The Network towards unity for health
VOLUME 29 | Number 01 | august 2011
NEWSLETTER A FIRST TIME FOR EVERYTHING This is the first time that The Newsletter of The Network:TUFH is edited by the new secretariat at Ghent University. First and for all I’d like to congratulate the Maastricht team for their outstanding work in the past and thank them for all the support they gave us with “the making of” this issue. We will try to do it as good as you guys! We also organized the Conference in Nepal for the first time and the one in Graz is already coming closeby! You can read more about that in our Annual International Conference section (see page 4).
In this issue, among others: In memoriam: Barbara Starfield 05 Jeanne De Vos, India 18 The Fred Hollows Foundation New Zealand 20 Hysterectomy in Rural Women 22
In the new section “Great stories from great people” we had the honor to interview an amazing woman at our Nepal conference, Jeanne Devos, founder of the National Domestic Workers Movement in India (see page 18).
EC Intelligence: Dr. Bishan Garg 26
More inspiring people and stories are to be discovered throughout the next 32 pages. Enjoy your reading! Julie Vanden Bulcke and Kaat De Backer, Editors
08 11 In the Newsletter we refer to The Network: Towards Unity for Health as The Network: TUFH.
contents 03 Foreword The Networking of the Network: TUFH 04 The Network: TUFH in Action 04 Annual International Conference Looking back to Nepal, looking forward to Graz | Post Conference: Site-visit to Dahran 05 In Memoriam Barbara Starfield 06 Education for Health 2010 a Banner Year for Education for Health. 07 International Health Professions Education 07 New Institutions and Programs Faculty of health sciences: Ben Gurion university, Israël 08 Problem-based Learning and Community-based Education Ahfad University for Women in Sudan 09 Distance Learning Global Health Online Resources 10 Medical Education Learning through Student-led Tutorials 11 Leadership Column Kofi Owusu-Daaku, Kwame Nkrumah University of Science & Technology (KNUST) 12 Yellow Papers Problem-based Learning Sessions in Pharmacology 14 Improving Health 14 Health Services Global Health Systems Impact Assessments: A call for Action | Reproductive & Child Health System in Post Conflict Settings 16 Rural Health Prevalence of Protein Energy Malnutrition among Children in Rural North India 17 Health Authorities Francisco Campos, Reorientation of Professional Education 18 Great stories from great people Jeanne Devos - The National Domestic Workers Movement, India 20 Health Promotion The Fred Hollows Foundation New Zealand: Supporting Eye Health in the Pacific | Brighter Smiles Africa - A Canadian Health School Model 22 Women’s Health Abused Women get a Second Chance through Community Development | Hysterectomy in Rural Women 24 Students’ Column 24 Students’ Speakers Corner SNO Nigeria Activities: Working with the Community 25 Students Interview The Big Five 26 Member and Organisational News 26 Messages from the Executive Committee EC Intelligence, Dr. Bishan Garg 27 Taskforces Women and Health Taskforce: Update | Social Accountability and Accreditation | Interprofessional Education 29 RE-assessing Full Members Faculty of Health Sciences - Linköping University | The Istituto Superiore di Sanità (ISS), Rome, Italy 30 New Members 31 Introducing Members European Forum for Primary Care (EFPC) | Curtin University, Australia | Department of General Practice – University of Antwerp 32 Interesting Internet Sites
Foreword
The Networking of the Network: TUFH
Prof. dr. Jan De Maeseneer
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Jan De Maeseneer ,MD, PhD | Secretary General, The Network: TUFH, Belgium; Email: jan.demaeseneer@ugent.be
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The Network: TUFH is very proud that it has been quoted in The Lancet paper by Frenk J et al.: “Health professionals for a new century: transforming education to strengthen health systems in an interdependent world (Lancet 2010;376:1923-58). In this paper, the need for a transition from a sciencebased towards a problem-based and a system-based curriculum has been clearly described. The analysis conforms with the analysis by the Network: TUFH that education cannot be disconnected from health system development. Moreover, it appeals on transformative learning and stresses the importance of interdependence and education, looking for equity in health. In the section on “Networking for equity”,
the Network: Towards Unity for Health is mentioned as “an association of health professionals and academic organisations that are dedicated to creation of a global platform of equitable health care through community-based education, dynamic research and dedicated rural service. The Network: TUFH has undertaken policy-based projects and case-studies on issues of great importance, such as rural internship programs (Brazil), promotion of healthy behaviours (Czech republic), integrity of participatory research (Kenya), family practice research in resource-poor settings (Greece) and international gra duate programs on pharmacy (Canada).” The challenge for the Network: Towards Unity for Health will be to position itself in this broader framework, and to establish meaningful and appropriate ways of linking and networking. The upcoming confe rence in Graz on “Integrating public and personal health care in a world on the move” (September 17-21, 2011) in Austria will be an opportunity to exchange experiences, ideas and reflections and to build a sustainable strategy. We hope to see you all at this conference to learn from your input!
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After the very successful Kathmanduconference, new links have been made with a lot of organisations, that are active in the field of education, transformation of health systems and social accountability. Already at the conference, the links with FAIMER (Foundation for Advancement of International Medical Education and Research: www.faimer.org) have been intensified, and FAIMER-fellows joined the Network: TUFH. Another linkage that was strengthened, was the link with the “Global Consensus for Social Accountability of Medical Schools” (http://healthsocialaccountability.org). At the Network: TUFH 2006-conference in Ghent (Belgium): “Improving the social accountability in education, research and service delivery”, the first steps were taken to start up the formation of this global consensus. The work culminated in a final document, published at a conference in East-London, South-Africa (10-13 October 2010), where 65 delegates from medical education and accrediting bodies around the world met. The consensus-document is an important point of reference, also for the Network: TUFH. The Network: TUFH was also in touch with “Training for Health Equity Network”: THEnet (www.thenetcommunity.org). THEnet is a learning community where institutions and individuals committed to eliminating inequity and injustice through socially accountable health pro-
fessions’ education, can learn globally and get support to reinvent locally. Some of the Network: TUFH-members are founding members of THEnet, so there are already a lot of connections. Further cooperation can be explored in the future. Recently, we have been in touch with a course organised by BMJ and KarolinkskaInstitutet: “Leading for change in the health professional education”. This course has a blended approach and addresses both cultural/organisational issues and issues regarding leadership on an individual level in an organisation. At the Graz-conference interaction will take place. The Network: TUFH has also been in touch with the Medical Education Partnership Initiative: MEPI (www.fic.nih.gov/grants/search/ pages/awards-program-MEPI.aspx) that awards grants to African institutions. In all these contacts the Network: TUFH brings its expertise in community based education and service, the principle of intersectoral cooperation for health, innovative learning and social accountability, with special attention for primary health care and public health.
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THE NETWORK: TUFH IN ACTION ANNUAL INTERNATIONAL CONFERENCE
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Looking back to Nepal, Looking Forward to Graz
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The Network: Towards Unity For Health Conference of 2010, held in Kathmandu, Nepal, is now a few months behind us. As you all know, this was the first conference to be organized by the new secretariat at Ghent University, and for all of us it was an exciting experience. Everything was new to us: making all necessary preparations, raising attention for the conference at the international forum, attracting as many participants as possible, and last but not least making sure that the 2010 conference would run as smooth and easy as in previous years. We were happy to welcome over 230 people to the conference in Nepal, and we were even more pleased to see so many participants from India and Nepal. Meeting you in magical Nepal and getting to know the faces behind the names, was for the secretariat a wonderful experience. The enthusiastic atmosphere, positive and friendly interaction and ongoing dedication to the Network: TUFH of so many participants were so inspiring and encouraging and we want to thank all of you for the great moments that we shared in Kathmandu.
Group picture at Nepal conference
Yet, there is not much time to sit back and relax. From September 17 to 21 the next conference of the Network: TUFH will take place. Together with our local host, STAFAM and Medical University Graz, we welcome you all in the beautiful city of Graz, Austria, to discuss, debate and elaborate on this year’s conference topic “Integrating Personal and Public Health Care in a World on the Move”. Also the European Forum for Primary Care (EFPC) is working together with the Network: TUFH to make this conference into a success. Preparations of the 2011 Conference are at full speed: abstracts of numerous participants from all around the globe have been submitted, interesting key-note speakers from various backgrounds will address important topics and an exciting social program is being put together. The conference will offer you a variety of interactive sessions for which the Network: TUFH conferences are famous, a whole day of outstanding community site visits and top-ofthe-bill, it will take you to Austria’s idyllic countryside for a unique conference dinner and dance. After the conference, you can board for post-conference trips to Slovenia
and Hungary, for one or more days. And if you are still in doubt whether or not to attend this year’s conference, let me just tell you that the city of Graz itself is already reason enough to make the journey! We hope to welcome you all in Graz on September 17th, 2011! For more information, check out our conference website: www.the-networktufh.org/conference
Kaat De Backer, Executive Director, The Network: Towards Unity for Health Email: secretariat-network@ugent.be
POST CONFERENCE Site-visit to Dahran We started of course the collection of basic demographic information. Everything was integrated in a comprehensive report. This report was then presented to the Secretary of Development in the community and the district health officer.
Professor Barbara Starfield died on June the 10th 2011: An irreplaceable loss for primary health care and equity in health.
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Prof. Jan De Maeseneer, MD, Ph.D. Secretary General The Network: Towards Unity for Health
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ders to do better. The single slide of hers that summarises so much of her life's work, stated: "Primary care is medicine's way of improving population health and relieving disparities, while containing costs – and no study shows otherwise". Barbara Starfield was the co-founder and first president of the International Society for Equity in Health, a scientific organisation devoted to the dissemination of knowledge about the determinants of inequity in health and finding ways to eliminate them. Her work focuses on quality of care, health status assessment, primary care evaluation and equity in health. At the 2001-conference of the Network: Towards Unity for Health in Londrina (Brazil), Barbara Starfield held the Network Lecture during the general meeting.
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The Network: Towards Unity for Health deeply and earnestly laments the passing away of Dr. Barbara Starfield at the age of 78 years. Barbara Starfield studied medicine between 1954 and 1959 at the State University of New York and specialised in paediatrics between 1959 and 1962 at the Johns Hopkins Hospital. Since 1994 she was in charge of the Department of Health Policy and Management of the Johns Hopkins Bloomberg School of Public Health. Barbara Starfield was a tireless advocate for family medicine and primary care. She reminded us of the importance of primary health care and equity in health. During the last decades, Barbara Starfield was constantly travelling around the globe to share ideas, to nurture young professionals and to push lea
Primary health care has lost an advocate with an extraordinary vitality. Our deepest sympathies go out to her husband, her 4 children and 8 grandchildren.
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In Memoriam: Barbara Starfield
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health care provider are.
The main task of health care providers is to go to people and to inform them and to motivate them in order to take appropriate measures to improve their health situation. When they are ill, they have to be encouraged to contact the primary health care system.” A little bit further in the ENT-Department we met with doctor Bharati Shakya. She was examining patients during her first year of community medicine - post graduate training. She stresses the importance of listening to the patient’s story, making a comprehensive diagnostic landscape, and then inform the patients about which steps they can take. Involvement of the patient in the whole pro cess is of utmost importance.
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As results we found that gastritis and stomach ache are important health problems in this community. Another issue is the poor coverage of immunisation of children: a lot of people in the villages do not have access to immunization programs. This has mainly to do with their economic status: especially the poor experience the problem of access to care. Regarding the gastritis we thought that poor access to food during the day may provoke stomach problems, but this is only one hypothesis. I think it’s important I had this experience in the first year of my training here. It’s helpful to have an idea of what the challenges for a
Sabitra explaining the major findings of the survey to community representatives and to faculty members
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Community-based learning in Haldibari-community During the post-conference tour, some 30 participants in The Network: TUFHconference in Kathmandu visited a health centre in the community of Haldibari, a village of 6,000 inhabitants. We spoke with Sabitra Bashyal (SB), a bachelor student in the first year (nursing/medicine). After two months of introduction at the campus in Dahran, she made a community-assignment in a rural community. “I started on the 1st of September in this community and contributed to the survey. We were 10 students in this community, and we went house by house to collect data on the health condition of the youth, we wanted to know what the main problems in relation to their health were. We were both medical and nursing students, which is important because that way we learn to work together, this will prepare us for future collaborations.
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THE NETWORK: TUFH IN ACTION EDUCATION FOR HEALTH
Education for Health (EfH), the journal of The Network: Towards Unity for Health, is experiencing substantial growth. For 2010, there were 146 papers submitted to the journal, a 29% increase in the manuscript submissions over 2009. Since 2005, submissions are up 74%. This growth may partly be attributable to the journal’s transition from hard copy to its current online format in 2007. On top of increasing paper submissions, through October 2010, the number of registered users of the journal increased by 567, to a total of 2,065. And, of course, most journal readers are not re gistered as users. EfH is in a growth stage, to say the least. Not only were the numbers up in 2010, but very encouraging was that papers were submitted from all the World Health Organization regions. Most were from Asia, closely followed by North America, the Eastern Mediterranean region and Europe.
Canadien de Partenariat Qui a Fait Ses Preuves (2007), Canada -
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Continuing Medical Education and Evidence-Based Clinical Pathways: Training Emergency Health Workers in Latium, Italy (2008), Italy Withering before the Sowing? A Survey of Oman’s ‘Tomorrow’s Doctors’ Interest in Psychiatry (2008), Oman
These popular papers address a broad range of issues in health professions education and represent a range of contribu ting countries – Education for Health is a truly international journal. In a survey of registered users in 2010, responses were very positive to the 3 key questions posed. On a scale of 1 = poor to 5 = excellent, the mean score in users’ reactions were: 1) Quality of the articles, 4.16; Relevance of articles, 4.21; and Quality of EfH compared to other health-related online journals, 4.08.
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It is interesting to consider the 5 articles accessed by readers most often since their date of publication in EfH (giving older articles the advantage of time) and their country of origin: -
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Application of the Health Belief Model for Osteoporosis Prevention Among Middle School Girl Students (2007), Iran
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Health-Related Behaviors of Sudanese Adolescents (2008), Sudan
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La Société Santé en Français: Un Modèle
Many of the comments of our registered users reflected our goals as the Network: TUFH journal: User friendly and easy access; Good information for us as medical teacher; Being a free online journal, EfH is truly valuable for health professionals in developing countries; I highly appreciate the efforts of the editorial team and reviewers in capacity building of resear chers and manuscript writers from the developing world; I would say that the journal’s strength is that it serves a niche which other journals do not – Randomized controlled trials are great, but practice oriented papers are also helpful; Visionary; I enjoy reading and am gaining a lot from you; Education for Health has, over the past 5 years, continued to improve the quality of its publications; It would be nice
The photograph shows Antonio F Moreno SJ the President of Anteneo de Zamboanga University, Mindenao, Philippines, with Charles Engel during his visit to London on 20th May 2011. Charles (recently reached his 90th birthday) was privileged to assist Khryss Cristobal, the Dean of the Medical School, in the initial design of his innovative, socially responsible and community oriented curriculum. to have more issues per year! So, 2010 was a good and productive year and helpful to our readers. We look forward to more of the same in 2011, which by numbers of submissions to date pro mises to be as busy as last year! Please visit, often, the Education for Health website: www.educationforhealth.net. With increasing numbers of submissions, we are also looking to increase our number of reviewers. If you are interested in making a contribution to EfH and Network: TUFH by applying your knowledge as an educator and/or researcher or writer in reviewing other educators’ manuscripts, please send a note to Marie-Louise Panis, Journal Managing Editor, at: efh@maastrichtuniversity.nl We look forward to seeing many of you in Graz at the annual Network: TUFH confe rence. Michael Glasser, PhD | Co-Editor, Donald Pathman, MD, MPH | Co-Editor, Marie-Louise Panis | Managing Editor Email: efh@maastrichtuniversity.nl
INTERNATIONAL HEALTH PROFESSIONS EDUCATION new institutions and programs
Faculty of Health Sciences Ben-Gurion University, Israël
The Faculty of Health Sciences, Ben-Gurion University of the Negev, was founded in 1974 on the principles of promoting community oriented primary care with the mission and vision of improving health care services of the Negev region. Clinical teaching clerkships are carried out in three affiliated centers: Soroka Medical Center, (major campus), Barzilai Hospital, Ashkelon and the Beer-Sheva Mental Health Center in addition to community clinics in the periphery.
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Our conclusion is that the founders of the school had impressive foresight as to the needs of the region, the country and medicine as a whole. May we be as successful today in anticipating the problems and solutions for the coming decades?
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Established almost ten years, the Negev Health Forum began its multifaceted acti
A further project “Nitzanai Refuah” (medical cadets) is an affirmative initiative that offers special pre-academic courses and tutoring to Negev Bedouin high school students seeking careers in the health professions. Designed specifically for Bedouin women, a new nursing program was opened at the beginning of the academic year. The Faculty is also providing academic training to 18 Jordanian students in emergency medicine.
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Under the leadership of Dean Shaul Sofer, the Faculty has six health professional
The MSIH has a unique, U.S. style four year medical degree program in global health, refugee and disaster medicine. It is the only M.D. program that emphasizes preventive and population medicine. BGU’s network of community health facilities, outreach programs and research projects is an ideal setting for the teaching and promotion of international health. MSIH students do their elective studies in Third World Countries
The Medical Students Association is involved in a large number of community-oriented projects including aid to humanitarian organizations, intervention programs for troubled youth, enrichment programs and educational workshops.
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• Service Collaborating in the development of effective preventive and curative health services for the population of the Negev, with special emphasis on the provision of services to all and with sensitivity to the needs of individuals and communities. Exploring appropriate innovative models of care. • Teaching Using progressive, quality teaching methods, including student participation, to educate humane and competent physicians who will be oriented towards primary care and the community. • Research Encouraging quality research in all the health sciences through cooperation between basic researchers and clinicians to facilitate solving health problems.
The main teaching clinical facility, Soroka, integrates almost all practical needs of our schools and teaching goes hand in hand with research. Practical clinical questions are often solved by collaborative research in the basic sciences and the multitude of specialists in various health centers: medical education, pharmacy, microbiology, immunology, epidemiology, sociology or physiology, provides the opportunity to incorporate basic scientists in research teams. The number of Ph.D. students has grown from 101 (2001) to 202 (2009) and competitive research grants have risen from $6 million (2002) to $15 million (2009).
vities which encompass high school and university students, Bedouins and the community at large with the aim of minimizing the gaps in community health status. These activities include smoking cessation and healthy life style courses, peer education for Bedouin women in health and nutrition in the largest Bedouin city of Rahat and health promotion at work. In addition, Beer-Sheva recently joined the Healthy Cities Network. Special attention is granted to high risk communities inclu ding the Bedouin population, immigrants from the former Soviet Union and Ethiopia. Monthly lectures on current health issues are open to the public.
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Mission Statement of the Faculty of Health Sciences “To open new frontiers through the pursuit of excellence in medical education, service and research. Within the context of the Beer-Sheva mission, excellence has the following specific dimensions:
schools with an enrollment of 2,500 students: Goldman Medical School, Medical School for International Health and Medicine (MSIH) in Collaboration with Columbia University NY, Recanati School for Community Health Professions (nur sing, physiotherapy, emergency medicine), School for Medical Laboratory Sciences, School of Pharmacy (with emphasis on clinical pharmacy), and the School for Continuing Medical Education There are also two undergraduate programs: Health Systems Management and Biomedical Engineering.
Students working with the community
Shaul Sofer | Dean, Ben Gurion Universtity of the Negev, Israel Email: caroline@bgu.ac.il
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INTERNATIONAL HEALTH PROFESSIONS EDUCATION problem-based learning and community-based education
Ahfad University for Women in Sudan
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Ahfad University School of Medicine was the first medical school for girls to be set up in Sudan and in the Eastern Mediterranean Region (EMRO) in 1990 and has been a member of the Network: TUFH since 1989. Since its establishment, Ahfad School of Medicine has adopted community-orien足 ted medical education and problem-based learning as its two main educational strategies. In addition the university courses required to be performed by the medical students, namely rural extension and women studies, are strategically aiming to orient our female medical students to Sudanese community needs. The community-oriented medical education starts early in phase (1) of the curriculum and extends along within phase (2) and (3). It has to be mentioned that the community-based educational activities are varying in nature and length from one phase to another. The implementation of the community-based educational activities is held in partnership with the health personnel and community members especially in the rural training programs. It is clearly stated in the curriculum document that community-oriented medical education and problem-based learning are the main educational strategies. The students in phase (1) semester (1) are introduced early to the community through the following: The community-orientation course: The main educational objectives are to orient the students to the various aspects of community-oriented medical education and to maximize the competencies and skills of the students in community-based activities.
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The rural extension program: The University requires this program for the medical students. The main educational objective is to train the students on concepts and skills of rural extension and development. In phase (1) semester (2): The problem-based learning sessions are introduced within the Introductory Module as a step to improve the capability of students in addressing and approaching the community, family and individual health problems. The problems selected mainly focus on major health problems such as immunization and investigation of epidemic situations. Community-based educational activities are not well addressed within this semester and confined to the fieldwork of the rural extension program. In phase (2) of the curriculum: This phase is composed of 10 systembased modules, the Family attachment course and the Primary Health Care (PHC) course. Within the modules, the emphasis is focused on developing/strengthe足 ning preventive skills as one of the major skills required to graduate doctors who are responsive to their community needs. Although the opportunities for the students to widely practice preventive skills are limited the students are motivated to do so. The Family Attachment Course: This course is a longitudinal course exten足 ding although phase (2) aiming to introduce the students to the family health approach. With the student being attached to the family, her communication, preventive and problem solving skills are expected to be developed and maximized. The Rural Health Training Program: The students conduct educational activi-
Ahfad University School of Medicine was the first medical school for girls to be set up in Sudan and in the Eastern Mediterranean Region (EMRO) in 1990 and has been a member of the Network: TUFH since 1989 ties including surveys, health campaigns and assist health care providers in rural health facilities. The duration of the program is about 10 days each year of the two years of phase (2). The students gain good experience in dealing with rural community health problems and addressing rural community needs.
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Global Health Online Resources
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Mohamed Moukhyer MD, MPH PhD, | Associate Professor of Public Health | Assistant Dean for Graduate Studies and Research, School of Medicine, Ahfad University for Women, Sudan Email: moukhyer@hotmail.com
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• Global Health eLearning modules, each module covering what might be presented in a typical lecture for students and practitioners interested in global health. These modules are often supplemented by notes, references and a quiz. • Guidebooks for developing or improving: 1) a global health curriculum, and 2) a global health residency track. • A bibliography of selected citations divided into topic areas. Selection criteria emphasize ready accessibi lity and frequency on the Internet. Target audience: anyone recently introduced to global health. • A list of annotated websites re levant to global health divided into topic areas. • A variety of stand-alone documents available for downloading. These can help students prepare for an overseas field placement and a career in global health.
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In conclusion the school is contributing to graduate female doctors who are responsive to their community needs and possess basic competencies and skills required to fulfill those needs.
Go to www.globalhealthedu.org, click on the link Resources, and you will find the following information:
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Recently the school started to prepare a post graduate degree in Family Medicine in collaboration with Ghent University (Edulink-Primafamed project), Master of Public Heath (MPH) and Master of Science in Reproductive Health.
The Global Health Education Consor tium (GHEC) is pleased to make avai lable to the Network: TUFH members a wealth of educational materials on a wide variety of global health topics. All are free open access resources, without password or login requirements.
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It is clearly stated in the curriculum document that community-oriented medical education and problem-based learning are the main educational strategies
The graduation research: Each student has to submit a research paper in order to be eligible to apply for the final examination. The research topics are mainly focused on the major public health problems of Sudan. The students are usually supervised by supervisors either from the school staff or from other institutes or from the health services sector. The routine is the same for assigning the assessors of the student’s research. Some of the high quality research results were utilized by other researchers and health sector planners and managers.
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The PHC course: This course is usually scheduled at the end of phase (2) and before the students start their clinical training. The rationale behind this course is that training of medical students in the PHC facilities would enable them to gain the skills needed for practice at this level of the health care delivery system. The students usually spend 12 weeks in the PHC centers and a rural hospital. The training activities are either facility or community-based. The facility-based activities include emergency management, patient care, simple surgical procedures, Anti Natal Care, Family Planning, immunization and conduct of basic clinical skills. The community-based activities include home visits, IEC, attendance of home deli veries and home-based patient care.
For more information or to propose suggestions for future products, contact Thomas Hall. Thomas Hall | GHEC Executive Director Email: thall@epi.ucsf.edu
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INTERNATIONAL HEALTH PROFESSIONS EDUCATION medical education
Learning Through
Student-led Tutorials
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A Bhutanese medical doctor shares his country’s way of measuring happiness during his group’s discussion on poverty and a community’s knowledge, attitudes and practices on major health issues. In another group, a Nepali nurse talks about her 50 kilometre trek over mountainous terrain to reach a rural village to immunize children while a social worker from Lesotho explains the challenges she encounters when counselling young people living with HIV/AIDS. A project manager who has worked with MSF expands on logistical preparations when setting up camps in Pakistan and Afghanistan. In another tutorial, a debate rages on between students discussing tobacco control and advocacy- one side represents tobacco farmers, workers, local government officials while the opposing side role plays a Department of Health representative, a non governmental tobacco advocate and researchers. These are only a few of several dynamic examples of what our International Public Health postgraduate students do and learn during their tutorials. In 2000, University of Sydney’s School of Public Health started its one year Masters of International Public Health (MIPH) coursework programme. Its first semester had enrolled twelve students with only one international student from Uganda. The following year, in only its second year, the program attracted 51 new students; 26 international students from Bangladesh, Vietnam, India, China, Cambodia, Philippines, Uganda, Malaysia, Caribbean, Mongolia, France and the United States. Since then students from over 50 countries have completed the programme. Currently, there are 123 enrolled; 45% are international of whom 70% come from developing countries. Educational backgrounds: - Medicine, nursing, dentistry, pharmacy and allied health professions - Social sciences, anthropology, education, humanities and arts - Engineering, science, architecture - Law, peace and conflict studies, business, economics - Media, telecommunication, graphic design, music Most of the students from developing and developed countries have done health-rela ted work in their home countries prior to enrolment. Some are mature aged students in their mid careers deciding on a shift. The rest are fresh out of their baccalaureate degrees. Each group consists of ten students distributed according to educational backgrounds, part time or full time load, international/ local, work experience and gender. Students take turns facilitating an assigned session 10
based on lecture topics or related issues within a specific Unit of Study over 9 to 10 weeks. Facilitators are evaluated at the end of their assigned sessions by their tutors and marked against a standard assessment guideline. The rest of the group are also evaluated. Marks add up to a summative tutorial grade. Tutors hold regular feedback sessions to identify issues and to acknowledge student efforts. End of semester tutorial/tutor evaluation forms are completed. Creative approaches like debates, problem solving case scenarios, role playing and mini quiz games have been commonly used by students to enhance sessions. Challenges In earlier years, several tutors viewed facilitation as a ‘presentation’ thus diminishing interactive discussions. Issues regarding student attendance, lack of preparation prior to tutorials (pre-reading), assessment criteria and group dynamics were encountered. Some groups required more tutor assistance with directing flow of discussion. Facilitators experienced difficulties with quiet peers and felt neither equipped nor experienced to handle these situations. Tutors were ill prepared for sessions and unresponsive to the group. In the past five years, more MIPH graduates have become tutors and contributed immensely to the quality of tutorials. How have student-led tutorials improved learning Students develop critical thinking and hone their literature search skills. As facilitators go through their pre-tutorial preparations, they learn to sift through information, organize their ideas, plan their sessions with advice
from tutors and generate key learning issues. During tutorials, they learn to moderate, ini tiate discussions; monitor group dynamics, motivate members and articulate salient take home messages. There have been instances where discussions continue long after a session triggered by thought provoking issues. A truly outstan ding and memorable tutorial also inspires students to learn more about an issue. Improvements in communication, problemsolving and leadership skills were noted particularly among students with a NESB (non English speaking background). Tutorials encourage self-directed learning, creativity and resourcefulness. Students learn to listen, practice diplomacy and tact when expressing one’s ideas whilst interacting with peers and teachers. Tutors provide pastoral support especially to struggling students; ably assisting MIPH staff with monitoring students. Moreover, a tutor’s support provides a welcoming atmosphere during tutorials. In conclusion, the multi-disciplinary backgrounds of our students coupled with their work experiences in developing countries along with guidance from tutors have contributed to a deeper learning experience and more insightful understanding of international health and health system challenges in resource poor settings. Tutors have likewise benefited from their students’ experiences consequently strengthening their mentoring skills.
Giselle M Manalo, MD MIP, Sydney School of Public Health, University of Sydney Email: gmanalo@bigpond.com
leadership Column Within The Network: TUFH there is an increased attention for the role of leaders in educational innovations. Studies in this field demonstrate that leadership is not only an inherent characteristic of certain gifted people but can be learned as well. For that purpose some successful leaders share their experiences as a ‘change agent’ with the Network: TUFH membership-at-large.
Kofi Owusu-Daaku, Kwame Nkrumah University of Science & Technology (KNUST) continuing students and freshmen are guaranteed accommodation on campus.
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Kind of Leader I’m a gregarious person with the ability to press hands to get things done but leave no one in doubt that the buck stops with me. I would like to lead by example and am not afraid to apologize when things
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KNUST was a wholly residential university with a maximum capacity of 4000 and had increased fourfold to a population of around 15,000 as a result of governmentdriven expansion of access by 1998. The result was that some students were made permanently residential and others permanently non-residential. Given the paucity of decent student accommodation outside campus, the situation provided an undue advantage to those residing on campus. Ten years of private investors have come in to build student-centred hostels around the periphery of the University lands for
Role of other stakeholders All stakeholders are critical to the change process. In the specific change of mana ging a change from classical mode of medical training to training by PBL staff needed training to lead the change, the students needed constant orientation to buy into the change and run with it. Health authorities needed the orientation to assure them the change is an improvement and never retrogression. Community leaders needed to be assured that the change was to benefit the community. Being able to start and sustain clinical training in the North is one such assurance the community leaders have bought in to support.
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Change processes in the Past Some 15 years ago I was appointed Chairman of the KNUST basic schools board at a time when trade union influence had muscled the schools to their knees because of the insistence of low fees. In my 5 years in the chair, I was able to successfully negotiate to get the appropriate fees charged and therefore got facilities improved in the schools.
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Kofi Owusu-Daaku, Ghana
In September 2005 I left KNUST for what was to be a two year sabbatical leave in the School of Medicine and Health Sciences (SMHS) at University for Development Studies (UDS) in the North of Ghana. I was asked to stay on for two more years by UDS during which I rose from a head of department to acting Dean who moved students to a new site amidst strong opposition from staff and students. With perseverance and unwavering focus the dust settled and turned my attention to nurturing a PBL program for medical students, maintaining a traditional curriculum for the allied health, managed a fledgling admi nistration in a new site with all its teething problems. At the same time I managed to give my lectures and run labs. Even though I have officially returned to KNUST I still have a sustained interest in UDS SMHS where I am involved in some teaching and strategic planning.
In order to gain the needed influence to achieve your vision you should consis tently demonstrate that your work output is much higher than your peers. Find the right opportunities to sell your convictions to your superiors, peers and subordinates. Demonstrate transparency and ability to take on new ideas but remaining true to your core convictions. Never be afraid of the occasional open criticism and disagreements; they are helpful in realigning goals and clear any doubts about who is the leader in any scenario.
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For 10 years 1996-2006, I was the deputy president of the University Teachers Association of Ghana (UTAG) two of which was spent concurrently as the national vice president. I was a principal member of the Standing Joint Negotiating Committee –a body that dialogued with government on lecturers’ salaries. Our team succeeded in negotiating the best deal in salaries in history for lecturers.
go wrong. I am willing to walk the talk and talk the walk. I would always prefer kee ping an integrity that is above reproach.
Kofi Owusu Daaku, KNUST, Kumasi, Ghana Email: kofi.owusudaaku@googlemail. com
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INTERNATIONAL HEALTH PROFESSIONS EDUCATION yellow papers Between those outstanding publications that were already published in leading journals, and some preliminary notes scribbled on the last page of an agenda, there are also papers or reports that belong to the in-between (‘grey area’) category. Papers that, for whatever reason, have not been published before. Within this ocean of ‘grey’ papers, there are some which by content are most relevant to the Network: TUFH’s mission and aims. We will pick those pieces of gold from the ‘grey’ ocean, change their status to ‘yellow’ (because we can’t print in gold) and publish these in this section.
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1. Define clearly what skills you expect your students to acquire at the end of the program:
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Effective teaching-learning in Clinical Pharmacology can improve prescribing and immunize students against factors that may induce irrational prescribing in practice. The author has conducted problembased learning (PBL) sessions on rational use of medicines in medical schools in Nepal. Following are summarized suggestions for conducting PBL sessions in Pharmacology in developing nations:
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Problem-Based Learning Sessions in Pharmacology
Pharmacology practical sessions should enable students to use essential medicines rationally. The various exercises, activities and assessment should be directed towards this goal. 2. Use important publications by WHO and other organizations: The World Health Organization (WHO) publications ‘Guide to good prescribing’, ‘Ethical criteria for medicinal drug promotion’ and ‘How to investigate drug use in health facilities’ are important for pharmacology practical sessions. Students should use the latest version of the national essential drug/medicine list, standard treatment guidelines (if available) and the national formulary during sessions. 3. Create a comfortable working environment: Creating a comfortable working environment is important. Doing this does not
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require heavy resource outlay. At KIST Medical College (KISTMC) student groups work around a six feet by two feet table and are seated comfortably on plastic chairs. 4. Train facilitators: The tutor (facilitator) should be clear about the educational objectives of PBL, alert to the behavior of individual students and group dynamics, and be able to give constructive feedback. Most workshops use small group methods and I would recommend persons interested in knowing about facilitation and conducting PBLs to attend them. The two year fellowship offered by the Foundation for Advancement of International Medical Education and Research (FAIMER) is also useful. These can be discussed and practiced during institutional teacher training workshops.
5. Arrange a computer for the PBL Room: Many good computer-based resources are available. The WHO Medicines Bookshelf provides access to nearly 500 publications. Martindale’s Complete Drug Reference, WHO Model Formulary (WMF) and British National Formulary (BNF) can be installed. Students can conduct experiments on a computer and learn to interpret experimental data. 6. Arrange a white board, flip board and flip charts for the PBL room: Flip boards and flip charts are extremely useful for group work and presenting data to other groups. Group members can write down their findings and observations on the flip chart and present it. Flexibility and low cost are major advantages.
7. Concentrate on group dynamics:
8. Obtain regular student feedback: We obtain regular student feedback about the sessions. This feedback has been very useful for us for further strengthening and improving the sessions.
Dr. P. Ravi Shankar MD, Department of Clinical Pharmacology; KIST Medical College, Imadol, Lalitpur, Nepal. Email: ravi.dr.shankar@gmail.com
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10. Teach students to maintain a proper relationship with the pharmaceutical industry:
These general suggestions will be helpful to Pharmacology educators especially in developing countries to conduct PBL sessions in an efficient and cost-effective manner.
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Personal or P-drugs are first choice drugs for common diseases. Students learn to make proper treatment choices and to individualize their P-drug for a particular patient considering individual characteristics. They also learn to write a proper prescription and counsel their patients about the disease, drugs and non-drug measures.
The assessment methods used should be in tune with program objectives and know足 ledge and skills sought to be developed. We allow students access to textbooks, formularies and other sources during P-drug selection examinations as the emphasis is not on memorizing and information recall but on critical analysis and comparison of information.
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9. Conduct sessions on P-drug selection:
12. Use assessment methods in tune with program objectives:
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We teach students to analyze drug advertisements and promotional material using the WHO ethical criteria. Students verify the claims made in promotional materials using textbooks and independent sources.
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Effective teachinglearning in Clinical Pharmacology can improve prescribing and immunize students against factors that may induce irrational prescribing in practice.
Proper group functioning and interaction in PBL fosters high quality learning. At KISTMC each group selects a leader, a time keeper, a recorder and a presenter for each session. The roles are rotated each time. Facilitators should give each group clear instructions on their activities, what is expected of them and the time allotted.
ting the pharmacovigilance center in the hospital are activities which can be carried out.
11. Teach students about pharmacovigilance: Doctors should be able to report adverse drug reactions (ADRs) and be aware of its importance. Designing an ADR reporting form, carrying out causality, preventability and severity assessment of ADRs and visi足 13
improving health health services
Global Health Systems Impact Assessments A call for Action
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Vertical programs The best primary health care physicians and nurses in a community are recruited by a malaria-project, financed by an external donor where they earn 3 times more than their income in the local public health sector. A patient hospitalised in Tanzania, who was suspected to have HIV/AIDS but at the end of the week his lab-tests revealed that this was not the case: as a consequence the care was not “free” and he had to pay the bill (two months of family income). Vertical disease oriented programs often have important consequences for the local health systems: they may lead to fragmentation, disintegration of care, problems with access, and problems with staff in the health system. Health Systems Impact Assessment Therefore methods that anticipate the effect of targeted global health initiatives on health systems are needed and will improve health care worldwide1. Both Secretary General Jan De Maeseneer of the Network: TUFH and Board President David Egilman of GHETS1, have contributed to the formulation of the Call for global health - systems impact assessments. Use of Health Systems Impact Assessment often need a change in philosophy and approach of the (I)NGO’s. Every organization that is planning a health intervention in a developing country needs to give thought to the long-term implications of its actions at different levels: service delivery, health work forces, health-information systems, medical products, vaccines and technologies, health financing, leadership and governments, but of course also in other sectors outside health, like environment. If such an analysis is not made, initiatives targeted at specific diseases will probably, at best, continue to duplicate efforts within health systems and divert personnel and resources; or at worth erode longterm capacity.
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Therefore, the Network: Towards Unity for Health and Global Health through Education Training and Service, call for action that focuses on WHO, donors, government lea ders, academic institutions, (I)NGOs and other organizations. Academic Institutions and researchers should prioritize research for development of Health Systems Impact Assessments (HSIAs) that are evidence-based and take into account local realities. Nongovernmental organisations and staff who participate in humanitarian work should: - participate in development of and sign on to codes of conduct, such as the NGO code of conduct 2 - take into account the effect of their programs on existing health systems - work with academic and other institutions to develop HSIAs that are appropriate to their specific situation. We invite you to sign on to the call at: http:// ghsia.wordpress.com/sign-onto-the-call-forghsias. 15by2015 campaign The Network: Towards Unity for Health is very well placed to look at the consequences of vertical disease oriented programs. Together with GHETS, European Forum for Primary Care and WONCA2 the Network: TUFH launched in March 2008 the “15by2015”campaign (www.15by2015.org). “With the “15by2015” campaign we ask donor organizations to allocate, by the year 2015, 15% of their vertical funding towards sustainable comprehensive primary health care that is accessible and affordable in all regions of the world”3,4.
Conclusion In this time of economic crisis, we need to think pro-actively and make the changes that are needed to improve health care worldwide and especially in the communities of the most vulnerable. With the WHO 2008 report5, “PHC now more than ever” in the back of our minds and the WHO 2006 report6, “Working together for health”, we must understand that health care workers and in PHC are of utmost importance. All health initiatives of (I)NGO’s should think before they act and assess the impact of their initiative in the bigger picture and long-term. References 1. Swanson RC, Mosley H, Sanders D, Egilman D, et al. Call for global Health Systems Impact Assessments. The Lancet 2009,374: 433-435 2. The NGO code of conduct for health systems strengthening initiative. http://ngocodeofconduct.org (accessed February 16th 2010) 3. De Maeseneer J, van Weel C, Egilman D, et al. Editorial: Funding for primary health care in developing countries: Money from disease specific projects could be used to strengthen primary care. British Medical Journal, 2008;336:518-519 4. De Maeseneer J, van Weel C, Egilman D, et al. Editorial: Strengthening primary care: addressing the disparity between vertical and horizontal investment. British Journal of General Practice, January 2008;58:3-4 5. The World Health Report 2008 – Primary Health Care (Now More Than Ever), www.who. int/whr/2008/whr08_en.pdf (accessed February 16th 2010) 6. The World Health Report 2006, Working Together For Health www.who.int/whr/2006/
We invite all readers to go to the website and sign the petition: www.15by2015.org/index.php/petition/ Case reports are welcome on the website in order to document examples of vertical programs and the consequences of what happens when no Health Systems Impact Assessment takes place.
whr06_en.pdf
Maaike Flinkenflögel, Department of Family Medicine and Primary Health Care, Ghent, Belgium Jan De Maeseneer, Secretary General, The Network:TUFH, Belgium Email: Jan.DeMaeseneer@UGent.be
Reproductive & Child Health Systems in Post-Conflict Settings Rebuilding reproductive and child health sys-
ship with policy makers, health providers,
tems in post-conflict settings is critical to long
community leaders, local & international
term sustainable health and the overall well-
NGOs and communities to produce evidences
being of a country. It is important for Health
and do research that can listen to hard-to-
Systems, NGO’s, development professionals
reach communities in post conflict settings,
and health care workers to make this issue a
and to support evidence-based health sys-
top priority.
tems decisions and policies.
Foundation
Methods
They conducted more than 30 focus group
In May 2010, we launched “Rebuilding
We apply several methodological approaches;
discussions, critically analyzed 30 incidents
Reproductive & Child Health Systems in Post Conflict Settings Initiatives”1 ‘ReReCHI’, a
some of them have never been applied before
and events of maternal deaths, maternal
in the literature in post conflict settings.
near-miss, neonatal death and abortions, and
collaboration between University of Medical Sciences & Technology ‘UMST’ in Sudan2 and
These include Participatory Ethnographic Evaluation and Research PEER4, critical inci-
interviewed more than 50 key informants.
Connecting Health Research in Africa and Ireland Consortium ‘ChRAIC’3.
dents Analysis, Reflexive photography, and
Ethnographic Evaluation and Research PEER
verbal autopsy, and House Hold Survey. This
to interview 50 women in 16 villages. They
This initiative is founded and led by Master
initiative seeks to use a mixed approach to
trained undergraduate students from the
students at Public and Tropical Health at the
listen to the people in order to identify ways
local university to conduct Household sur-
UMST, under the supervision of Dr. Khalifa
to generate evidence for strengthening the
veys to cover more than 500 houses in Renk
Elmusharaf a PhD researcher in ‘ChRAIC’ and
reproductive and child health systems from
County.
the executive director of this initiative. The ini-
bottom up, provide learning from commu-
We presented 3 papers out of this initia-
tiative team is multidisciplinary and consists
nity views on current practice, understanding
tive in conferences in Nepal and Ireland.
of researchers from different backgrounds;
the determinants, and identifying gaps and
Twenty potential peer reviewed articles will
medical, nursing, laboratory, family sciences,
strategies for rebuilding health systems in
be submitted during the next 12 months. Ten
public health, health system & Policy, interns,
post-conflict setting.
Master Degrees will be awarded on the basis
ging from 50 years of conflict and fragility.
Training and Capacity Building are fun-
Through this initiative it is hoped that repro-
damental parts of the initiative. Since its
ductive and child health system, policy and
launching, the initiative has played a major
References
services in post conflict settings will be better
role in training and capacity building ranging
1. www.rerechi.webs.com
informed in order to improve policymaking
from non-literate women to PhD students.
2. www.umst-edu.org
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and program development and that we will
We trained and built the research capacity
3. www.ChRAIC.org
be closer to attaining the health related
of 40 Master Students in Public Health, 25
4. www.options.co.uk/peer
Millennium Development Goals. The driving
Masters in Tropical Health, 15 Doctoral
force behind such an initiative is that policy
Students in Nursing, 16 non-literate conflict
makers require reliable evidence to make
affected women, 5 local Students in Upper
effective and informed decisions. Our claim is
Nile University, and 5 employees of Local
that if researchers are enabled to produce the
NGO in Renk, in addition to more than 10
evidence and have the capacity, skills and the
health education sessions in public.
based health systems decisions and policies
Achievements
are more likely to take place.
Twenty five researchers from UMST (MPH
Partnership
have been working in this initiative in Renk
In this initiative we are working in partner-
County in South Sudan, an area just emer
Dr. Khalifa Elmusharaf | Executive Director of ‘ReReCHI’ | Head of Reproductive & Child Health Unit, University of Medical Sciences & Technology, Khartoum – Sudan Email: Khalifa_elmusharaf@yahoo. com
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resources to do the research, then evidence
ders’ workshops, and media.
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translated in forms of policy briefs, stakehol
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They trained 16 women in Participatory
Students, PhD Nursing, and undergraduates)
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IMPROVING HEALTH rural health
Prevalence of Protein Energy Malnutrition among Children in Rural North India
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Most of our little subjects were cooperative Malnutrition is an important public health problem in India accounting for 46% of all children under the age of 5 years. Approximately 20 percent of children in India under the age of four suffer from severe malnutrition. A cross-sectional nutritional surveillance study was done by a group of 2nd clinical year medical students of Christian Medical College, Vellore, India during their secon dary hospital posting at Herbertpur Christian Hospital, Uttarakhand, in rural north India in May 2009. The aim of this 3 week secondary hospital posting was to orient medical students to primary health care systems in remote parts of the country where they have to work for a
period of two years after graduation. As part of this posting, a community based health project was done to find the prevalence of malnutrition among children under five in Herbertpur, and to study its association with various risk factors. A total of 103 children from 5 villages of Herbertpur were included in this study. Verbal consent was obtained from the parents of the children. Standardized proformas with details regarding breastfee ding practices, common infections, diet and factors like parents’ education, occupation, birth weight and birth order were filled and anthropometric measures such as height/ length, weight and mid-upper arm circumfe rence were taken. The data was entered into Epi-info and then analyzed using SPSS 16.0. Data was analyzed referring to WHO growth charts. Of the 103 children who were considered for the study, there were 51 boys and 52 girls. Based on weight for age, 59.2% were underweight1.There was no significant gender difference. Prevalence is higher than the National Family Health Survey data (43%) and a similar study in South India (Vellore) (Urban- 41%, Tribal-50%). 51% were stun ted2 (indicative of chronic malnutrition) and 53% were wasted3 (indicative of acute malnutrition).
1) Underweight = < 3rd centile of WHO weight for age 2) Stunted = < 3rd centile of WHO height for age 3) Wasted = < 3rd centile of WHO weight for height. The analysis of the association of the risk factors with malnutrition is depicted in the underlying tables.
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Though the risks factors were statistically insignificant2 in terms of confidence interval, while analyzing the odds ratio1 its was observed that both prolonged and inadequate exclusive breast feeding as well as the presence of worms in stool have a high odds ratio. This highlights the fact that these risks factors need
1) Odds ratio is the measure of the strength of the association between risk factor and disease. The higher the value of odds ratio, greater is the association of the risk factor with the disease. 2)The data is said to be statistically significant only if the confidence interval does not have the value of 1 in its range
to be stressed while giving health education to the community. After analyzing the results, health education was provided to the community about how mothers can improve their child’s nutrition by adding commonly available protein rich food in the diet. The importance of exclusive breast feeding for first six months, need to maintain good hygiene and prompt medical treatment on noticing worms in stools were emphasized. The mothers were also taught how to make High Calorie Cereal Mix, which is an easy to make supplementary feed made from commonly used food products like milk, rice flour, oil and sugar. This study has also highlighted how the medical students can help the community as well as the local health care system in identifying and addressing common public health issues like childhood malnutrition. Gutta Smitesh, Christian Medical College, Vellore, India Email: smiteshg@gmail.com
health authorities
Francisco Campos Reorientation of Professional Education Francisco Campos was one of our key note speakers at the Nepal Conference. He gave an inspiring speech about why reorientation of professional education is essential to a health system reform. This is a summary of the talk we had with him afterwards.
the Family Health Program 32 000 teams are working in the country covering 70% of the population. Every team is responsible of a geographic area, and contains a doctor, a nurse, an auxiliary nurse, community health workers and sometimes even dentists. They are responsible for the health of the assigned population.
They are not isolated in the country but have referral systems for second opinions and emergencies. Thanks to the strongly developed National Telehealth Program, the teams can also contact university hospitals. It provides remote assistance and permanent education. (www.telessaudebrasil.org.br )
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Professor Francisco Campos, MD, MsC, PhD; Full Professor, Federal University of Minas Gerais, Brazil Email: francisco.campos@saude.gov. br
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There is a strong focus on primary care. In
The quality of medical education is very important because it defines the quality of the system. If no proper health care professionals graduate, you will spend more money because there will be more referrals, unnecessary prescriptions and so on. This drives the Ministry of Health to have an action in an area that is not initially their concern. There’s a strong connection between the health authorities and the medical education.
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The National Health System (NHS) in Brazil is based on a health system through citizenship. Health is defined as a right of every citizen and a state duty in the constitution of 1988. The Brazilian society does not accept the idea of previous contribution in order to have access to health services.
Brazil has a strongly coordinated health system. The fact that they were the leader with the H1N1 vaccinations and being the first country in the world to universalize Anti Retroviral Treatment in the world proves this.
Dr Campos concluded with the following quote: “Some great ancestors (George Miller, Durocher, Mark Twain, F.D. Roosevelt, Woodrow Wilson,…) said: “It’s easier to change a cemetery than a medical school” but I spent 35 years of my life in this endeavor and I still think that it’s possible.”
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In 1974, when he was president of the student union of his university, he was involved in one of the most important and sustainable curriculum changes which are now -40 years later-still in place. This curriculum change involved the introduction of rural internships. This was a very important process at an important time in Brazil because of the expansion of medical educational institutions. During his career he kept following the track that he started as a student.
scenario for training students. Students are made more sensitive to Primary Health Care (PHC) and encouraged to work in PHC after graduation. PHC physicians earn even more then residents for specialties. But still it’s a challenge to motivate people to work in Primary Care.
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His main areas of professional involvement are Human Resources for Health (HRH), with a focus on Medical Education and more specifically on the professional education and the scaling up of HRH education in developing countries.
Francisco Campos
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This system is the consequence of the clear vision that there are not enough resources to have everything in hospital based care. These teams are the gate keepers of the system.
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Francisco Campos is a medical professor at the Federal University of Minas Gerais in Brazil. He is a national health authority for human resources within the Ministry of Health of Brazil and he is also a board member of the Global Health Workforce Alliance of WHO.
In the Brazilian educational program it’s important that the hospital is not the only 17
improving health great stories from great people
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Jeanne Devos (°1935) is a Belgian missio nary sister who devoted her life to the poorest in India. In 1985 she founded the National Domestic Workers Movement in Bombay which now is active in almost all of India. In 2005 she was nominated for the Nobel peace prize and during her career she received numerous recognition awards. We were very proud to welcome her as one of our keynote speakers at our last conference in Nepal. Of course we took the opportunity to interview this inspiring woman! In 1963 you left to India as a Missionary sister, what drove you to make this choice? As a child of 12 years old I already had the idea to go to India, it must be something in my genes! At that time we heard a lot about the poor fisher communities and I guess that this was what gave me the idea. I always wanted to choose for the poorest. Also the mystic of India intrigued me: yoga, meditation but also the transcendence with the others and the Other. I studied orthopedagogy and joined the monastery at a later age. Soon after your arrival you founded the First National Student Movement in India. How did you get involved? This was very spontaneous as well as the domestic workers movement. I was working in a centre with deaf and blinded, which was very enlightening. It’s wonderful how people with a handicap can create a different world as they are not connected to the conventional. On a regularly basis, students came to play with these children but they had difficulties because they didn’t know how disabled children played. So often the children became the victim of their good intentions. So then instead of playing with the children we started to have group discussions. What was happening in their school? For exam-
Jeanne Devos
ple the Caste system which meant that students of lower castes couldn’t study at night because there was no light. From these small level discussions we extrac ted the discussions to a bigger environment and this connected with the radical student movement of 1968. Theologians and sociologists started to meet students in order to know what’s going on between them. This is how the Young Student Movement for Development was born. This voluntary diligence of young Indian graduates prepares the breeding ground for the first non-governmental organizations such as People’s Watch and Lawyers for human rights. I still have contact with the original 10 students, one of them is our lawyer.
I was already a member of the social democratic women’s group in the South of India.
And how did you evolve from the student’s movement to the domestic workers? Naturally I am a movement person. From the student movement grew the voluntary work and action groups and with this the awareness of the exploitation of the woman in the society and in the church. As a woman I felt that I had a future in the commitment for these women. What can we do to help them?
How does the movement work? We work around several objectives and one of them is the dignity of the domestic worker. Through role plays we ask them what they like to be. Most answers are in the line of the work that they already do: nurse, air hostess, etc … We want to have an insight in their work, what are their rights? People who don’t have rights don’t exist.
There were 3 major repressed groups: the sexworkers, the bonded laborers and the domestic workers. My first choice was the sexworkers but then you are already too late, I wanted to work preventive so the obvious choice became the domestic workers as they are also the most sexually abused group and in forced labour. The movement wasn’t meant to do welfare work. We didn’t want to donate clothes and food because this makes them only more dependent and more aware of their exploitation, lack of chances and pain. The goal was to do it together!
Children born in domestic work are not even registered at birth, they don’t exist. They have no working rights, no children’s rights; they can just disappear. This is a very scary situation. We listen to them and we give them a face. We try to determine their needs.
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My successors are very capable but I can still be there. They still count on my presence. I am the face but the movement is getting much larger then that now. The future is in good hands!
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Did you get a lot of opposition? How did you fight against it? The opposition was enormous! In the beginning I got a lot of threats. I always
What about your own future? The responsibility of the movement has been transferred, but as long as possible I will continue working with them. When this is no longer possible I will return to Belgium. I don’t want to be a bother for the movement, I don’t want to be a burden just because I was the person who started it all!
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The basis of the communication is our own members! The bigger the movement, the more we will be known!
Every child and woman working as a domestic worker should have the chance to be a full child or woman with the same rights as anybody else.
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Of course the movement is the least known with those who need it the most. These are the ones who never leave the house; some of them are even bonded to the table when their boss leaves the house…
Every child and woman working as a domestic worker should have the chance to be a full child or woman with the same rights as anybody else
Further it’s important that the house will be seen as a working place, so people who work there will have protection and rights as all other workers. Now for example there is no protection against sexual abuse because a personal house is not recognized as a proper working place.
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We started with women but in every house there are also children who were brought or born there. Often they are very lonely or abused and a lot of them don’t talk anymore. These women and children meet each other at the market or at the school gates where they drop off the children of their bosses. These meeting points are inevitable so of crucial importance for the spread of information.
Were you ever scared? Did you ever get tempted to give up? Sometimes I was scared, especially when I got these threats in the traffic but at a certain point I accepted this. What has to happen will happen.
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How do domestic workers get in contact with your organization? How does communication go?
We never receive big donations, only small donations but from a lot of normal people. This reassures me, it means that a lot of people care!
What are the future plans for the movement, what do you still want to realize? We wanted to get the convention for the rights of domestic workers approved in June 2011. This will concern all domestic workers without status in 183 countries It’s very important this gets approved because it will change the lives of hundreds of millions of people who are now not getting any chance.
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Now we have over 2.5 million members.
Law proposals were counter acted by employers, the middle class and the society who didn’t wanted to lose their cheap working forces.
I never wanted to give up. Once I had to submerge after a threat of the mafia, but in this case I was warned in advance.
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How are you organized? Our national office is situated in Bombay and we have 24 head offices. Further, there are numerous district offices where they can go to as a point of contact, to put in a complaint, to look for help. We help them in 28 different languages. Our offices are not big buildings. We have small houses or even rooms. We don’t use a car because it’s cheaper to go and save children by taxi. We wanted to stay a basic movement!
drive a Vespa and they told me they would kill me in traffic! Now these personal threats stopped, as the movement is no longer one person.
www.jeannedevos.org National Domestic Workers Movement: http://ndwm.org/
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IMPROVING HEALTH health promotion
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The Fred Hollows Foundation New Zealand: Supporting Eye Health in the Pacific The Fred Hollows Foundation is inspired by the work of the late Professor Fred Hollows. Fred was a skilled eye surgeon and a champion of the right of all people to good health and a strong advocate of social justice. It is a non-governmental organization committed to eliminating avoidable blindness and vision impairment. The Foundation works in Africa, Asia, the Pacific and Australia. The Fred Hollows Foundation New Zealand (FHFNZ) focuses on the western Pacific. About 8.5 million people live in the region ranging from about 6.5 million in Papua New Guinea, and a about a thousand each in Niue and Tokelau. Health care provision is challenging as 70 to 85% are rural dwellers in remote communities separated by vast expanses of ocean or mountainous terrain. Health systems are fragile as countries in general have low per capita government health spending, low ratios of doctors and nurses to population, and inadequate health infrastructure at every level. Most blindness and vision impairment in the region is due to cataract and uncorrected refractive error. Conditions such as presbyopia and conjunctivitis are common, and although unlikely to have sight threatening outcomes may significantly affect quality of life. Diabetes eye disease and childhood blindness may also significantly contribute to disability. Yet, up to 80% of vision impairment is avoidable, that is, it can be treated or prevented by cost-effective health interventions. Human resource development and deployment in this region is, however, ina dequate to protect and restore ocular and visual health.
Torba Tour 6 (Motalava), september 2003
Some of this need could be met by using appropriately trained mid-level personnel instead of conventional health professionals. However, in 2005, there were few formal training opportunities for eye health professionals in the Region. Nurses could learn about eye care during courses of two weeks to four months duration, and on-the-job training of up to a year that were intermittently available. FHFNZ thus embarked on planning to ensure regional eye health needs would be met. An iterative process sought input from the literature and local stakeholders from various fields. This information was used to develop competencies for mid-level personnel to meet quality standards for educational outcomes. The consultative process resulted in broad acceptance of the need for an appropriately educated mid-level cadre that could be recruited, educated, deployed, supported and retained in the western Pacific region. Ophthalmology courses for doctors were adapted from the International Council for Ophthalmology curriculum. Qualifications are awarded by the Fiji National University (FNU) for nurses and other health personnel • postgraduate diploma in eye care • postgraduate certificate in eye care • postgraduate certificate in diabetes eye care • master of community eye care and for doctors • postgraduate diploma in ophthalmology • master of medicine (ophthalmology) These courses are offered at the Pacific Eye Institute (PEI), an initiative of FHFNZ. It is located in Suva, Fiji, and attracts doctors,
nurses and other health personnel from across the Pacific region. They gain a solid academic basis for their practice and consi derable supervised practical experience in an environment similar to the clinics in their own countries. Similar courses for mid-level personnel are offered through the Divine Word University in Madang, Papua New Guinea. Learning is undertaken with the guidance of a collaborative network of well-respected eye care professionals from around the world. One of FHFNZ’s aims is however to move towards a model of learning led through Pacific lecturers and supervisors. PEI’s innovative programs are competency based and founded on active learning principles, allowing the opportunity for practical implementation of skills. In addition to clinical training in general and diabetes eye care, courses in community eye care, health promotion and quality management are also offered. Health personnel also have access to FNU courses in public health research and human resources for health management, which are offered online, via the Pacific Open Health Learning Net. Mid-level personnel can thus remain in their home countries and follow a multi entrance-exit approach towards gaining a Masters qualification. FHFNZ recognizes the importance of supporting graduates to implement their lear ning and maintain their competency through continuing professional development. FHFNZ further works within a health systems strengthening framework: supporting the capacity development of graduates to enable them to engage with and strengthen health systems in order to provide quality care.
Adrienne Kohler | Communications manager, The Fred Hollows Foundation, New Zealand Email: akohler@hollows.org.nz
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health promotion
Brighter Smiles Africa A Canadian School Model
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From 2006-2009 five health-promoting communities have been established and the teachers, children, and families remain engaged; on-going evaluation of the 600 children originally enrolled shows an overall improvement of oral health markers, health practices and knowledge; each year the children benefiting from in-class brushing/education increases as new children join the grades 1-4 classes participating. Fifty-two MU and thirty-nine UBC team members have collaborated to deliver the program. Ongoing evaluation indicates MU achieved new community-based educational opportunities for all dental students and unique experience with preventive health practices; UBC reported valuable global health learning, and
The linking of trainees and faculty from different countries in effective partnerships such as Brighter Smiles Africa affords both groups a range of valuable educational and servicedelivery opportunities, but also exposes them to unique experiences and insights that result directly from the process of collaboration. Meanwhile, the communities involved benefit from contact and dialogue with the health professionals they meet, the health-promo ting mindset established in their school, and the new knowledge and improved health practices their children acquire from the core objectives of the program.
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Key steps involved UBC orienting MU to the logistics of the index Canadian program, especially how best to engage communities, sustainable school-based program delivery, and effective evaluation methodology. MU next identified rural communities where hospitals could provide MU trainees community-based learning, and recruited four local schools prepared to become ‘health-
Evaluation
benefits from faculty/student involvement on their return to Canada that included mentorship of others planning to work abroad and an ability to drive curriculum change on global health. Both teams valued the oppo rtunities the partnership afforded for collaborative learning, evaluation, and research and acquisition of data suitable for scientific presention and publication. Both teams also reported positive outcomes for teachers and parents, and awareness and support of the program amongst key opinion lea ders in the communities. Leadership capacity was built in both universities. As intended, project delivery has evolved to address other community-identified child health concerns, which often enable our teams to promote elements of the WHO millennium goals.
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The Brighter Smiles intervention model involves in-class oral health education by the team initially, daily in-school tooth-brushing supervised by teachers; and for a cohort of half the children enrolled, additional biannual topical fluoride application (the first time the preventive potential of fluoride has been studied in Sub-Saharan Africa). On-going program delivery provides quarterly education/evaluation/service-delivery visits at the schools conducted by MU teams as part of their community-based rotations; one visit annually (conducted jointly with UBC) involves comprehensive examination and of all children.
Brighter Smiles team in action
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In 2005 Makerere University, Uganda (MU) and the University of British Columbia, Canada (UBC) established a partnership based on translation of the Canadian Brighter Smiles ‘Health-Promoting School’ model to Uganda. Health-promoting schools (by World Health Organization [WHO] definition) create an environment that educates and promotes physical and mental health both within the school and in the community. Healthy behaviors are taught and practiced at school and health topics are incorporated into the regular curriculum. Our partnership objectives were to collaborate to promote delivery of health education, develop mutual expertise related to global health, create or expand education opportunities and research capacity, and establish health-promoting schools to improve poor oral health in rural Ugandan children.
promoting’. The joint MU/UBC team (trai nees/faculty) planned delivery; obtained ethics and consent, collected children’s demographic and baseline oral-health data, and then initiated the program in the four communities. Challenges included difficulties with international communication/planning (inconsistent internet); differing Canadian and Ugandan concepts regarding ethics/ informed consent; the time and care required for community engagement: and the steep initial learning curve experienced by trainees regarding accurate data collection.
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Rural children face many health challenges worldwide. Providing opportunities for trai nee health-professionals to be educated in a community setting increases their understanding of the health issues rural children face, and engages them in such a way that some consider rural community practice or service in a global health context in their career plans. Curricula with communitybased rotations provide opportunities for local trainees; international partnerships incorporating such activities share the challenges and rewards of rural health-service delivery and community education with foreign graduates, providing valuable experience in the context of global-health.
Andrew Macnab | Department of Pediatrics, University of British Columbia, Canada Arabat Kasangaki, MD | Faculty of Dentistry, Makerere University, Kampala, Uganda Email: ajmacnab@gmail.com
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As third year community health students we were placed in the community of Mitchells Plain, Cape Town, South Africa for a period of six weeks. The project was initiated by Community Health Sciences Faculty and the School of Nursing at the University of the Western Cape. We were under the direct supervision of our lecturers and a coordinator of the UWC Rehabilitation centre. We were a group of eight students and placed at Heaven’s Shelter House located in Woodlands, Mitchells Plain. It is a temporary residence where women and children are rehabilitated following abuse. There are about thirty women and children residing at the shelter. When we first met the residents of the shelter we observed that many of the ladies lacked self esteem, were withdrawn and had limited knowledge about health issues regarding themselves and their children. Most of the client’s needs surrounded everyday things we so often take for granted like employment, food, housing, education, shoes, clothes etc. Our aims and objectives were to empower the women on different levels in their lives, to build self esteem, to educate on health, to holistically prepare the ladies to be reintegrated back into society and to give them a sense of self worth. The previous group of students handed out wish lists but many of those ladies had left the shelter so we handed out a new wish list in which they had to state five wishes that they would want in the immediate future. Some of the ladies suggested that they would like to do a Home Based Careers course so that they may find employment. We sent donation letters to various local businesses and KFM a local Cape Town radio station. We had to establish trust between the students and the residents. We planned
Ice breaker- spider’s web. Nursing students and residents of Heavens Shelter.
weekly workshops and various icebreakers to get everyone involved. The weekly workshops consisted of stress management, motivation, recognizing the signs of abuse and basic health information about the importance of immunization, breastfeeding and female health and the importance of pap smears and when women should go and where the tests are available. Before every workshop, we used various icebreakers like spider’s web, talking behind your back and following the voice to encourage participation of the women. The icebreakers had a positive outcome and created a relaxed atmosphere amongst the residents. Following the workshops the residents felt that the information was helpful and relevant to everyday life. They also felt a sense of empowerment with the knowledge they had gained and believed they would be able to take better care of their children and themselves. Initially our aim was to raise enough money to send two ladies on the course because of a limited time period. Due to the tremendous support by local businesses and KFM radio station we
managed to raise a total of R23 300.00. A Mitchell’s Plain business donated twenty blankets and second hand clothes collected by staff. With the generous donations we could enrol eleven ladies in the program to do the Home Based Careers course and purchase basic needs of the shelter like food and electricity. These ladies have completed the course and are busy with their practical so that they may gain the relevant experience and then find employment. Trust was gained between the students and the community. The experience has helped us to apply theory to practice and implement the Ottawa charter principles by developing personal skills, strengthe ning community action and creating a supportive environment. The residents of the shelter were grateful for the opportunities they received and had a sense of renewed belief in society; a society they thought had turned their backs on them. Bronwyn Burger, School of Nursing, University of Western Cape Email: 2822824@uwc.ac.za
Women’s health
Hysterectomy in Rural Women Context
Analytic study of trends in hysterectomy (prospective retrospective cases)
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During the study period, 94.4 % of hysterectomies were for benign gynecological diseases. Analyzing the demographic profile of women who underwent a hysterectomy, more women were from lower income groups (86.9%), and were less educated (42.5%) compared to higher income groups (1.5%) and higher education (15%). Various reasons include issues of poor compliance and follow up as well as lack of awareness and finances. In
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4829 women who have undergone hysterectomy at a rural tertiary health care educational institute, Maharashtra, India, over nearly two decades.
Gynecologist’s attitudes towards hysterectomy decisions are complex, multifactorial and variable. Nine out of every ten hysterectomies are performed for noncancerous conditions that are not life threatening but have a negative impact on quality of life (Domingo et al 2009). Surgical morbidity and associated morbidity are much lower with VH than with AH (3.2 and 0.9% vs. 6.2 and 4%, respectively) (Baskett et al 2001). In a ran domized, controlled trial comparing the three methods of hysterectomy, abdominal technique required an extra day in the hospital and an extra week of convalescence. VH was regarded to be the most cost effective of all three types of surgery (Ottosen et al 2000). Furthermore, VH was the best approach for
In this study it was revealed that hyste rectomy for abnormal uterine hemorrhage where conservative treatment was possible was reduced, however cancers and precance rous lesions contributed to bigger numbers. It was also revealed that if safer alternative management and patient compliance is possible for benign conditions which include counseling and/or hormonal therapy, it should be welcomed and should be used to reduce the number of hysterectomies as it is a major surgery with associated morbidity and mortality which can also be reduced with proper care.
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The present study was done to understand trends, indications, relationship to education, socioeconomic status, medical disorders, and morbidity and mortality in women who have undergone hysterectomy for benign gynecological disorders.
for precancer and cervical cancer due to increasing detection of cervical intraepithelial neoplasia (CIN). Dysfunctional uterine bleeding (DUB) is a main indication in nearly 50% of all hyste rectomies in the United Kingdom and half of the women undergoing hysterectomy for menorrhagia has a normal uterus. (RCOG 1999a). There have been decreasing trends in cases of DUB because of use of counseling and availability of medical treatment. The rates of hysterectomy for fibroid, fibroid with adenomyosis and PID have increased.
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obese patients and elderly patients with comorbidity. The incidence of hysterectomy was significantly more in rural populations probably because radical decisions are taken more often as patient follow up is difficult; patients don’t comply with medical advice or report when disorders are advanced and also because of low educational levels. Trends of hysterectomy in relation to age have been stable for benign gynecological disorders over 20 years but an upward trend was seen a u g ust
Hysterectomy continues to be a major surgical procedure all over the world with varied physical, social, psychological and economic implications, not only for women, but also for her family/society at large. The ratios of indications of hysterectomy have been changing over the years with advancing diagnostic techniques. Indications for relief of symptoms rather than treatment of organic disorders are continuously increasing. Across all indicators, except for malignancy, patients and their physicians may differ about timing and the need for a hysterectomy. There may be physician to physician disagreement as well. Hysterectomy is a major surgical procedure with morbidity and mortality and many disorders have alternative medical management, hence indications deserve careful scrutiny.
addition, women often do not seek advice until disease is advanced. The majority of women were multipara. Cases of hysterectomy for pelvic inflammatory disease had increased from 4.2% in the first five years of the previous decade to 6.2% in the last five years of the present decade; fibroid from 26% to 32.9%; for fibroid with adenomyosis from 3.07 to 8.41%. Cases of dysfunctional uterine hemorrhage showed a decreasing trend from 21.7 to 16.91%. There has been no change in trends of hysterectomies for genital prolapse. This study mainly focused on benign gynecological disorders, however it was observed that rates for ovarian and cervical cancer increased from 3.3 to 4.3%, endometrial carcinoma from 0.37 to 1.15, and cervical dysplasia from 0.48 to 10.4%. Common medical disorders in cases were obesity, hypertension, and diabetes. Overall complication rates in abdominal hysterectomy was 19.4% and vaginal hysterectomy 14.6%, which included hemorrhage (13%), injuries to adjacent organs (0.2%), post operative infection (8.65%), urinary tract infection, fever (1.17%) and postoperative vaginal bleeding. Surgical morbidity could be curtailed by proper preoperative and post operative care.
S.Chhabra, S.Chopra, S.Mehta | Dep. of Obstetrics and Gynaecology, Mahatma Gandhi Institute of Medical Sciences, India Email: chhabra_s@rediffmail.com 23
students’ column STUDENTS’ SPEAKERS CORNER
SNO Nigeria ACTIVITIES: Working with the Community focused on health promotion regarding clean water and personal hygiene. We had good results.
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In another, bronchopneumonia in children under age five appeared to be a big problem. A predisposing factor was the poor ventilation in small houses. Often big families of 8 or more people live in a small room without windows. Also malnourishment was a problem. We gave health education regarding the determined problems and booked good results.
Olufemi Akintayo I became president of the Student Net working Organization (SNO) in my university in October 2009. The main goal of our SNO activities is to promote health care, improve quality of health care delivery, reduce infant morta lity rate and fight against diseases like HIV and cholera. Our university is situated in a rural environment and we are working together with the 10 communities surrounding the university. We want to improve their health care and make our contribution to achieve the Millennium Development Goals. We believe we can have an impact on people’s lives in the community. Currently about 100 students are involved. We have 5 groups taking care of different communities. We visit them about once a month in order to insure sustainability and continuity. In one community we found there was a high prevalence of diarrhea with a high mortality rate. In this community we
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We are supported by our professors; they give us directions and help to put our ideas into practice.
The main goal of our SNO activities is to promote health care, improve quality of health care delivery, reduce infant mortality rate and fight against diseases
We also work together with health care providers in the community. The biggest challenge of our projects is sponsorship. All the financial resources are coming from the students own pocket, there are no resources from the university. Another challenge is the language; in Nigeria we speak more than 400 langua ges! Whenever we visit a community we first make contact with the eldest person and afterwards we use an interpreter to facilitate communication. The communities appreciate our work a lot. They know that the education we give them about good personal hygiene, drin king clean water and keeping the environment neat reduces sickness! In the future we will continue with our community projects depending on the needs. After my studies I want to work with an international organization and I think it’s very important to get the students involved because they are the leaders of tomorrow! Like this we can put 15 by 2015 into action! Olufemi Akintayo, Medical Student, 5th year, SNO President of Igbinedion University, Agege, Nigeria Email: luvmioak@yahoo.com
students’ column students interview How do students from all over the world perceive the educational programme at their Faculty, or the educational system in their country? How do they see the future, for their nation and for themselves? And what changes would they make, if they had the chance? We wanted to know. Therefore we ask a student five questions.
The Big Five Tim Joye ties. There’s a huge problem of meals and rooms for students, and the cost of student life is becoming increasingly expensive. As a democrat, I think I would focus more on these problems, because I think income or wealth cannot be a barrier for higher education.
This interview was conducted with Tim Joye, 1st master medical student at Ghent University, Belgium
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4. What would you change if you were Dean of your Faculty? Or on a national level if you were Minister of Education in your country? Right now, in my Faculty, I think the main problem for students is not so much content or level of education, but rather the price and amount of student facili-
If we really want to improve global health, we have to look at and try to change the social determinants
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3. What is your opinion about innovative educational formats like problem-based learning (or the education format that your own Faculty uses)? It’s a very good concept. We have had
‘tutorials’ for several years already and at first the practical part still needed some improvement; not all students were as happy with the initiative. But thanks to our student representatives and continuous adaptation, it was optimized and became a welcome innovation in our curriculum. Students are stimulated to learn by themselves and you feel this sticks longer in your memory. And you know what I like most about it? Students have to work together and exchange information, while the competition between students is growing and I notice there’s a lot less sharing between students in normal lectures for example.
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2. Can you as a student influence the educational program of your Faculty? Yes, very. We have our own student workgroup that works on this. They have representatives from year 1 to 7 and address worries and complaints to the right committee. Moreover, they continuously discuss how they can improve our educational program and are allowed to make recommendations to adapt it. For example, this year we are working on a proposition for ‘global health’ in the curriculum. This is already very present, but we feel it can still improve a lot.
Tim Joye (21y)
5. Imagine if you were to choose: a practice in a town or in a rural area. What would you choose and why? I think I would prefer the city. If we really want to improve global health, we have to look at and try to change the social determinants. I really want to contribute to this process and I think this is harder to do in a small, rural village. You need a big community to mobilize people and struggle for the right to health, together. I don’t want to focus on one community.
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1. Why did you choose to study Medicine? As a youngster, science wasn’t really on my mind; I loved to read and learn more about history and philosophy. During my secondary school I followed 6 years of Latin and old Greek and read Homer and Cicero. But when I was 17, I saw the movie ‘Motorcycle Diaries’, about the youth of Che Guevara as a medical student, and I decided to become a doctor. I wanted to help people and what is a better profession than medicine to do this? So then I started reading manuals of physics and chemistry, because in Flanders there’s an entrance exam, and I passed!
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Member and organisational News MESSAGES FROM THE EXECUTIVE COMMITTEE To learn more about the personal believes, motivation and goals of our EC Members, we have invited Bishan Garg to share his thoughts with us.
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EC Intelligence: Dr. Bishan Garg These words of wisdom mean no less today than in the era of suffering and self when they were quoted; thoughts of the alike have been the foundation of service to mankind. Gandhiji, the Father of the Modern India, envisaged to provide for the poor and suffering in the land of villages. Borrowing on the same principles, we at the department of community medicine, Mahatma Gandhi Institute of Medical Sciences (MGIMS) conti nue to make humble efforts to move forward on the same ideology. We have taken the responsibility to inculcate young medical students the qualities of austerity, humility and compassion towards the underprivileged & to create a rural service orientation amongst medical undergraduates. We are advancing on a path to provide meaningful education to medical students to develop a holistic insight into the health problems of rural communities that may be fruitfully utilized for the service of the nation. We have been lucky to have a trail left by
“There is no higher religion than human service. To work for the common good is the greatest creed.” Albert Schweitzer
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Dr. Sushila Nayar, the Founder Director of MGIMS, to tread on while we work towards accomplishing her goal of seeing a healthy India in its villages. Lately I have been involved in improving Public Health education in India. In India as well as in other developing countries, the curriculum for public health education was designed several decades ago and very few changes have been made since then. The time has arrived when public health education must address societal values such as Human Rights, Democracy, Equity, Social Justice and Gender & Ethics. The main challenges for public health institutions have been to reflect social responsiveness/social accountability, developing quality assurance system, keeping pace with advancing technology & developing an interface with the community & health care delivery system. An urgent action is required to meet health needs in an ever changing scenario in the era of globalization & market economy. It requires coordinated input from policy makers, health professionals, academic institutions & communities. The inspiration to take up such work came through the exposure to The Network:TUFH activities. I learned a lot attending the annual conferences of the Network: TUFH during the last 15 years & tried to build up the component of social responsiveness in the curriculum of MBBS as a member of the curriculum revision committee of the Medical Council of India & am also currently developing a strategy to improve the functioning of the department of community medicine with WHO South East Asia regional office. I have been instrumental in promoting community-oriented research & secured 35 research projects from various funding agencies in last the 10 years are testimony to it.
Dr Bishan Garg The Network: TUFH provided me inspiration to take up all these research projects. The NGOs working for health in Maharashtra were not united, so I initiated the Voluntary Health Association of Maharashtra (VHAM) in November 1997 with 35 NGOs members present. More and more NGOs are joining the VHAM, which is helping them in their capacity building. For the last few years I have also been instrumental in promoting epidemiological skill development through NGOs utilizing the platform of Voluntary Health Association of India & Maharashtra. Again every meeting of The Network: TUFH provided me inspiration & insight to work for social justice & advocacy on priority health issues through NGOs. I further wish to promote the community based teaching & research in my capacity of Executive Committee member of The Network: TUFH through the member institutions and. at the same time, through the 4,500 member NGOs of the Voluntary Health Association of India (VHAI) who are working at their full potential to make health a reality for rural & marginalized populations in my capacity as President of VHAI.
Dr Bishan Garg | Executive Committee Member; Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India Email: bsgarg_ngp@bsnl.in
taskforces
Women and Health Taskforce Update
TThe 2010 Conference in Kathmandu, Nepal was one of the most successful yet for the Women and Health Taskforce (WHTF).
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The WHTF is busy planning for the upcoming Network: TUFH conference in Graz, Austria. In addition to publishing the 3rd Edition of the WHLP, we are excited to announce that in September 2011 the WHTF will hold elec-
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The next steps for the development of the WHLP include the addition of case studies to the first nine modules (out of nineteen) in the next edition, forging strategic partnerships for publishing and dissemination, and exploring the possibility of launching the models on an interactive online platform.
If you are interested in joining the WHTF listserv, running for a position on the Mana gement Committee, contributing case stu dies or new modules to the WHLP, or are interested in learning more about microgrants and fellowship opportunities, please contact WHTF@ghets.org.
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The strength of the WHLP is its collaborative authorship and adaptability to individual institutional needs. Taskforce members have integrated WHLP modules into the curriculum of their home institutions in a variety of ways including as part of core or supplement coursework, extra credit workshops, and continuing education courses for faculty and community health providers.
The WHTF would like to thank Global Health through Education, Training, and Service (GHETS) for their support in funding travel fellowships, micro-grants, and the continued development of the WHLP. We would also like to thank Taskforce members Professor Judy Lewis, Director of the Global Health Program at the University of Connecticut’s School of Medicine and Dr. Deyanira de la Paz González de León Aguirre of Metropolitan Autonomous University in Xochimilco, Mexico for their role as editors of the 3rd Edition of the WHLP.
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• Increasing the breadth and depth of health professions training focused on the health related challenges facing poor women in developing countries at medical, nursing and allied health sciences schools throughout the developing world • Encouraging students and health sciences schools to partner with women’s groups and community organizations in an effort to organize grassroots solutions to women’s health challenges • Creating new spaces and strengthening existing support for addressing women’s health and human rights at health sciences schools in developing nations • Facilitate local, regional and internatio nal linkages between practicing healthcare providers, community groups and
The creation, distribution and implementation of the WHLP is part of a broader effort to encourage open dialogue about important gender-related health issues, such as contraception, unwanted pregnancy, unsafe abortion, and violence against women. To date, the WHLP has been downloaded in over 100 countries worldwide.
tions for the WHTF Management Committee. The committee consists of six members who meet by phone conferencing through the year to promote and manage the activities of the Taskforce. The WHTF Management Committee is currently chaired by Nighat Huda, Director of Medical Education at Bahria University Medical and Dental College in Karachi Pakistan. Ms. Huda was elected Chairperson of the Network: TUFH at the Nepal meeting. We congratulate her and wish her well in this important role. The WHTF is proud of her work and the recognition of the WHTF in Network leadership - the current and past chairs of the Network: TUFH have also been Chairs of the WHTF.
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Highlights include a pre-conference workshop, thematic poster sessions, miniworkshops (Conducting Community Level Maternal Mortality Reviews and working towards the achievement of MDG 5), and a special event – a film festival and discussion about sex trafficking in Nepal and Southeast Asia sponsored in partnership with Global Health through Education, Training, and Service (GHETS) and Pro Public, a local Nepali non-profit advocacy organization. Central to the pre-conference workshop and WHTF plenary meetings was the continued development of the 3rd Edition of 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). The collaborative curriculum, authored by WHTF members from around the globe, seeks to improve the accessibility, availability, and quality of healthcare for women and girls by
university faculties and staff in support of the health and human rights of poor women • Improving access to high quality, appropriate healthcare for women in lowincome communities in developing countries through the training and deployment of health professionals prepared to serve as well-informed caregivers and advocates for women’s health • Serving as a forum for women’s health advocates from developing countries to shape regional training agendas suppor tive of women’s health and human rights
Ms. Nighat Huda | Chairperson, Pakistan Email: nighathuda@zu.edu.pk
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Member and organisational News Interprofessional Education (IPE) Taskforce
taskforces
Social accountability and Accreditation (TFSAA)
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Workshop Accreditation and Social Accountability: medical schools’ role in social change in November 2010 in Kathmandu The workshop was well attended by participants from around the world and provided very fruitful discussions and ideas for the implementation phase of the Global Consensus on Social accountability of Medical Schools. A meeting of the TFSAA held during the same conference drew a further 20 participants who formed a network in advancing the translation of the Global Consensus into action at the regional and national level. The Chair attended The Second Global Forum on Human Resources for Health (HRH) in Bangkok in January 2011 and further advanced the evolving regional strategies for implementation. While much of the strategic development will be in the hands of the Steering Committee of the GCSA and its subsequent expression as a Global Task Force on Social Accountability, the TFSAA will be an ongoing source of consultation and reflection for the broader strategies that were outlined in our founding plan in Kampala. The ongoing work with the World Federation of Medical Education (WFME) in advancing the review of WFME Global Standards will be of particular interest to TFSAA members in the next year and your active involvement is sought.
Implementation Conference in Yvoire, France June 13-15, 2011.
As regards the implementation of the GCSA process the momentum continues to build as the translations of the document proceed apace (English, French, Spanish and Russian completed, Arabic on the way) and increasing numbers of requests come in for participation in various venues, most recently in Doha in December. A working group is advancing in planning a FAIMER supported initiative in South Africa aiming towards practical appli-
2. The coordination of regional activities such as the creation of the Global Task Force (GTF), and the bridging of the activities of AMEE, Africa, SEARO, the French Deans, theNET, the WFME initiative, etc in order to respond to expressed need, effect coordinated action on accreditation systems and deploy practical instruments. Clearly these are not mutually exclusive streams and, indeed, properly managed, are both necessary and potentially synergistic.
cation of the GCSA Consensus and the development of “centers of excellence” for explo ring and applying the implications of the GCSA in the African context but with intended broad application of the lessons learned. All of which underscores the importance of the strategic planning focus a planned Strategic 28
The meeting will be strategic planning exercise to develop: 1. A 5 year plan for rolling out the GCSA for implementation across the various regions and nations 2. Identification of membership and development of the Global Task Force envisioned in East London 3. A resource development strategy to support 1 and 2 4. Next steps for initial development of test sites, tools, evaluation and partnerships for implementation 5. Priority areas for use of current implementation funds Future actions will involve two overarching streams of activity: 1. The building of practical instruments/ experience for the implementation and evaluation of the CPU model as an expression of the GCSA Consensus. The FAIMER related initiative in South Africa and some of the work with the French Deans may be examples of this.
Bob Woollard and Charles Boelen Co-Chairs Email: woollard@familymed.ubc.ca / boelen.charles@wanadoo.fr
The Network:TUFH conference in Nepal this year provided the forum for IPE enthusiasts to get together and present workshops and poster presentations. Contributors on the work being undertaken in interprofessional education included the following countries: Indonesia, Kenya, Malaysia, Philippines, South Africa, Sweden, UK, USA. It was clear in a number of these presentations that the WHO (2010) Framework for Interprofessional Education and Collaborative Practice www2.rgu.ac.uk/ipe/WHO_report_ Interprofessional%20Ed%20Sep2509.pdf is being implemented. The task force would like to encourage the sharing of good practice as colleagues progress this work. Over the forthcoming year the task force has agreed to: • Encourage more abstract submissions for the conference in Austria 2011 and Ontario 2012 • Revise the IPE position paper • Provide an update via email to IPE task force members each month • Share IPE reference information and evaluation tools where possible • Encourage publication, particularly in “Education for Health” www.the-networktufh.org/publications_resources/ educationforhealth.asp If you have appointments in IPE which you would like to ensure the taskforce is aware of, please let us know. One such post is for a Professor of IPE at Curtin University Perth Australia and further details can be found at: www.curtin.edu.au
Professor Dawn Forman | Chair of the taskforce IPE Email: dawn@ilmd.biz Left : Dr Lynda D’Vray St Georges, University of London. Middle: Professor Dawn Forman representing Curtin University, Australia. Right: Dr Johanna Dahlberg Linkoping University, Sweden
re-assessing full members Since 1998 Full Member Institutions (FM) are being re-assessed on a regular basis. As part of this re-assessment procedure FM perform a self-evaluation report. In this section you find summaries of self-evaluation reports. The FM in question have recently been awarded continuation of their Full Membership.
Faculty of Health Sciences Linköping University Improving health by nurtu ring knowledgeable professio nals
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Problem-based Learning Most FHS study programmes have been employing Problem-based Learning (PBL) in all semesters for over 20 years now.
Implementing PBL is an ongoing innovation process. The FHS is constantly scrutinizing and developing PBL for all the different study programmes. Recently, for instance, all tutorial problems were reviewed and web-based multimediaenhanced scenarios were introduced.
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• a common introductory course on health, ethics and learning; • a common course on sexology; and • a common placement period on the socalled student ward.
PBL endows students with the utensils to approach learning in an inquisitive manner, favours the acquisition of self-directed learning skills, and moreover provides longterm training in teamwork. Additionally, PBL is an excellent tool for facilitating the acquisition of life-long learning skills which are needed in order to keep pace with new professional knowledge and developments.
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To achieve this goal, the FHS employs an educational method that emphasizes a holistic approach to health, communityoriented education, integration of theory and practice, problem-based learning, early patient contact and professional and interprofessional development. The programme contents are chosen in such a way as to represent the most important health issues in the community and to reflect dif-
Interprofessional Learning The FHS was the first in the world to deve lop a complete interprofessional curriculum for all programmes. This curriculum consists of three parts:
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Mission Statement The mission of the FHS is to promote better health through excellence in education and research. The FHS aims at fostering graduates who are knowledgeable professionals and aware of differences and inequalities in health in society and who are prepared to take on responsibility and leadership for improvement of health on many different levels.
Community Orientation The FHS students learn by means of various different community-based practical training periods and assignments. Since its inception, the FHS has worked in close collaboration with the surrounding community mainly through the county council who is the main provider of healthcare in the region. A common clinical skills training centre, Clinicum, has been established. Students and professionals use the same well-equipped facilities to learn and deve lop professional skills and to learn how to work in teams. Students also work together with healthcare staff on continuous quality improvement projects. This collaboration also includes agreements and funding for research on priority health problems.
promote better health through excellence in education and research
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The Faculty of Health Sciences (FHS) at Linköping University encompasses the Medical programme, programmes for Nursing, Occupational Therapy, Physiotherapy, Speech and Language Pathology, Public Health Sciences, Medical Education, and Biomedical Science. Enrolment figures reflect a number of 3000 students in total. The FHS also engages in a broad gamut of scientific activities, ranging from basic biomedical and experimental clinical research to applied clinical studies and research within the fields of nursing, physiotherapy, speech and language pathology, occupational therapy, medical pedagogy, and public health.
ferences in health, both in our society and globally. All FHS study programmes contain humanistic elements, communication skills training, ethics, gender issues, philosophy of science and other content that aims to promote the maturity and personal development of the student.
Inger Sandström / Faculty Coordinator, Faculty of Health Sciences, Linköping University, Sweden Email: inger.sandstrom@liu.se
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Member and organisational News re-assessing full members
The Istituto Superiore di Sanità (ISS) Rome, Italy
NEWSLETTER NUMBER 01 | VOLUME 29
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Healthy life style promotion and disease prevention The Istituto Superiore di Sanità (ISS) or Superior Health Institute is the main Italian institute of technical-scientific research, control, advice and continuing education in public health. Founded in 1934, it has become the technical and scientific body of the Italian National Health Service (NHS) since 1978. Until recently, it was administered by the central Government as a state-owned public institution, in a similar fashion as are the other main research institutions in the country. Our Mission The ISS’s mission is to elevate the health status of Italian citizens on a national level through efforts in the field of healthy life style promotion and disease prevention. In accordance with its institutional mission, the ISS collaborates with the National Health Service accredited entities, ranging from the local agencies that provide services to individuals and communities to the bodies of management and coordination on a regional and national level that moreover fall under the supervision of the Ministry of Health. International Collaboration The ISS maintains relations with similar institutions on an international level, such as the Ministries of Health in China and the Republic of South Africa, and various public health institutions in Canada, Egypt, Liberia, Libya, Jordan, Iraq, Uganda, Swaziland, the Balkan region, China, and the United States of America. In addition to this, the ISS has worked in support of the Organisation for Economic Co-operation and Development (OECD), the EC, several specialised agencies of the United Nations, the Southern African Development Community (SADC), and the World Bank. The ISS’ Presidential Office (Ufficio Relazioni Esterne or External Relations Office), which 30
has direct ties with The Network: TUFH, is responsible for educational institutional activities, external relations (with NHS structures) and international collaboration.
vative didactic methods, such as PBL applied to distance learning, with the use of forum discussions, virtual classrooms and other interactive e-learning resources.
Continuing Education The ISS provides opportunities for certified continuing education to health professio nals on a national and international level, also by means of distance learning. The vast
Istituto Superiore di Sanità, Rome, Italy Email: manila.bonciani@iss.it
majority of Italian participants of the ISS continuing education activities dedicate almost 100% of their time to NHS community-based activities (permanent staff of NHS). The ISS educational institutional programme is built on the current National Health Plan and the Priority Educational Objectives as defined by the Conference State-Regions, based on epidemiological data and priorities set by local networks and validated by the Parliament. During 2003-2008, all ISS Laboratories and Services contributed at different degrees and levels to the institution’s community orientation through continuing education, research, service and control activities. The ISS offers short courses on community orientation, Community-based Learning, and Problem-based Learning (PBL). PBL has been disseminated as a didactic method in various NHS structures for their personnel CE. The ISS has secured the PBL know-how and has been devoted to the implementation of a University post-graduate course for Training of Trainers in the Health sector. Moreover, the ISS planned different post-degree courses on health services management and health promotion in collaboration with different Italian public and private universities. Distance learning The ISS is also managing the distance lear ning component of a Masters’ course in Clinical Governance for Internal Medicine, focused on continuity of healthcare, in collaboration with LIUC University, Castellanza and the Italian Federation of Internists. All these post-degree courses make use of inno-
New Members Full Members • University of KwaZulu Natal, Cape Town, Republic of South Africa • Jazan University, Jazan, Saudi Arabia Associate Members • University of Antwerp, Antwerp, Belgium • Curtin University, Perth, Australia • ICHO, Leuven, Belgium • European Forum for Primary Care, Almere, The Netherlands Individual Members • Ms. Valerie van den Eertwegh, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands • Mr. Ehigie Enoma Perema, Faculty of Occupational Health and Safety, Pervas International, Benin City, Nigeria • Dr. Judy Lewis, School of Medicine, University of Connecticut, Farmington, CT, United States of America • The Foundation for Advancement of International Medical Education and Research (FAIMER) sponsored 108 of their fellows to become Individual Member of The Network: TUFH. With this collective membership, FAIMER and The Network: TUFH want to continue strong collaboration and mutual assistance. We welcome all FAIMER fellows to the Network: TUFH and hope to meet many of them at upcoming meetings of The Network: TUFH.
Member and organisational News
Member and organisational News
INTRODUCING MEMBERS Problem-based leArning and community-based education
European Forum for Primary Care (EFPC) Strong Primary Care (PC) produces better
of stakeholders in the field of Primary Care:
health outcomes against lower costs. That is
• the health care field; this includes practi-
the briefest summary of available scientific
tioners from the different professions: physi-
evidence. By promoting strong PC the popu-
cians, nurses,social workers, physiotherapists,
lation’s health can be improved. Strong PC
pharmacists,dentists and several others. • health policy makers, • the producers and evaluators of (health) care information: universities and other research groups.
does not emerge spontaneously. It requires appropriate conditions at the health care system level and in actual practice to make PC providers able and willing to take responsibility for the health of the population under
ments for organizing primary care. There is a
More information needed? Please have a look
their care. A key element is effective collabo-
strong need to collect and share information
at our website: www.euprimarycare.org.
ration with well-organized secondary care.
about what structures and strategies mat-
Other guiding principles are: relevance, equi-
ter. This is a support to practitioners but will
ty, quality, cost-effectiveness, sustainability,
also provide the evidence to convince policy
patient-person-population centeredness and
makers at different levels that PC needs to be
innovation.
strengthened.
Everywhere in Europe the process of streng
The European Forum for Primary Care is mul-
thening PC is ongoing, with a large diversity
tiprofessional and brings together interested
in the way PC is organized. Therefore, Europe
parties from many European countries. The
is in a sense a laboratory landscape of experi-
aim of the Forum is to connect three groups
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Diederik Aarendonk | Forum Coordinator Email: d.aarendeonk@euprimarycare. org
N E W S L E T T E R newsletter
Curtin University Australia evaluation of innovative models of health
students whose education is based on the tri-
& Speech Pathology, and Public Health. The
care service delivery. Initiatives integrate the
ple i curriculum which emphasises our gradu-
Faculty recognizes the need to change the
three cornerstones of practice, education and
ates having intercultural/Indigenous/inter-
way health professionals are educated to
research.
national awareness, being industry ready,
prepare them for the ever-changing health
and undertaking interprofessional learning
and social demands worldwide.
The Faculty vision of being International lea
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experiences.
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force development and the development and
Work, Pharmacy, Physiotherapy, Psychology
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an institute of technology, has over 42,000
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Our university, initially established in 1966 as
ders in Interprofessional Education, building new health workforce models for the future
the Faculty’s key strategies. The focus is on
is fast being realized with staff presenting
mately 8,500 students, 490 academic
providing practical, integrated and inter-
at a number of national and international
and 275 professional staff organized into
professional approaches to enhance health
conferences, the Faculty being awarded a
7 schools: Biomedical Science, Nursing &
and social care, organizational and work-
national Teaching and Learning award for its
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Interprofessional Education (IPE) is one of
The Faculty of Health Sciences has approxi-
international interprofessional program “Go Global”, and recent success in obtaining over $20 million in government grants to increase the range and number of interprofessional fieldwork placements available to health science students at Curtin.
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Member and organisational News
The Network towards unity for health
INTRODUCING MEMBERS
N E W S L E T T E R
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Department of General Practice University of Antwerp, Belgium
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The Centre of General Practice was founded in 1972. Now it is part of the Department of Primary and Interdisciplinary Care of the Faculty of Medicine of the University of Antwerp (PICA). PICA also encompasses the following units: Palliative Care, Studies for People with Disabilities, Geriatrics and Skills Laboratory Training. More than 50 researchers and teachers are working within the department. Through education in the undergraduate curriculum, specialist training and continuous medical education, we contribute to the highly valued academic medicine in Flanders. There is an emphasis on interdisciplinary care of acute and chronic primary health care. PICA offers a broad spectrum of expertise through a variety in research areas (medical education, diabetes mellitus, respiratory tract infections, palliative care, care for the elderly, sexual health, EBM) using both quantitative and qualitative research methods. PhD projects in and outside the country assist in deepening and enlarging this expertise. We publish in national and international journals. There is an intensive participation in a network of various organizations and research groups. An innovative undergraduate curriculum In 1998, we played a key-role in the deve lopment of an innovative curriculum in the University. We now teach integrated blocks, with a focus on problem-oriented learning, instead of specialty-oriented teaching. We
GP department Antwerp
are involved in the learning activities in all 7 years of the curriculum. Besides dedicated modules of general practice in year 3 and 5, we teach in blocks and focus on `skills’, `scientific work’ and `integration’.
Vocational training Vocational training starts in year 7 of the core curriculum. In the first semester students do clinical work in hospitals and General Practice (GP). In the second semester we offer theoretical weeks at the university and clinical training in our GP training network. Ample time is available for small group work and discussion, focusing on topics like care for family and children, terminal care, working in teams, acute medical care, chronic illness, prevention and health promotion and vague complaints. Multidisciplinary courses and meet-theexpert sessions are offered. Students perform group work around case studies and the necessary literature research involved. Students have to manage their own portfolio and learning agenda. An electronic lear ning environment is offered as an interface between the department, the students and the GP training network. For the assessment we are using a knowledge test, brief clinical examinations, a portfolio, small working groups and an OSCE. This prepares our students to start in the full time GP training in the 8th and 9th year. For further information: www.ua.ac.be/ chaenglish
Newsletter Volume 29 | no. 1 | August 2011 ISSN 1571-9308 Editors: Julie Vanden Bulcke, Kaat De Backer Language editor: Amy Clithero The Network: Towards Unity for Health Publications UGent University Hospital, 1K3 De Pintelaan 185 B-9000 Ghent, Belgium Tel: (32) (0)9 332 1234 Fax: (32) (0)9 332 49 67 Email: secretariat-network@ugent.be www.the-networktufh.org Lay-out: Anja Peleman Print: Drukkerij Focusprint
INTERESTING INTERNET SITES The Network: TUFH Interactive - Recommended Internet sites www.the-networktufh.org/publications_ resources/interactive.asp National Domestic Workers Movement http://ndwm.org/ Master in health informatics http://mastersinhealthinformatics. com/ Education Project, Nepal www.phulelischool.org