NEWSLETTER Newsletter Volume 31/no. 2/December 2013
In this issue, among others: • Community Site Visits • Interview Mechai Viravaidya • Ayutthaya Highlights
Editorial Dear readers, As somebody suggested to me during this year’s conference we shouldn’t call this newsletter a conference report because the word “report” gives the impression that it’s something boring. I think everybody who participated at the conference agrees that the contrary is true! So we decided to call it “Conference Flashes”. Inspiring key note sessions, interesting poster sessions, innovative workshops and eye opening community site visits! Ayutthaya 2013 had it all! As we were discussing with some people about what does the network: TUFH really stands for, one of our wise eminences said: ”it’s all about the mutual learning.” Take the opportunity to learn from different countries, from different continents, and from different experiences. Take comfort in the fact that they are battling the same struggles at the other side of the world and come up with a solution together! Well, I couldn’t agree more! Enjoy your reading! Julie Vanden Bulcke, Editor
In the Newsletter we refer to The Network: Towards Unity for Health as The Network: TUFH. The Tufh nieuwbrief dec 2013.indd 1
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Contents Message from the Secretary General
Tradition Needs Future
Conference Flashes Annual International Conference
Looking Back to Ayutthaya and Looking Forward to Fortaleza! Ayutthaya Poster Winners
AIDS Temple and Saraburi Hospital Thanyarak Princess Mother National Institute for drug abuse treatment Banphaeo Hospital
Students Perspective of Ayutthaya Conference
Community Site Visits
Impressions Students Report
Great Stories from Great People
Ayutthaya Highlights
Mechai Viravaidya
Stella Mini Grant
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Foreword
Tradition Needs Future During the Annual Conference of The Network: TUFH, participants could enjoy the hospitality of our Thai host. The events at the Conference brought an image of integration of tradition on the one hand and an orientation towards the future, striving at tackling the new challenges for health (care) on the other hand. The health system in Thailand made an important contribution to Universal Health Coverage. Illustrative of this were the site visits involving Primary Health Care-Centers. Our group visited the Regional Hospital in Ayutthaya where a dynamic director explained how the hospital responds to the needs of the local population. To our surprise, the hospital director accompanied us to visit the local health center, explaining that the Regional Hospital could not fulfill its tasks if there was not a well-organized and strong primary care system. A committed family physician explained to us the organization of the health center, the preventative, curative and rehabilitative programme, and the outreach to families most in need. All participants were very much impressed by the report and the way the health center responded to the “big flood”. The staff of the health center knew where the vulnerable people were located in the community and did home visits by boat during several weeks in order to support families and provide the care needed. But, in Thailand one has to “expect the unexpected”: the over 250 participants (coming from 40 countries) were very much impressed by the beauty of dance and music at Loi Krathong on the 17th of November. The festival goes back to a 700-year old tradition at the kingdom of Sukhotai, celebrating the end of the rainy season. The conference enjoyed the friendly atmosphere of both Thai hospitality and The Network: TUFH conviviality. The usual intensive exchange and interaction took place at the thematic poster-sessions, didactics, plenary sessions, mini-workshops… The participants could easily find their way. Thanks to the presence of Dr. Erica Wheeler, The Network could discuss the WHO-recommendations on “Transforming and Scaling Up Health Professional Education and Training”. Within The Network: TUFH, a taskforce will continue to work on the implementation of the recommendations under coordination of Sue Berry (NOSM). The local host, Princess of Naradhiwas University, invited the conference participants to the “Graduation Ceremony” festivities, celebrating the first 12 graduates of this medical school that recruits predominantly in the underserved southern areas of Thailand. The students, not only demonstrated their links with the local traditions, but also the social accountability through their commitment to serve the population they were recruited from. This University, supported by the Department of Family Medicine at Rockford, University of Illinois (USA), has the ambition to bring quality health care to populations living in rural and remote areas. The feedback from participants was unanimous: appreciation, respect and gratitude for all the opportunities to explore new perspectives in an historical environment. Thanks! Jan De Maeseneer, MD, PhD; Secretary General The Network: Towards Unity for Health Email: jan.demaeseneer@ugent.be
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Conference Flashes Annual International Conference Looking Back to Graz and Forward to Thunderbay It is actually true that The Network: TUFH is a living species. All year round we continuously breathe the values of The Network: TUFH. Every year when we gather together and our thoughts are in a state of natural flow, lightning fast and effortless. Our discussions electrify the atmosphere. Afterwards we spread the message about what we learned and apply those ideas locally at our institutions. We can become stronger through the contributions of engaged members. We can grow by reaching out to new people and make them part of The Network: TUFH. This year the Annual Conference was hosted in the wonderful city of Ayutthaya. The conference brought together 300 health care workers from all over the world. The co-hosts were the Princess Naradhiwas University and the University of Illinois at Rockford. Thank you for all the hard work making every part of the conference a good experience for the participants. We got
Maarten Declercq, Executive Director, The Network: TUFH Email: maarten.declercq@ugent .be
energized by the Thai hospitality, excellent cuisine and Loi Krathong festivities. Most memorable was the show put together by the students of Princess Naradhiwas University. Next year, the conference will be held in Brazil. The Universidade Federal do Ceara welcomes you to join the 2014 Annual Conference in Fortaleza November 9-23, 2014. The theme for the conference is “Strengthening Health Professions Education to Improve the Health in the Communities”. Again, we are partnering with several other local and international organizations for realizing this event. Many thanks to everyone who put their shoulders into making this conference a success. See you next year in Fortaleza!
Executive Director and Editor burning a candle at the Loi Krathong festival and wishing for a smooth conference
Ayutthaya Poster Winners Every year before the conference begins, the Executive Director of the Network, Maarten Declerq, asks conference registrants if they are interested in participating on the poster evaluation committee. It is fabulous to see how many people are willing to give their time and expertise in this endeavor! As Chair of the Committee, I was asked to put together a team of 6-8 persons and devise a method for the review. Not knowing the participants, I did my best to ensure there was a balance in gender and representatives from a variety of countries. This committee deserves a huge thank you for their work: - Mona Ghaly – Egypt - Angela Maria Hernandez Pardo – Columbia - Thomas Chacko – India - Cynthia Arndell – USA - Y.S. Sivan – India We decided to divide the poster sessions based upon interest and expertise. We individually attended between 2 - 4 sessions and reviewed posters based upon a rubric given to us by the Network. On the final day, we met as a group with our number 1 overall
and number 1 student poster selections. There were a few with tied scores and so we collectively viewed the posters in the main display area. After reaching a consensus agreement, the final winners were selected: OVERALL: Building Communities of Practice for Effective and Sustainable Health Systems Knowledge Translation: the Knowledge Translation Network (KTNet) for Africa Approach First Author: D. Walugembe Co Author: S. Kiwanuka School of Public Health, Makerere University, Kampala, Uganda STUDENT: A Risk-Factor Profile for Chronic Lifestyle Diseases in Three Barangays of Sabangan, Mountain Province First Author: HG Dulnuan Co-authors: E. Baldo-Soriano, JA. Dulawan and JD Mier College of Medicine, University of the Philipines Manila, Manila, Philippines
CONGRATULATIONS EVERYONE! Amy Clithero, University of New Mexico Family & Community Medicine, USA Email: AClithero@salud.unm.edu
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Conference Flashes Community Site Visits Banphaeo hospital Banphaeo hospital is an autonomous, non-profit hospital that serves a population of 91,900. It serves 19 community health centres in a relatively rural area to the south west of Bangkok. The hospital was founded in 1970 with land for building, construction budget and medical equipment donated by the community. From its original 30 beds, the hospital has grown to 300 beds with all the equipment one would expect to find in a modern hospital. It includes in its core values client-centeredness, continuous quality improvement and responsibility for community and society. Its community actively participates in strategy setting and funding-raising and ensuring that hospital services respond to community needs. Its board includes members from the community. As an autonomous public organisation, the hospital has the freedom to develop community responsive strategies and programmes. An example of this response is its child development centre, a service not usually provided by hospitals, which was demanded by the community. To improve community access, the hospital provides outreach services around the re-
gion. Also, responding to the high rate of cataracts in a community with many agricultural workers, it developed mobile cataract services. It now provides them to the whole of Thailand and, occasionally, to neighbouring countries. Also, in collaboration with other services, the hospital is setting up disease prevention and health promotion programmes. As a result, it is recognised by the Ministry of Public Health as a Health Promoting Hospital. Unfortunately, Bangkok traffic being what it is, the visiting group arrived later than expected. Nevertheless, after a warm welcome, the hospital’s Medical Director presented the hospital, its history and its service provision. The presentation elicited many questions and discussions which had to be curtailed to allow time for the excellent lunch which preceded the tour of the hospital. This included a visit to its well-equipped intensive care unit, its child health clinic, and other out- and inpatient services, including the centre for Thai traditional medicine and spa. All units were welcoming and keen to show off their services.
Denise Donova, MD, UniversitĂŠ de Sherbrooke, Canada Email: Denise.Donovan@USherbrooke.ca
Group photo in front of the hospital
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Conference Flashes Community Site Visits AIDS Temple and Saraburi Hospital About an hour drive away from Ayutthaya we arrived at the “Wat Pra Baht Nampoo”, also known as the AIDS temple, situated in Lopburi District at the foot of the Nampoo hill. This temple was founded in 1992 by monk Phra Udom Prachatorn as a home and caring facility for full blown AIDS patients. More than one million Thais are affected with HIV/AIDS and the rate was rapidly increasing 14 years ago. Ten of thousands of children have caught AIDS from their mothers and almost all of them would soon die. Those who survived became orphans and some of them were taken in by the temple. Also terminal stage AIDS patients, homeless patients, elderly persons who are left without support are welcomed in the temp le.
Patients performed a dance at the AIDS Temple
Once a week a doctor visits the temple, all the other care is provided by monks and volunteers. One part of the project since the beginning is focusing on caring for the end stage AIDS patients, but today another part is focusing on reintegration in society by caring for patients who are well enough to take care of themselves, providing medical care and education for them and try to help them live a normal live. Upon arrival we first watched a video about the project followed by a very nice Thai Dance by some of the facilities patients. Afterwards we took a walking tour through the temple where we saw the housing project, the wards with very sick patients and also the morgue. Then we drove to Saraburi Regional Hospital. While we were enjoying a delicious lunch offered to us by the hospital, we listened to a short presentation on the hospital and the Thai health care system. Thailand is divided in 12 health areas and Saraburi is part of the 4th one. Saraburi hospital is a tertiary hospital with 139 doctors and 700 beds. In the OutPatient Department (OPD) there are about 2,000 consultations per day. It’s a specialized centre, they call it a five disease centre (cancer, heart, trauma, stroke and newborns). People are referred there by Primary Care Units (PCU) situated all over the area. These PCU’s are managed by one nurse and 20 village health volunteers. One doctor is responsible for more or less 6 PCU’s.
OPD Waiting room
To finish we took a walk through the hospital and saw the pharmacy, OPD and emergency department! We had a wonderful day and gained great insight into the Thai Health Care system.
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Conference Flashes Community Site Visits Thanyarak Princess Mother National Institute for Drug Abuse Treatment Thanyarak is one of a handful of regional drug treatment hospitals in Thailand. It has a network of six affiliated smaller hospital branches in their region. The visiting Network group received an on-bus and in-hospital orientation lecture and running commentary from Dr. Song K. Piyaka who is an Addiction Specialist at Mahidol University. His staff reviewed the history of drug abuse in the country along with vital statistical information. While alcohol and smoking are the number one and two leading abusable drugs in Thailand, they are legal. Alcohol was introduced about 6,000 years ago, opium came ~200 yrs ago, and Methadone about 50 yrs ago. Today, there is a growing epidemic of methamphetamine (ICE , yaba, etc). This is accompanied by a growing prevalence of co-existing conditions among drug users, for methamphetamines induce a greater degree of physical wasting, “meth mouth” and psychiatric conditions—paranoia, psychosis, etc. The majority of users are from 15-34 yrs old.
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Treatment is tailored to each patient, but the stages fall into four categories: Pre-admission screening, Detoxification, Rehabilitation (can take up to 4 months) and After care (can take up to one year). Our Network team visited the hospital wing devoted to patients with alcohol dependency and explained that about 20 of admitted patients go into delirium tremens. But treatments vary including group therapy, cognitive behavioral therapy, and intravenous valium for frank DTs. The unit offers group counseling, cognitive behavioral therapy, Buddhist prayer and work with family members. They have found that the western model is inadequate for the Thai context. The staff for the whole hospital is only 14 physicians but numerous nurses. The treatment goal is to reintegrate patients into their society. The day ended at a local middle school where a drug treatment prevention team works with youth subject to pressures from inside and outside the school pushing drugs. Students put on shows, give youth live talks on save drug prevention and make up songs containing positive lyrics about avoiding drugs. Art Kaufman,Vice Chancellor for Community Health, University of New Mexico, USA Email: akaufman@salud.unm.edu
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Conference Flashes Student reports The conference in Ayutthaya was for me and many fellow students the first Conference of The Network: TUFH. We didn’t have a very clear idea in mind of what to expect, but I think I speak for all of us when I say we had a very refreshing, eye-opening and interesting time. The best example of what the Conference meant to us as students was the mentormentee session. In this session, which was our start of the Conference, we had the opportunity to meet different health experts. After 5 minute conversations, in which the mentors explained their work, and the students discussed their future, we each had to choose a mentor whom we thought had the most similar interests and/or ideals. Then we had time with our mentor to discuss how we saw our future after graduating. The mentor could give us ideas, guidance, or just a reality check, which was all very useful and interesting. This was during the entire conference a recurring factor: the ideas that began to emerge, the guidance from different health experts, and sometimes the brutal reality check. An example of this last one was the different health problems that I learned were very problematic in some other countries, but not a topic in my own region. The abortion problems that were discussed in the Women & Health sessions are an example of this. However, this reality check was very refreshing, since it showed me the bigger picture of the health problems in this world. I think it really helped us as students to have a better view of the situation, and on what we want to do in our future health career. Beside these eye-opening moments, the Conference also meant a lot to us because of the international contacts. We could meet mentors, speakers and students from all over the world, which led many discussions to a more global perspective. It was also fascinating to discuss our own work field in our poster sessions, and to hear different global opinions about it. As for the student’s perspective: unfortunately there were no student activities except for the mentor-mentee session. It seemed that the former Student Participation Commission no longer existed. Nevertheless, this didn’t stop us from meeting many students, have many students discussions, and go for a drink together. Even more: after a spontaneous student meeting, it was decided to work on the student participation for next year. This is what we discussed: First, we want to have more promotion for the Conference among students. In every continent at least one student was willing to make contact with different universities, and ask them promote it. In this way, we would like to reach 200 students who will come to Fortaleza in 2014. Secondly, we decided that we want host families for the students. Apparently, this happened at the previous Conferences, but not this year. Although we liked our hotel or guesthouse facilities in Ayutthaya, we think host families would be a good way for students to really meet locals, and learn from their everyday lives. It is also a cheaper way of travelling, because for some students it was a big challenge to finance the Conference, the stay and the journey to Ayutthaya. This brings us to the third topic we discussed: we would like to have more students attending the Conference from less prosperous regions. Maybe it could be possible to arrange something for them, e.g. with lower prices. This is still a working topic. Other things we discussed were to read each others abstracts before submitting them (to make the conference more accessible for uncertain students), to organize a poster session with only students as speakers, and to organize some student social activities. Our biggest dream was to organize a one day student-only preconference. It is not certain yet which of these ideas will be possible in Fortaleza, but it is already clear to us that student participation will be a much more present factor. We had a very interesting and enjoyable time in Ayutthaya, and we want to take this experience with us and bring it to the next level in Fortaleza!
Leen Vermeire, student of the Master of Science in Health Promotion, University of Ghent, Belgium. Email: leenvermeire@hotmail.com
Students reunited at the Loi Krathong festival
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Conference Flashes Great Stories from Great People Mechai Viravaidya Mr. Mechai Viravaidya founded the Population and Community Development Association (PDA) in 1974 to address the unsustainable population growth rate in Thailand of over 3% annually at the time. A variety of humorous, innovative, and unorthodox methods were utilized in conjunction with mobilizing and educating a network of rural school teachers and village community members to make contraceptives available throughout Thailand. This resulted in the more sustainable population growth rate of 0.5% by 2003. When HIV/AIDS first appeared in Thailand in the mid-1980s, similar methods were used to launch a major prevention program, which resulted in a 90% decline in new infections according to UNAIDS and an estimated 7.7 million lives saved according to the World Bank, within 12 years. We were thrilled to have him as our first key note speaker at Ayutthaya and were very lucky to catch him for a short interview!
Thank you for your very interesting key note speech! So you’re an economist by education, what made you think in that direction, what kind of experience drove you to this community approach? Probably because I was not forced into anything too specific because that prevents you from thinking outside the box. I had a broad education and a lot of space in my brain to take in other things so that was just the first general thing. Because my education was broad I had to continue learning, probably also because I was not a good student! You were inspired to this broad approach what I would like to call a generalist view, somebody who looks in a broad perspective and tries to solve the problems from different angles. Do you agree with this? Health is not just a doctor’s perspective, the patient needs to see the doctor also, so of course we need to see this from different perspectives. So concerning contraceptives, why should anyone see a doctor about issues related to sex. If you are not ill you don’t need to see a doctor. You have to understand it first, it needs to be a contraceptive in the brain before wherever contraceptives need to go! That’s very interesting because in our medical education we invest a lot of efforts in order to train doctors and nurses in sexual counseling. But you say, we should look at this the other way around and see which people in the community are fit for this purpose. In many societies, how many people can see a doctor? Take a look at Pakistan, India or Thailand! How many get to see the doctor and when? Often they only see a doctor when it’s too late! So you say, let the people have in their environment others, peers, shopkeepers where they can interact with preventive health?
Yes, everyone who can link to the community! To me a doctor in my society is as a repair shop for cars that had an accident. But we need somebody upfront to prevent accidents! The doctors can’t do everything so get others to do it. Should we not take another approach to the training of doctors because now we train them very strict in a biomedical model. I would like to suggest that you train doctors how to train other people to do the job for them. You don’t need to wipe the floor, you should teach somebody else to do it! They must be the multiplier of good health, not just the provider. You need another profile of a doctor, more focused on the generalist approach. Today we have a lot of doctors trained in subspecialties, knowing everything about nothing. Let’s say we have a very deep pond that only fits one foot, but what we really need is a big lake! Thailand achieved a lot of good results. Today Thailand is also faced with the problem of improving the health coverage by the health system. Do you think that your approach is something that will help to reduce the inequities in health? Of course, let the community play as much role as possible and as considered appropriate. For instance, we have the mobile telephone, we should use a lot more of it. Nearly everybody in Thailand has one, so we can just say, oho time for your baby to get an immunization, don’t forget mothers group today, … so many things! You need to use all these things that can be combined and teach health as part of integration of the subject. Teach with Math, with English, … Health can fit in, blended into the regular subjects. A type of integrated comprehensive learning project!
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Conference Flashes Ayutthaya Highlights I asked random participants about this years conference highlights! Here’s what they had to say! Maaike Flinkenflögel, Ruanda: I always meet these like minded people who are doing amazing projects and who I really feel are very inspirational. I always feel very motivated to continue my work in Ruanda where focus on primary care is a big struggle! Ian Cameron, Australia: The visit to the AIDS temple and the opening speech of Mr Mechai Viravaidya! I have been going to cabbages and condoms for many years. But, as always, the intimacy of the people who come here and the formats that are used during the conference, like thematic poster sessions are the best! Seani Adrinah Mulondo, South Africa: The organization of the health care in Thailand is an example for my country! We should implement these things in South Africa. Bernard Groosjohan, Mozambique: The contact with the people I didn’t see for a year and with who I can discuss my job and the same problems we face. It gives me a lot of energy to continue! Johanna Dahlberg, Sweden: To experience the differences compared to my place and realize how different health care is all over the world. Margaret Matthews, South Africa: What happens in different communities in relation to primary health care, and this encourages me to think about more than only the hospital care. There is a lot that we can do in the community to improve the health of the patients. Aricia De Kempeneer, België: The community site visit to Saraburi hospital where I had the chance to visit the neonatal ward. As a midwife I thought this was amazing, I also talked to a Thai midwife about the differences between our countries and saw an antenatal class of pregnant wives and their husbands. This proves there is a very good organization in this area! Fred Stevens, Maastricht: The session about integrating public health and medicine and from the social activities of course the Loy Krathong festival! Sarah Kiguli, Uganda: The Thai key note speaker, the way he presented his program with simple strategies but great success to promote contraceptives and family planning Samuel Maling, Uganda: The site visit to the substance abuse hospital. I was impressed with how the deal with this problem at different levels. The school program on how students are taught about this matter is very interesting.
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Conference Flashes Ayutthaya Highlights Gerard Majoor, Maastricht: The poster session about community based projects and their impact showed some very interesting posters and discussions. And also the Loy Krathong festival! David Egilman, USA: Meeting people, making connections. Help people meeting each other and facilitate exchanges! Jan Baudonck, BelgiĂŤ: To prepare and moderate our own workshop with the Belgian students Amy Clithero, USA: The site visit to the middle school and seeing their drug prevention programs. Nighat Huda, India: The first keynote of the Thai speaker and the community site visits. I saw one of the best health care models I have ever seen in South-East Asia. So well organized from the ground level to the top! And of course the women and health plenary and poster sessions! Arthur Kaufmann, USA: Learning about the different programs and what we can still improve at the University of New Mexico Ramon Pedro Paterno, Philippines: Getting to know more about the Thai health system, how they achieved universal coverage. During the site visit we met a Thai family physician explaining how they conduct home visits. That was very striking for me.
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Conference Flashes Ayutthaya Highlights Stella Mini Grant The Stella Mini-Grant is a grant to finance a small-scale community project, aiming to improve equitable health care. The goal of The Network: TUFH is to foster equitable community-orientated health service, education, research and policy. Therefore, the focus of the project can be one of these four areas.
This year’s winner was Martha Kirabo, a student of the Makarere University of Kampala, Uganda.
There will be a general rise in the use of modern family planning methods by women in Panyango.
Her projects title is: “Promotion of Long Term Family Planning Methods by Women in Panyango Sub county (Nebbi District-Wes Nile Region).”
The project will be carried out in Panyango subcounty, Nebbi district where the predominant ethnicity is Alur and major economic activity is subsistence farming. Panyango has 7 parishes and a total of 109 villages. The villages are small and closely set. The total population of the area is 37,600 and it is one of the highest populated areas in the district.
The major objective of this project is to promote the overall usage of modern family planning methods, specifically long term methods, by women of child bearing age (15-49) in Panyango sub county through a community based and community oriented health campaign involving village health team personnel, reproductive health personnel from the community health centers, community heads and women leaders, for a twelve month period in the seven parishes of the sub county, involving 2 villages in each parish.
The project team will comprise 5 medical students. From each parish, the two villages will be selected by random sampling to offer each community equal opportunity.
Training of village health team leaders, community heads and women leaders in 14 villages in Panyango sub county on how to conduct health education programs in their communities on the types, benefits, side effects and areas to receive from modern family planning methods. These leaders will be able to provide health education even after the project has ended and the message will pour into neighboring villages.
Newsletter Volume 31/no. 2/december 2013 ISSN 1571-9308 Editor: Julie Vanden Bulcke Language editor: Amy Clithero The Network: Towards Unity for Health Publications UGent University Hospital, 6K3 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 Internet: www.the-networktufh.org Lay Out: Marijke Deweerdt, Anja Peleman Print: Drukkerij Focusprint
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