quotes only) Article 6 3. The Chairman shall be elected for a period of four years. He does not have to be or represent a Network: TUFH member. The Chairman cannot be re-elected. 4. The retiring Chairman is by right a member of the Executive Committee for the duration of the four years subsequent to this retirement.
• Executive Committee (relevant quotes only) Article 8 1. The Executive Committee shall consist of the Officers, and at least five and at most seven members. The Editor of Education for Health: Change in Learning and Practice and a representative of the Student Network Organisation (SNO) are ex-officio members of the Executive Committee. 2. The seven members of the Executive Committee shall represent the seven regions of the world: five of which as defined by the World Health Organization (WHO): Africa; Eastern Mediterranean; Europe; South-East Asia; and Western Pacific. The Network: TUFH has divided the Americas into two regions: Latin America and USA/Canada. 4. The members of the Executive Committee shall be chosen by the General Meeting and from among all members (Article 4.2) for a period of four years. 5. No member shall serve as a member of the Executive Committee in the same role for more than two successive terms. • Elections (relevant quotes only) Article 10 4. The Chairman and the members of the Executive Committee will be elected by the General Meeting. 5. Candidates for election to membership of the Executive Committee must be or represent a Network: TUFH member. Election Procedure In Amman, Jordan, the GM will be split into two sessions, one to be held on Sunday October 11, 2009 and the second on Thursday October 15,
V O L U M E 2 8
Honorary Membership Candidates At the 2009 GM decisions to award Honorary membership to individuals who have rendered exceptional service to The Network: TUFH shall be taken. We would like to draw your attention to the procedure of proposing candidates for Honorary membership of The Network: TUFH. Any Net-
|
Nominations for Tamas Fülöp Award At the occasion of the Network: TUFH’s 25th anniversary in 2004, the Executive Committee established the Tamas Fülöp Award (TFA). The TFA is being handed out once every two years at the GM to a person, organisation, institution or group for outstanding contributions to The Network:
0 1
Last but not least: in case you would be elected you are expected to attend the first session of the new EC on Thursday October 15 (right after the closing of the Conference) in Amman, Jordan.
Nominations for the TFA should be accompanied by a letter of support (between 300-350 words) and must be received at the Network: TUFH Office in Maastricht, the Netherlands no later then August 15, 2009.
N U M B E R
The TFA consists of a certificate, an economy ticket to travel to a future Network: TUFH Conference (to be used within three years from the year of award), space in the Newsletter and a world-wide announcement through the Network: TUFH digital Alert.
For your convenience we have printed below the relevant quotes of the Network: TUFH By-laws concerning Honorary membership: Article 9 1. Individuals who have rendered exceptional service to The Network: TUFH can be granted Honorary membership. 2. Members can propose candidates for Honorary membership to the Executive Committee. 3. Proposal for the granting of Honorary membership shall be put forward before the General Meeting by the Executive Committee. A decision to award an Honorary membership shall be taken at the General Meeting.
N E W S L E T T E R
If you consider standing for one of the vacancies in the EC specified above, it may be helpful to know that EC Members receive hotel expenses for the nights related to the EC meetings in order to undertake their responsibilities.
The following criteria for eligibility of the nominee are: • At least for the last four years the nominee has participated in Network: TUFH activities by being a leader and by giving outstanding contributions. • The nominee has been relevant to the advancement of health in his/her/its community, country or region in any of the different areas that The Network: TUFH considers crucial (education, professional societies, health delivery, health policy, and community work). • The nominee should be an ethical human being, organisation, institution or group who/which has had lasting influence on the domain defined under item two.
work: TUFH member can suggest candidates for Honorary membership of The Network: TUFH by writing to the Network: TUFH Office in Maastricht, the Netherlands no later then August 15, 2009. With your proposal we would like to receive a letter (between 300-350 words) explaining your reasons to propose for Honorary Membership.
2 0 0 9
In brief, at the second session of the GM, the new EC Member and the Chair will be elected from all the candidates who have been nominated for these positions. This round should yield the new EC Member + Chair.
TUFH. Last time credit went to Dr. Khalifa Elmusharaf from Sudan and in 2005 the TFA was granted to Dr. Vibhore Prasad from the UK. This year, at the GM in Jordan, the third TFA will be handed out.
J U N E
2009. In the first session of the GM an explanation of the election procedure will be given. Thereafter, but only until Tuesday October 13, 2009 at 1.30 p.m., nominations of candidates may be submitted to the Network: TUFH’s Secretary Yoka Cerfontaine. A nomination contains a filled-in candidate profile form (which can be downloaded at www.the-networktufh.org/conferences/generalmeetings.asp), indicating that (s)he is willing to stand for the position of Member of the EC or Chair. The candidate profile must be signed by the candidate and contain written support from two individuals (who are Individual or Honorary Member, or represent Full or Associate Member institutions).
Honorary members are exempted from the payment of membership fees and enjoy all common assets of membership. Honorary members have no voting rights.
27
MEMBER AND ORGANISATIONAL NEWS ABOUT OUR MEMBERS
Training Modules
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 8
J U N E
2 0 0 9
At the Network: TUFH website you can find eight training modules that have been set up by our members (www.the-networktufh. org > Publications/Resources > Training modules / Curricula).
28
Initially, we wanted to choose the most interesting module for publication in the Newsletter. But after examining all eight of the training modules, we had to conclude that they are all worth giving special attention in the Newsletter. Therefore, we present a summary of all eight modules. You are invited to make use of any of the modules. Breast Screening and Self Examination Breast cancer is a major risk for women’s health. Since women are a main important part of the world community, it is very necessary to set up a complete scientific programme on breast cancer. According to the WHO, national scientific programmes are the most effective way to breast cancer control and prevention. The module consists of: • Global Overview of Breast Cancer (including the following chapters: Incidence; Risk Factors; Prevention and Risk Reduction; Factors Not Related to Breast Cancer; Breast Lumps). • Breast Screening and Self Examination (including case studies).
Building Leadership for Health Building Leadership for Health (BLFH) is a set of free training resources to support health systems’ development in resourcepoor and resource-rich countries. It is designed to be adapted and delivered by local health leaders to reflect the specific experiences and needs of their teams, based on the observation that leadership is a relationship and not a solo performance. Currently BLFH has over 70 courses and hundreds of lectures on aspects of health leadership, community leadership, public participation, health economics, health futures planning and knowledge management for health. Contributions in the form of courses, lectures and case studies have been provided by more than 25 leading experts. Educating to Improve Population Health Outcomes in Chronic Disease A curriculum package to integrate a population health approach for the prevention, early detection and management of chronic disease when educating the primary healthcare workforce in remote and rural northern Australia. The document is a package of materials that aims to assist health educators to integrate chronic disease education into existing and new programmes, using a population health approach. It consists of: • background reading about how the package came about, • a curriculum framework upon which to develop new or adapt existing educational programmes in a population health model, • a list of expected core outcomes for all graduate remote and rural primary healthcare practitioners working in the prevention, early detection and management of chronic disease, • an implementation framework to assist
in conducting or managing orientation and professional development, including accredited programmes, • some suggested teaching and learning approaches, and • some tools and resources for educators to use. E-Learning for Clinical Teachers This series of open access short modules covers core topics in clinical teaching and learning. They were developed by the London Deanery to inform and support the professional development of clinical teachers. On completion of a module, a certificate can be printed out for your own records. The short modules are: Assessing educational needs; How to give feedback; Careers support; Small group teaching; Diversity, equal opportunities and human rights; Improve your lecturing; Teaching clinical skills; Involving patients in clinical teaching; Setting learning objectives; Supervision; Workplace-based assessment; Facilitating learning in the workplace; Introduction to educational research; Appraisal; Interprofessional education; Managing poor performance. More information is available at: www.faculty.londondeanery.ac.uk/e-learning
0 1 | V O L U M E 2 8
Ugandan Child Health Project This manual is for Community Owned Resource Persons (CORPs). It contains the information CORPs can use to help rural communities to improve the health of children under the age of five years. The man-
The first module introduces child health. The next two modules look at the role a community volunteer can play and the community action plan. There are modules on common diseases of children such as malaria, cough and diarrhoea. There are modules about health practices that are important for the health of children such as growth, nutrition, hygiene, newborn care and immunisation. Several modules deal with maternal health including antenatal care, breastfeeding and family planning. Other modules provide information about first aid, HIV/AIDS and special children.
N U M B E R
These modules lead the reader through the different stages of a qualitative research project from start to finish. Each module is interspersed with practical exercises. Take
The available modules include: Adolescent health; Gender and health; Cervical cancer; Use of medicines; Safe motherhood; Men’s involvement in promoting reproductive health; Nutrition and women’s health; Menopause; Female genital mutilation; Mother-to-child transmission of HIV/AIDS; Domestic violence; Unwanted pregnancy and unsafe abortion; Violence against women; Contraceptive practices.
N E W S L E T T E R
Introductory Research Modules The Primary Health Care Research Evaluation and Development Introductory Research Modules are an introduction level resource for novice researchers. Equally they can be a refresher course for those who have been away from research practice for a time. The papers were written with Australian urban and rural primary care practitioners in mind, so the content uses examples which we hope you can identify with in your practice.
Women and Health Learning Package Members of The Network: TUFH Women and Health taskforce have developed a series of training modules on topics ranging from violence against women and contraceptive practices to adolescent health and unwanted pregnancy/unsafe abortion. These women’s health modules make up the Women and Health Learning Package (WHLP), a free e-learning resource for use by educators, health providers and health sciences students (particularly medical and nursing students) in developing countries.
ual is organised into topics called modules. Each module contains the key messages, the role of the CORPs and questions for community discussion. Modules about diseases include the danger signs, home care and prevention activities. The information in each module focuses on disease prevention, health promotion and health education for rural Africa.
2 0 0 9
Our central objectives are to improve the quality and efficiency of global health education. We seek to do this by providing high quality modules on a wide variety of topics that students and practitioners can review either on their own or in instructorled courses. To see the modules go to http://globalhealthedu.org/Pages/Default.aspx, click on ‘Modules’ on the task bar.
the opportunity to use these readings and exercises as a step by step guide for developing your own project.
J U N E
Global Health Course Modules The modules have the following features and characteristics: PowerPoint presentation with a common ‘look-and-feel’; suitable for introductory and more advanced courses; suitable for all health profession students and residents/fellows; most modules include learning objectives and quizzes; usable in either instructor-led or self-instructional mode; developed in partnership with various organisations; peer-reviewed and field-tested by students and faculty prior to final author revision and posting on the Internet; can be linked with a global health wiki so users can add content and dialogue about the topic; potential for ‘internationalisation’ of modules (translation, regional modules).
The Appendix at the end of the manual includes some additional information such as writing a referral letter, assisting at Child Health Days and games for children. 29
MEMBER AND ORGANISATIONAL NEWS ABOUT OUR MEMBERS
NEWSLETTER NUMBER 01 | VOLUME 28
J U N E
2 0 0 9
Network Alumni: A Unique Experience I believe The Network: TUFH has made a difference for several generations of healthcare professionals. This was no different for me. I started my academic activities in the local student directory, working as a collaborator in the scientific department. In 2001, as a second-year medical student in a small university located in Londrina, Brazil, I was very happy to be invited to join The Network as Secretary General of the Student Network Organisation (SNO). A special mission, but a difficult one. I had no idea what to expect, what to do and of course, I had no previous experience with international networking. But I accepted the challenge, and our SNO team had a hard job to develop. We all knew that SNO suffered from absence of continuity. We tried to fix it and in the end, I believe, we succeeded in some aspects. Discussing vital points as by-laws and constitution, facilitating SNO workshops and creating new projects as the mentoring programme; these were our main objectives. A real attempt to keep ‘the fire burning’ between the intervals of the conferences. Now, eight years after my first contact with The Network, I have started my residence programme in Nephrology. An important choice, which I made a long time ago. It has been a stimulating experience, but a tiring one. I have spent a lot of time inside the hospital, taking care of patients and trying to
TRIBUTE TO… * Prof. dr. Henk Schmidt - Honorary Member of The Network: TUFH - has been appointed Vice-chancellor of the Erasmus University Rotterdam, the Netherlands. Dr. Anton van Rossum - Chairman of the Supervisory Board - is very pleased with the appointment: “With Henk Schmidt we are getting an excellent Vice-chancellor. He is a top scientist, as well as an experienced governor.” 30
RE-ASSESSING FULL MEMBERS It is with pleasure that we would like to inform you that the following Full Member has been awarded (a continuation of its) Full Membership: Up to 2013 Community Based Education Office, Jimma University, Jimma, Ethiopia. Silver Full Member
Dr. Janaina Garcia Gonçalves teach them co-responsibility for their treatment and improvement. Now I can see that all that time spent in workshops on ‘student leadership’ was extremely important for my personal development. Working as a facilitator between patients and multiprofessionals has shown to be vital these days. And of course, this is not a usual skill that you learn during the medical programme. I had the privilege of being part of the Network history and there is so much to be thankful for! A unique experience that changed my life and the way I saw my role as a student, doctor and citizen. Janaina Garcia Gonçalves | Nephrology resident, Universidade Estadual de Campinas, Brazil Email: janagarcia2004@yahoo.com.br
Escuela Colombiana de Medicina, Universidad El Bosque, Bogotá, Colombia. Silver Full Member Up to 2014 Faculty of Medicine, Makerere University, Kampala, Uganda. Silver Full Member Faculty of Medicine and Health Sciences, International University of Africa, Khartoum, Sudan. Bronze Full Member
NEW MEMBERS Full Members • Department of Clinical Medicine, Luohe Medical College, Luohe City, Henin Province, People’s Republic of China • Faculty of Medical Sciences, University of Cuenca, Cuenca, Ecuador Associate Members • Centro de Estudios Interculturales (CEMI), Cota, Cundinamarca, Colombia Individual Members • Dr. Erlene Woollard, Vancouver, BC, Canada
Prof. dr. Henk Schmidt
Primary Healthcare Resolution Adopted in Geneva! The 62nd World Health Assembly adopted a resolution on primary healthcare, including health system strengthening (see: page 3-5 at http://apps.who.int/gb/ebwha/ pdf_files/A62/A62_52Draft-en.pdf). A62_52Draft-en.pdf A62_52Draft-en.pdf).
N U M B E R 0 1 |
important. This resolution illustrates that NGOs can play an active role in the WHO.
2 8
In the evening of Thursday the 21st of May, a forum discussion on The role of civil society in primary healthcare renewal illustrated the need for implementation, and started an active dialogue in the presence of Carissa Etienne, Assistant Director-General of the WHO.
V O L U M E
This resolution is among others a result of co-operation of different NGOs: The Network: TUFH, Wonca, European Forum for Primary Care (www.euprimarycare.org). All work together and interact with local Ministers of Health. The role of Wim Van Lerberghe (WHO) and the preparatory work by Charles Boelen has also been very
N E W S L E T T E R
Moreover, the resolution urges member states “to encourage that vertical programmes, including disease-specific programmes, are developed, integrated and implemented in the context of integrated primary healthcare”. The Secretary General of The Network: TUFH intervened at the end of the debate, supporting the interventions to make the document more precise, namely by being explicit about the primary healthcare providers and the position of the family physician in the primary healthcare team. He also mentioned the 15by2015 campaign (see: www.15by2015.org) that is in line with this resolution. Chris van Weel,
It is also very important that the resolution requests the Director-General to ensure adequate funding for health systems strengthening and revitalising primary healthcare in the programme budget 2010-2011, and to prepare implementation plans for the four broad policy directions: dealing with inequalities by moving towards universal coverage; putting people at the centre of service delivery; multisectoral action and health in all policies; inclusive leadership and effective governors for health; to ensure that these plans span the work of the entire WHO, and to report on these plans through the Executive Board to the 63rd World Health Assembly and subsequently on progress every two years thereafter.
THIS RESOLUTION IS AN IMPORTANT ACHIEVEMENT: IT MAKES THE PRIMARY HEALTHCARE AGENDA MORE CONCRETE, AND TRANSLATES IT TO THE CHALLENGES OF THE 21ST CENTURY.
2 0 0 9
Many countries supported the fact that this resolution “puts people at the centre of healthcare by adopting - as appropriate - delivery models focussed on the local and district levels that provide comprehensive primary healthcare services, including health promotion, disease prevention, curative care and palliative care, which are integrated with other levels of care and coordinated according to need”.
This resolution is an important achievement: it makes the primary healthcare agenda (set for the first time at Alma Ata in 1978) more concrete, and translates it to the challenges of the 21st century. It introduces the principle of levels of care with a referral system. Moreover, it stresses the need for a team, and - for the first time family physicians appear in a resolution of the WHO, together with primary healthcare nurses, midwives, and allied health professionals.
Prof. dr. Chris van Weel (Wonca) en Prof. dr. Jan De Maeseneer (The Network: TUFH) celebrating the adoption of the resolution on primary healthcare by the World Health Assembly in Geneva
J U N E
In follow-up of the World Health Report 2008, Primary healthcare, now more than ever, the Executive Board of the WHO had prepared a resolution on primary healthcare, including health systems strengthening. During the debate, more than 50 countries intervened and proposed to make the resolution more precise. The Dutch representative suggested being specific on the primary healthcare team, “including primary healthcare nurses, midwives, allied health professionals and family physicians, able to work in a multidisciplinary context”.
President of the World Organisation of Family Doctors (Wonca), intervened in the same way. On Thursday the 21st of May at noon, the resolution was adopted unanimously by the 193 member states in the committee.
Jan De Maeseneer | Secretary General, The Network: TUFH, Belgium Email: jan.demaeseneer@ugent.be 31
MEMBER AND ORGANISATIONAL NEWS
THE NETWORK TOWARDS UNITY FOR HEALTH
INTRODUCING MEMBERS
Styrian Academy for General Practice and Family Medicine Since our organisation is a new member of The Network: TUFH, we would like to introduce ourselves. We are the Styrian Academy for General Practice and Family Medicine (Steirische Akademie für Allgemeinmedizin: STAFAM), Austria.
Editors: Marion Stijnen and Pauline Vluggen Language editor: Sandra McCollum The Network: Towards Unity for Health Publications P.O. Box 616, 6200 MD Maastricht
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 8
J U N E
2 0 0 9
Lecturing staff of STAFAM
32
STAFAM is an academic association of general practitioners (GP’s) with currently 326 active members. The main aims of the association are to support all practising colleagues by supplying information exchange and CME. Among other activities, STAFAM organises the largest annual congress of family medicine (FM) in Austria. General Practitioners The Austrian province of Styria is home to 1.5 million inhabitants, who are cared for by 932 GP’s in private - mainly single handed - practices. Doctors are not entitled to employ colleagues. Recently, group practices with two or more doctors have become possible, but they are not yet very popular. Most practices hold social insurance contracts. Social insurance is obligatory for every employed person in Austria and covers most of the medical expenses for the insured persons and their families. Even with patients seeing private doctors or specialists without consulting a GP first, GP’s are the main suppliers of first-line medical care to a majority of the local population. Medical University Graz For more than two decades, members of STAFAM have been teaching FM at Medical University Graz (MUG). FM used to be an elective subject, very well accepted by many students. Since 2003, MUG - having become an independent university restructured the curriculum and made GP/ FM a compulsory subject. STAFAM was invited to set up a new curriculum that would meet the needs of modern GP/FM and to
Newsletter Volume 28 | no. 1 | June 2009 ISSN 1571-9308
The Netherlands Tel: 31-43-3885633, Fax: 31-43-3885639
take over the lecturing part. Currently, we teach more than 300 students annually. Twenty-eight academy members met the challenge and became staff members. All the colleagues continue to run their practices, so they lecture part-time. STAFAM has also organised the five weeks’ community-based practice training for the students of the sixth year (‘the practical year’). This ensures that in future, every single student graduating from MUG will have had at minimum a month’s practical experience in a primary healthcare setting of an Austrian GP. At MUG an institute for GP/FM is to be established. Thanks to our experience, the STAFAM lecturing staff has been able to promote this step. Qualified Contribution Having learned about The Network: TUFH on occasion of the annual Conference 2007 in Uganda, we became aware of many synergies regarding our activities and the concept of The Network: TUFH. We are keen to learn from other members and are happy to share our experience. Furthermore, we would like to get some of our undergraduate students involved in the Student Network Organisation. Being involved as well in primary care as in medical education, we offer our qualified contribution to The Network: TUFH global academic family. Reinhild Höfler | Doctor in General Medicine, Lecturer at the Medical University Graz, Austria Email: reinhild.hoefler@meduni-graz.at
Email: secretariat@network.unimaas.nl www.the-networktufh.org Lay-out: Graphic Design Agency Emilio Perez Print: Drukkerij Gijsemberg
INTERESTING INTERNET SITES The Network: TUFH Interactive Recommended websites www.the-networktufh.org/publications_ resources/interactive.asp Foundation for Integrated Medicine in Africa (FIMA), previously known as Organized Medicine Foundation (OMF) is a registered Canadian charitable foundation geared towards delivering integrated medicine to rural communities in Africa, treating people regardless of race, religion, political views or sex. www.fimafrica.org