NEWSLETTER Newsletter Volume 32/no. 2/December 2014
In this issue, among others:
Editorial Bomdia caros letores,
• Community Site Visits
Already a few weeks have passed since our last wonderfull Network: TUFH conference but the energy and atmosphere that I felt there is still fresh on my mind!
• Students Perspectives
We enjoyed an amazing venue and listened to inspiring key note speeches under the improving eye of Maya Angelou and Nelson Mandela . A very full scientific program made it sometimes difficult to choose the right workshop or poster session.
• Poster Winner • Winners Stella Mini Grant • Updated Mission Statement
But the most remarkable fact about this conference, I think, was the Brazilian hospitality. After a busy day schedule, we enjoyed local food, drinks, culture and danced the night away. Muito obrigada!
Enjoy a new edition of Conference Flashes!
Julie Vanden Bulcke, Editor
In the Newsletter we refer to The Network: Towards Unity for Health as The Network: TUFH. The Tufh nieuwbrief dec 2014-2.indd 1
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Contents Message from the Secretary General Message from the Secretary-General
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Conference Flashes Annual International Conference
Looking Back at Fortaleza and looking forward to Pretoria! Fortaleza Poster Winners
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Community Site Visits
Students Report
Stella Mini Grant
10
Great Stories from Great People
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Conference Declarations
Fortaleza highlights
14
Updated Mission Statement
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In memoriam Kerr White
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Banco Palmas Escola de Dança (EDISCA) foto! Instituto da Primera Infancia (IPREDE) Associaçao Peter Pan SNO Update Once upon a time…
Paulo Speller
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Fortaleza Declaration 12 Women and Health Taskforce Declaration 13
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Foreword
Message from the Secretary-General Fortaleza gave us the energy to tackle the challenges we are facing! The Network: TUFH Fortaleza Conference 2014 was a vibrating experience. More than 1000 participants, coming from more than 40 countries with a large participation of students attended the conference that was important in many ways. First of all, the conference illustrated the dynamism of Brazil and the enthusiasm of the team of the University of Ceará, under the leadership of Professor Henry Campos. Secondly, there were many “high level” interactive sessions: The Network: TUFH is the place where advocacy experiences coming from 3 Jan De Maeseneer and Henri Campos different continents can be exchanged, where family medicine organization in 4 continents can be debated with input from people working in the daily practice,…Respectful sharing of information and ideas and exchanging of experiences, remains a fundamental reason for our existence. Thirdly, the conference brought a revival of the Student Network Organization (SNO), and created linkages with IFMSA (the International Federation of Medical Student Associations): The Network: TUFH becomes an active participant in the worldwide student commitment for more equity in health. The fourth point we learned is that the participants expressed the need to have the site visits accessible for all conference participants, without competition with simultaneous activities. As an organization, The Network reflected on its future: there was a very positive interaction with FAIMER in relation to the future secretariat of The Network. This interaction stimulated the fundamental reflection on the positioning of The Network in the future. As always, the conference enabled new contacts and “networks”: there was an increasing “connectedness”, where people not only share facts, strategies, analyses, but also inspiration, energy and engagement. Finally, it was a pleasure to discover the beautiful country of Brazil. During our visits, we have seen that the health system SUS is present in all places, also in remote areas, to serve the people. When visiting Chapada Diamantana, we were told by the guide that the geological context of this area is, that 250 million years ago, it was linked to the region of actual Gauteng in South Africa, where Pretoria is situated and where we will have our next conference. May this “historical geological unity” inspire our next conference. Welcome in Pretoria in 2015! Professor 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 at Fortaleza and Looking Forward to Pretoria The Network: TUFH is a hotspot of sparkling ideas and incentives for action. Therefore we are very excited to announce that we are developing an interactive platform to support continuous collaboration. This move will spearhead us into the forefront. The platform will contribute to strengthen the organization and, most importantly, improve how we can support you as a member. Keep your eyes on our public announcement in the first trimester of next year. This year, we experienced the power of policy in action during the Fortaleza Conference. The conference brought together 1300 health care workers, staff and students from 56 countries. We extend a big thank you towards the Universidade Federal do Ceara. This conference would have been impossible without their dedication and positive spirit. The anchoring point was made by honoring Maya Angelou and Nelson Mandela. We are very excited by the Fortaleza Declaration which is a completely student-driven statement. We got energized by the musical surprise during the opening ceremony; what a great start that was! The writings are on the wall, during the conference participants shared their messages on a massive banner. A memory forever, in the hallways of
the Universidade Federal do Ceara. Next year, the Annual Conference of The Network: TUFH will be held in Pretoria, South Africa from September 12 to 16, 2015. The event is hosted by the University of Pretoria. The organization is the result of the collaboration between SAAHE (South African Association of Health Educationalists) and The Network: TUFH. The conference theme “Education for Change” will challenge you to find solutions to change health and education systems and to become a force for change. 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 Pretoria!
Hilde Cnudde, Office Manager; Maarten Declercq, Executive Director, The Network: TUFH Email: secretariat-network@ugent.be; maarten.declercq@ ugent.be
Fortaleza Poster Winners Also this year we had a great variety of high quality posters so selecting one winner was quite a challenge but finally we decided on: PRIMARY HEALTH CARE, FAMILY AND COMMUNITY PROGRAMS WITHIN A MEDICAL SCHOOL CURRICULUM. First author: Luz Angela Carvajal Pabon Co-authors: Martha Emilia Galarza Salamanca (presenting); Juan Carlos Gonzales Quinones; Jenny Paolo Salamanco Preciado; Angela Maria Hernandez Pardo Fundacion Universitaria Juan N. Corpas, Bogota, Colombia Context: As a result of a medicine curriculum reform, some lectures were designed so the students would do community work and social projection oriented practices. These subjects are spread from 1st to 9th semesters in a 12-semester academic program, and are in charge of the Community Medicine Department. Setting: This medicine program has three formation cycles: 1. Foundation Cycle (From 1st to 4th Semester) 2. Linking Cycle (5th and 6th Semester) 3. Medical-Surgical Cycle (7th to 12th Semester). Objectives: Within the reform, the need to include student participation in the community care setting in the medical-surgical cycle
was established, instead of only in the initial two cycles of training as it was in the previous curriculum. Design: The different community activities take place at the medical school’s three medical centers in Suba, Bogota, where various primary care programs are developed. These programs are designed as academic spaces for the students to work with children, adolescents, elderly, chronic patient’s groups among other population groups under constant companionship and direction from the Community Medicine Department professors. Main outcomes & Results: Every student in their second up to ninth semester are part of these programs and its activities, working with the community they acquire social awareness and skills including the use and benefits of some of the family medicine tools (family diagram, bio-psycho-social diagnosis, etc.), as well as other diagnostic and therapeutic skills in their professional growth allowing them to act in unity with the explicit needs of primary care. Conclusion: This curricular reform allowed our students to combine and merge their community and hospital practices transversely in their whole training, not only in the first two cycles thereby achieving the applicability of a true primary health care.
CONGRATULATIONS!
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Conference Flashes Community Site Visits Banco Palmas In the 1970’s in Fortaleza, people living on the coast were forced to move inland to make way for the development of tourism infrastructure along the sea front. The uprooted people gradually built the Conjunto Palmeira neighbourhood from nothing, however, having lost their livelihoods, they and their Group picture in front of Banco Palmas neighbourhood remained impoverished. In the 1990’s, with the help of community workers, residents mapped their production and consumption and showed that most of the residents’ spending went out of the community. To counteract this outflow, the Banco Palmas was created in 1998. The aim of the Banco Palmas is to create local wealth by stimulating local consumption – keeping money in the community. It created a social currency, known as the palmas, which can be exchanged for goods and services within the community but not outside. In most respects, it acts as a normal bank except that it operates in a deprived area, it provides microcredit in palmas to people who would not otherwise have access to credit but who are rated by their neighbours as likely to repay the loan, its interest rates are lower than the market rate and progressive: the larger the loan, the higher the rate and, finally, “profits” are reinvested in new credit for the community. The
Banco Palmas model has five integrated elements: 1 credit for production, 2 credit for consumption in the form of a social currency, 3 banking services, 4 financial education and 5, a high level of community control over the bank’s activities. It was the first of what is now a network of community development banks in Brazil. During our visit we were welcomed by Mr. Joaquim Melo, the project’s Coordinator General, who has been with the project since its inception as well as Mr. Asier Asier Ansorena, Coordinator of Credit and Innovation. They explained that, in parallel with the bank’s activity, the community has set up a number of independent community development initiatives, some of which we visited including: Palma Tur, a simple bed and breakfast that provides work for local people and an alternative place to stay for tourists and researchers, the Loja Solidária (Solidarity Shop) which exhibits and sells products manufactured in the neighbourhood, and the Bate Palmas Company, a youth musical group that also manufactures musical instruments from recycled materials and sells them. A full description of the Banco Palmas can be found at: http://en.wikipedia.org/wiki/Banco_Palmas#Social_ Projects and those wishing to keep up to date with events can follow Banco Palmas on Facebook: https:// www.facebook.com/BancoPalmas Denise Donovan, MD, Université de Sherbrooke, Canada Email: Denise.Donovan@USherbrooke.ca
Escola de Dança (EDISCA) EDISCA offers opportunities for talented children from poor families in Fortaleza to follow daily dancing classes. The other half-day the children go to school, like other Brazilian children. The children and their families are screened at the beginning (at the age of 10) on several criteria. Once they are accepted, EDISCA also pays attention to the social context of the families. The mothers of the children can follow sewing classes, social problems in the family are dealt with, etc… For the children, who enter at the age of 8 and stay until they are 18, the school becomes a way of life. They learn how to behave, how to eat healthy food, etc. As a group of dancers they perform first locally. The most talented group travels abroad for performances, for example, in Paris.
Some of the children become successful professional dancers. They come back to the school as teachers or support the school in other ways. (http://www.communitydance.org.uk/DB/animatedlibrary/edisca-dance-and-social-transformation-innortheas.html?ed=31348) The school gets financial support from many sources, including the (well known) Ayrton Senna foundation. Pictures show various activities we witnessed during our site visit. Anselme Derese, Professor, Department of General Practice and Primary Health Care, Ghent University, Belgium Email: Anselme.derese@ ugent.be
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Conference Flashes Community Site Visits IPREDE (Instituto da Primera Infancia) On the first day of the TUFH Network conference a group of about 10 conference participants took the opportunity to visit IPREDE, an urban facility in Fortaleza founded in the 1980s to prevent and treat children with malnutrition. In the 1980’s, the state of Cearå had a reality that only 100 children in every thousand born were able to reach one year of age, and that 30% of malnourished children had growth problems. Recently this situation seems to have improved; the child malnutrition rate has become less, between 6% and 7%, and a mortality rate below 20 per thousand births, substantiating IPREDE’s success and evolving mission. IPREDE (Instituto da Primera Infancia) focuses on nutrition and early childhood development. It develops programs, projects and services in conjunction with various sectors of society. The institute works for the public and is involved in the generation and dissemination of technical and scientific knowledge gained from its experiences. It uses the production and promotion of culture and art as instruments of awareness and appreciation of the citizen. Its approach is multidisciplinary and includes different disciplines. Health students from different university programs (e.g. medicine, nursing, social work) visit every day. So what are they actually doing? We were hosted by several staff members who showed us around a nice building and informed us in a rather nice and wellequipped conference room about all kinds of activities regarding early age mother and child care. Since its early years of existence as the Institute of Early Childhood, the facility focuses on the first stage of childhood, setting up nutrition programs for young children in families living below the poverty line. Besides preventing malnutrition the house is also involved in developing family responsibility, which we could observe in a room where mothers were instructed how to play and bond with their children (see picture). Obviously, for many children (and mothers) being in this nice facility must feel like heaven. For its functioning, IPREDE primarily depends on donations, and with these donations for its yearly 1200 children with malnutrition (from 800 families) it uses 15 tons of nutrition. To give an idea of the logistics, on a daily basis 450 cans of milk are consumed. For each child the institute, in fact a day care facility can provide two meals a day. Moreover, the mothers of registered children are coached on healthy cooking. Besides this the institute plays a role in the transfer of technology to the community. We visited a room where women (mainly mothers) were instructed how to make clothes (see picture). Recurring TUFH Network conference participants are aware of the importance of the site visits next to attending sessions and reconnecting with colleagues in a (much too) cold conference building or (hot) dance venue. IPREDE was a local highlight and as a group of visitors we were impressed by the dedication of the people working there, which includes the students and our guides. Fred Stevens, Dept. Educational Development and Research, Maastricht University, The Netherlands Email: fred.stevens@maastrichtuniversity.nl
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Conference Flashes Community Site Visits Associaçao Peter Pan
The 21st of November 2014 we were part of the conference delegates that were welcomed by beautiful smiles of children suffering from cancer at the Centro Pediatrico Do Cancer (The Pediatric Cancer Center), under the auspice of the Peter Pan Association in Fortaleza. Was this because of the hugs from HELLO KITTY! We were received by a very hospitable administrator who gave us a brief of the institution and took us around. The hospital setting and organization, trend and approach of patient care was way different and much better than that back at home. The center was founded in 1997 by a group of volunteers. It serves children between 5 to 15 years. The Centre serves about 1300 children with about 50 children being seen by the physician every day. The children are enrolled for treatment (mostly chemotherapy) and followed for utmost 10 years. It is sustained on donations from the Brazilian citizens and organizations like McDonald. The center The delegates at the Peter Pan pediatric Cancer Center in Fortaleza, hopes to expand the service to fully meet the need Brazil of cancer treatment of children and adolescents in the state of Ceara with humanized support from the projecto Casa da Crianca. The hospital setting, organization, trend and approach of patient care are way different and much better than that back at home. Back home children suffering from cancer are admitted on the same wards as the other children. And the care they receive is not very sophisticated and specialized like what we observed here! The interaction between these children and a group of professionals and volunteers provides hope for yet another day despite the illness; these include the physicians, nurses, teachers, social workers, nutritionists etc. The environment is designed innovatively to make the children feel at home and put a smile on their faces. It was impressive to see that this center had lots of play rooms to engage children of all ages, a school to receive formal education, clean accommodation and admission wards that are conducive to healing. Last but not least, Hello Kitty’s visit which made the children feel so special. Nevertheless, the center with its aims and implementations depicts this year’s The Network: TUFH conference theme, “Strengthening health professionalism education as a means to achieve quality and cost effective community health”. Faith Nawagi, Makerere University college of Health sciences Uganda. Josephine Najjuma, Mbarara University of Science and Technology Uganda. Email: fnawagi@gmail.com; najjumajosephine@yahoo.co.uk
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Conference Flashes Students Report SNO Update
In 2013 Janaina Leitão Vilar had students enrolled and logistics of the pleasure and the honor to be students activities. the student representative of the Our goal was to achieve effective Federal University of Ceará (UFC) student participation in the Meeat the 2013 Annual Conference of ting. Several students from diverse The Network: TUFH themed “Rural cultures were able to enjoy the pos& Community-Based Health Care: ter presentations, workshops and Opportunities and Challenges for plenary sessions promoted in the the 21st Century” in Ayutthaya ThaiMeeting, which was of great releland. There occurred a meeting of vance for each of them. This enastudents that were motivated to bled the development of discussicreate an active group of students ons related to various health related inside The Network. Only a few stuissues. Many students were encoudents attended this meeting and, raged to discuss about the particuSNO team with Henry Campos using a large dose of persuasion, larities of each country regarding five student representatives could the Primary Health Care making student participation even more be nominated, one for each of the following continents: Africa important. (Najjuma Josephine – Uganda), Asia (Vincent Balilla), Europe (Aricia de Kempeneer – Belgium), North America (Nick Druar – USA) For this conference, besides the usual activities destined for stuand South America (Janaina Leitão – Brazil), and we also had one dents, we planned an academic program, where students were friend, Maya Cohen, from the USA that worked with GHETS who able to visit local units of primary health care and discuss about agreed to help, completing the new board of the Student Netthis theme, sharing their own countries realities. From this valuwork Organization, that we tenderly nicknamed SNO. able experience, came out a document that summarizes and expresses the students thoughts: the Declaration of Fortaleza. This Through this year of hard work, SNO team gave their best weldocument, written by students contains the learning guidelines for come to Alexis Barnes from the USA, some of the SNO members health professional’s education. The Declaration of Fortaleza was gave up, other was replaced... But it didn’t impair all the work officially presented during the main conference program and sigto be carefully executed. Student Network Organization (SNO), ned by the representative of the Student Network Organization, a member institution of Towards Unity for Health (TUFH), seeks Janaina Leitão Vilar, the representative of The Network TUFH, Procollaboration with health systems to adapt, develop, and improfessor Jan De Maeseneer, and a representative of the academic ve the education of health professionals and the functioning of sector, Professor Henry de Holanda Campos, on November 19th, their health systems, to improve community health. The goal of 2014. The full version of the document can be found at The NetSNO in Fortaleza Meeting (2014) was to increase student partiwork: TUFH website. cipation in the event, integrating the activities of the students to the main event schedule and produce a document that would The Student Commission organized gatherings at night for stube the actual result of the work done by the students during the dents from different cultures to socialize. There was a party at the Meeting: the Declaration of Fortaleza. Student Housing and at a local peculiar bar called Pirata Bar, which is famous to propitiate “The craziest place on earth on a Monday In Brazil a student Executive Committee (EC) was established in night! ”, according to The York Times. Also in the last day students January 2014, supervised by Henry de Holanda Campos, PhD and could go to the Beach Park, the largest water park in Latin America. president of the organizing committee of The Network TUFH Fortaleza Rendez-vous. The team consisted of six medical students Without a shadow of doubt, this was a unique experience for all from UFC: Janaina Leitão Vilar, Antonio Guilherme Fontenele participants of this conference in Fortaleza, especially for students, Freitas de Castro, Évellyn Taline Barros Queiróz, Hassã Pereira who will never forget the new cultural exchange, the pleasant enLemos, Fábia Maria Maia Moreira, and Francisco Victor Carvalho tertainment and the enriching personal and academic living. Barroso. Fortaleza already misses you! Let’s meet again this year in Pretoria, Executive Committee, members of SNO and The Network TUFH South Africa for more interactions and networking. Fortaleza Rendez-vous Organizing Committee worked together Janaina Leitão Vilar; President of Student Network Organizaon the preparation of the Meeting, including division of work for the pre-Conference activities, selection and training of Lotion; Medical Student cal Team, programming meetings, establishing dates, goals and Faculty of Medicine; Federal University of Ceara (Brazil) schedule for the event, providing low cost accommodation for Email: janainalv@hotmail.com
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Conference Flashes Students Report Once upon a time…
Once upon a time, five enthusiastic medical students from the University of Ghent stumbled upon the opportunity to present a workshop at the TUFH conference of The Network in Fortaleza. A simple announcement got them thinking. “What if we talked about the way we get consultation training?” The simple idea slowly started growing. With help of our promotor this dream became reality. Working towards this conference, the tension got higher every day. During the whole five days we challenged ourselves to participate in as many activities as possible. The five of us all have different interests and we all went our own way. Some of us went to all the site visits and got a clear insight of different social, economical, medical, cultural and sport-driven projects. Group picture in front of our workshop In fact, the most important goal of all of these projects was educabanner tion. The organizations were located in different areas of Fortaleza, mostly in the less fortunate neighborhoods, and all of them were life-changing for the target group. Dance, micro credits or a specialized clinic for children’s cancer treatment played a central role in people’s lives. A good project can make a difference! Some of us went to as many workshops, panels and plenary sessions as they could. Vivid discussions and debates about women empowerment, the composition of the medical curriculum or community health care were a great stimulus to empower our own opinions and stand up for them. Some of us made as many friends as they possibly could in five days. Being part of such an international community, gave us the opportunity to exchange thoughts, insights and experiences about health, medicine, health care, world issues and of course about life. For every one of us, this was the very first conference. We all had our ideas about what it would be like, but the reality is always different. When the day of arrival finally came to be, our expectations were answered appropriately. Arriving through the air-conditioned main entrance was an experience all by itself. We immediately participated in student activities and enjoyed its multiculturalism. During the whole conference it was very clear that students were welcomed more than anything. We were constantly involved in discussions, panels and poster sessions. We all got to moderate a poster session, which taught us all a lot about what it is like to lead a group of people in a discussion without saying what we thought ourselves. This annual congress opened our minds on a diverse and broad spectrum of topics. More specifically, we could experience a huge difference in visions about health care between people and even states or countries. Being aware of the advantages and disadvantages of our own health system and in other places, reminds us about the achievements that already have been accomplished and what still Selfie with our professors can be improved for the better. We think it is safe to say that this entire experience changed us all for the better; Wherever the future may take us (hopefully to Pretoria). Louis Onghena, Melissa Ooms, Suzanne Fisher, Iris Janssens en Prisca Donadoni; Medical Students, Ghent University Email: louisonghena@hotmail.com
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Conference Flashes 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.
The FIRST WINNER of this year was Louricha Opina-Tan an academic staff member of the University of the Philippines in Manila.
The SECOND WINNER of this year was Menyo Innocent, a student at the department of health sciences at Makerere University in Kampala, Uganda. His project title is: “Promotion of cheap effective nutrition practices by people of Kayunga Sub County (Kayunga District – Central Uganda)”
Meeting with leaders and community health workers Her projects title is: “Community-based Smoking Control Campaign” The University of the Philippines-Community Health and Development Program (CHDP) is the university unit mandated to enter into partnerships with local government units in the country. The program is managed by an interprofessional team of faculty and staff representing the different colleges of the university and has two objectives. First is to provide learning opportunities for the university’s students, faculty and staff in the field of community health and development. Second is to assist its partner community in attaining increasing capacities in developing their community where health is included. At present CHDP is in partnership with the Inter-Local Government Unit Collaboration Council of AMIGA, composed of five rural municipalities (Alfonso, Mendez, Indang, General Aguinaldo and Amadeo) situated at the Southern Luzon part of the Philippines. The project hopes to contribute in attaining an over-all objective of the community; At the end of one year, there will be 10% decrease in the number of adult community members who smoke by implementing a community-based smoking control program in five chosen villages in the AMIGA municipalities situated at the Southern Luzon part of the Philippines. This objective was formulated after discussions with the community. This project specifically aims for at the end of six months community leaders of the chosen barangays will be able to plan, implement and evaluate a community-based smoking control campaign in their respective barangays.
During our Community Based Education Research and Service (COBERS) program we conducted a study on ‘EFFECTIVE NUTRITION PRACTICES CARRIED OUT BY PEOPLE OF KAYUNGA DISTRICT’. As the Principal Investigators, the major objectives we came up with were to assess the nutrition practices carried out by the people of Kayunga district in regards to foods prepared, foods given to infants and willingness of people to adopt the right nutrition practices. The project aims the promotion of cheap effective nutrition practices through teaching of the masses and practically showing them how to select foods explaining the different nutritients selected. Also to prepare simple dishes of all food values as an exhibition to create a platform for them to obtain the knowledge of food selection and preparation. Health education, even if only given once is very important to gain and implement this new knowledege. Majoring in agriculture and fishing as they are close to River Nile and Lake Kyoga, this can effectively improve the health of the Kayunga people. This cuts down on costs that would go towards treating people from complications of malnutrition. The major objective of this project is to reduce the burden of malnutrition related disease by promoting widespread cheap effective nutrition practices among all the age groups in Kayunga sub county in Kayunga District through a community based and community oriented health promotion campaign involving Village Health Team, nutrition health personnel in Kayunga hospital and the Local Councils, for a period of twelve months in the 4 parishes of the sub county, involving 5 villages in each parish.
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Conference Flashes Great Stories from Great People Paulo Speller
Dr. Paulo Speller is a psychologist and a doctorate in political science. He was a rector of the Universidade da Integração Internacional da Lusofonia Afro-Brasileirade from 2010 to 2013. He is currently Secretary of Higher Education of the Ministry of Education. At our opening ceremony he represented the Minister of Education and gave an inspiring speech. We were very lucky to catch him for this short interview!
What are the most important challenges in the problem Brazil is facing about training sufficient number of health care professionals, especially doctors? We have a deficit not only in numbers of doctors but also in distribution of doctors all over the Brazilian territory, which is a very big country. Our first challenge of course is to train more medical doctors and our second challenge is to organize internship trainings so that every student that finishes his undergraduate curriculum can get a proper training. Nowadays we lack places. With our “More Doctors Program” we are currently addressing these challenges temporarily with medical doctors coming from foreign countries. But in the meantime we have to prepare more doctors to take their places. Among these foreign doctors, around 11 000 come from Cuba? Yes we have a lot of Cuban doctors through the Pan-American Health Organization (PAHO). They are integrated in the Brazilian health care system. They especially work in the small municipalities and the Indian districts. Brazil is a very varied country. Do you have an idea how you could improve recruitment of doctors from remote areas, from the Indian communities? Yes, we know this is very important because they are more likely to work in their own region. We already try to have more internships in different and remote areas. A next step is to increase the number of medical schools and hospitals in these areas so we can create an atmosphere for young doctors who can study and live there. The idea is also to attract more young doctors to family and community medicine because with the increase of chronic diseases, family doctors will become only more important. There were 700 municipalities who never ever saw a doctor! Medical presence can completely change and I think improve their lives. We have a big challenge in building more infrastructure.
People or patients are also very important players of your health care system. Are there programs to empower patients, to educate them so they can better cope with health? We have family health teams who are very much responsible for health education. Also in basic education of children, health education is becoming an important component. So there is articulation between the ministries of health and education. Do nurses and other health care professionals already work together in teams with the doctors? Yes it depends on the municipality, but we provide a small team of at least 3 people to work together with the doctors. It can be nurses, family health program, dentist, or community health workers. It depends on the municipalities because they are involved, the state is involved, the federal government is involved. But in order to have a good health system you need to involve local authorities and this works better in some places than in others, mainly because of individual differences. How can The Network:TUFH contribute best to be of relevance to help this development in health care in Brazil? What can we give in terms of cooperation, inspiration, exchange of ideas? The best contribution that The Network can give is starting from the idea that health system issues exist everywhere in the world and different countries cope with them in different ways. The problem exists everywhere and has to be addressed by bringing together all the experiences here of 37 different countries! I wish you a very inspiring conference! Thank you.
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Conference Flashes Conference Declarations The Fortaleza Declaration of the Global Learning Objectives for Health Professionals By the student participants attending The Network, TUFH conference and the Student Network Organization AFFIRMING the promotion of equity and quality in health through community-oriented education, research and service; AFFIRMING the search for equity, quality, relevance and costeffectiveness in health care for all communities; AFFIRMING our participation in actions for a change of policies according to our objectives; RECOGNIZING the difference in culture and teaching methods globally; DESIRING a worldwide uniformity on the key elements in teaching future health professionals. HEREBY DECLARE THE FOLLOWING LEARNING OBJECTIVES:
Henry Campos, Janaina Leit達o and Jan De Maeseneer signing the declaration at the closing ceremony
All students should: 1. Receive training that is embedded in primary health care; 2. Learn where power and influence lies in health systems and management locally; 3. Understand health systems and management globally; 4. Share best practice of how to efficiently use resources; 5. Be community advocates for strong local systems for best access to healthcare; 6. Be trained towards globally standardized outcomes; 7. Be skilled in how to center community through stakeholder involvement within health objectives; 8. Be encouraged and incentivized to go in primary health care; 9. Understand their role to influence health economy; 10. Realize the specific role of every health professional and the complementary role of all in a team and its impact on health; 11. Practice working on interdisciplinary teams modeled by other health practitioners; 12. Include all determinants of health in patient care; 13. Be trained in people- and psychosocial skills; 14. Be taught preventive medicine, rather than just curative; 15. Be able to promote health on the basis of the Ottawa charter; 16. Acknowledge that success in primary health care depends on community involvement; 17. Develop research skills to design and/or implement evidence based programs; 18. To be motivated into advocacy as a tool to improve health care; 19. Have leadership and management skills.
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Conference Flashes Conference Declarations Women and Health Taskforce Declaration India - Ensure gender justice and human rights approach to family planning! In a state like Chhattisgarh, which has one of the highest rates of maternal mortality, the state government organizes sterilisation camps regularly to control population while turning a complete blind eye to other more important health care needs of women. Furthermore, women’s health is further jeopardized by this high volume, unhygienic, ill-equipped and target driven camps.Shockingly, at this camp, 83 women underwent laparoscopic tubectomies with only one instrument in less than 5 hours—less than 4 minutes per operation. This is clearly a violation of government guidelines (Standard Operating Protocols for sterilisation camps) which state a doctor cannot conduct more than 10 tubectomies with a single instrument, and not more than 30 tubectomies in one session by a single doctor.
whtf Serious violations of women’s human rights and repression of reproductive choice continues globally. The recent case in India demonstrates that in addition to human rights violations, government medical guidelines were ignored. This resulted in the tragic deaths of 13 women and critical injury of more than 20 women at the Government Sterilization ‘camp’ in Bilaspur district of Chhattisgarh. This is a painful reminder of the inadequacies of India’s public health system and, more importantly, it demonstrates that the focus of health programmes in India is wrong. The focus of reproductive health services should be on the health of women, not just on sterilisation. More than two- thirds of contraceptive use in the country is female sterilisation. The National Family Health Survey (NFHS) data shows that the percentage of women undergoing sterilisation has risen significantly from 27 per cent in 1992-93 to 37 per cent in 2005-2007. In comparison, the male sterilisation is very low at three per cent. The consent process for sterilization in India has been described by international, regional and national human rights bodies as an involuntary, coercive or forced practice, which is a violation of fundamental human rights. These include the right to health, information, privacy, to decide on the number and spacing of children, and the right to be free from discrimination. Any form of involuntary, coercive or forced sterilization violates ethical principles, including respect for autonomy and physical integrity, beneficence and non-maleficence.
While organizing free public health camps is a welcomed strategy to counter the increasing commercialization and privatization of health delivery systems, the general trend to have one-day camps with incentivized high targets is a flawed strategy. The monetary incentives include doctors, health workers and women. The motivation is thus provide as many procedures as possible. India’s Family planning program, in recent decades, has only targeted women resulting a negligible number of vasectomies. Vasectomies are a far safer method with zero side effects and post-surgery recovery period, unlike tubectomy or hysterectomy which have post-surgery hormonal disturbances and health implications. Monetary incentives to women are problematic because they contribute to a coercive environment, especially when the women are from poor and marginalized communities. The Network TUFH and the Women and Health Task Force (WHTF) express outrage and strongly condemn the continuous violation of women’s health rights in the form of coercive and unsafe sterilization procedures. The medical practitioners and responsible government officials made legally accountable. The Government must ensure that medical, procedural and ethical guidelines are strictly followed in every government run hospital and health camps. We strongly demand that the focus must shift to expansion and availability of non-surgical contraception to women and enhancing their contraceptive choices, along with programs to women’s empowerment and counselling around medical needs and reproductive choices.
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Conference Flashes Fortaleza Highlights
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Updated Mission Statement The Network: Towards Unity for Health Descriptive Statement
The Network: Towards Unity for Health (The Network: TUFH) is an independent global organization that mobilizes individuals and institutions committed to improving global health through community-oriented education, service and research. The core values of The Network: TUFH are equity, solidarity, diversity, sustainability and innovation. The network: TUFH is a non-governmental organization (NGO) in official relation with WHO. The Network: TUFH is defined through the strengths of its members consisting professionals, practitioners, students, community leaders and organizations from various disciplines of health. The global impact of The Network: TUFH can be observed through programs and collaborations on community health, women’s health, inter-professional health education and practice, social accountability in health education and service, and the well-being of underserved populations. For information on The Network: TUFH, go to our website: http://www.the-networktufh.org/ To further understand the global perspective and involvement of The Network: TUFH and to learn about programs dedicated to best practices related to community-based health professional education please review The Network: TUFH Newsletter and Education for Health, the official journal of The Network: TUFH.
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In Memoriam Kerr White Dr. Kerr White passed away. On July the 22nd 2014, Dr. Kerr White passed away. Dr. White played an important role in the starting years of what actually is The Network: Towards Unity for Health. Kerr White was born in 1917 in Winnipeg, Manitoba to a Scottish father and English mother. He first studied economics at McGill and Yale Universities and then attended Medical School at McGill University. He further trained at the Department of Internal Medicine at the University of North Carolina, Chapel Hill. Dr. Kerr was a pioneer in Health Services Research and contributed to knowledge in the fields of Health Statistics and Epidemiology. He defined primary medical care as “The provision of preventive and therapeutic health care and counseling for problems presented by individuals from a general population, with no more than 5-10% requiring referral to specialists”. Kerr White was convinced of the importance of linking primary care to public health and population health. His epidemiological orientation led to the seminal publication in 1961 in The New England Journal of Medicine: “The ecology of medical care”. This paper introduced the famous graph representing the proportion of people at different levels of care. This study was repeated in 2001, demonstrating the stability of the results in the distribution of the percentage of people that use the different levels of health care. In 1965, Kerr White moved to Johns Hopkins University, where he focused on health care organization and health services research. The Network was
in touch with Kerr White when he was serving from 1978 to 1984 as Deputy Director for Health Sciences at the Rockefeller Foundation, where he established the International Clinical Epidemiology Network (INCLEN). In that period, his work was inspiring for The Network as it helped to orientate the training of health professionals towards the needs of populations as they were documented in the Clinical Epidemiology. The Network recognizes the important contribution of Dr. Kerr White to improvement of health worldwide.
Newsletter Volume 32/no. 2/december 2014 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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