We can be that Generation
VECTOR
Issue 8, October 2008
a note from the editor
GHN, GHG, WHO, UNICEF, AMSA, IFMSA….just like the rest of medicine, Global Health seems to be full of acronyms. But which acronym managed to bring pertinent issues to the forefront, bought together 500 medical students nationally and from across waters, invited some of the most renowned and influential speakers, and united them all through the sole passion for International Health? GHC. The 2008 Global Health Conference held from the 4th – 6th July at the University of Melbourne stood by its slogan, Nelson Mandela’s words: “Sometimes it falls on a generation to be great. You can be that Generation.” As you will discover throughout the magazine, the GHC surely did “inspire, empower and arm delegates with the tangible skills and the knowledge necessary to assist them in bringing about global health equity” as its conveners adequately aimed. So it was fitting, that hot off the heels of such an extravaganza, for Vector magazine to celebrate, explore, inspire and enlighten Australian medical students to be that generation Nelson Mandela so eloquently urged us to be. Read the articles, follow the links, spread the word, get involved, do your part. Now it’s our turn. Nelu Jayawardena The University of Melbourne
“Sometimes it falls upon a generation to be great. You can be that generation. Let’s make poverty history.” - Nelson Mandela
the programme
A vibrant social array of African dancing, funny hats, and intense
networking complimented the basis for the conference’s existence: its world-class academic programme. Through three days of plenary lectures, debates, forums, workshops and case-studies, delegates had the opportunity to engage with one another in addressing the biggest issues facing our generation including climate change and climate refugees, complex humanitarian emergencies, Indigenous health and access to essential medicines. GHC was attended by internationally renowned keynote speakers such as Sir Gustav Nossal, Julian Burnside QC, Rev Tim Costello, Elizabeth Reid, Tom Calma and Pat Anderson.
Additionally, the conference organising committee oversaw some new initiatives this year: The AsPac Project We raised nearly $100,000 in funds from the Myer Foundation and AusAid to support 25 delegates from some 15 countries around the Asia- Pacific region to attend the conference and pre-conference programmes. This made GHC truly global in nature for the first time.
Signing the Close the Gap Pledge The culmination of the Indigenous Australia forum at GHC saw AMSA president, Michael Bonning, sign off on the Oxfam Close the Gap petition – a pledge to help close the 17 year life expectancy gap between Indigenous and non-Indigenous Australians. The need for wider emphasis on Global Health issues is pertinent within our medical curricula. Students must be equipped with knowledge of how seemingly distant issues and institutions can impact on health, for example, the implications of climate change or the World Trade Organisation. The learning undertaken during this conference transcended that of any medical classroom. As members of leading institutions, universities, we should seek to further develop medical education and provide the foundation for sufficient opportunities for students within the domains of Global Health. Jenny Jamieson Academic Convenor The University of Melbourne AMSA GHN, Vector Issue 8, October 2008
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G lobal warming is a fact. Only contrarians and the lunatic fringe are putting up any real opposi-
tion to the idea that the IPCC reports are accurate, but possibly conservative. The implications for global health and for national harmony are immense. It represents the greatest challenge the world has ever faced. It is your generation which will deal with the consequences or watch a human catastrophe on an unimaginable scale. Whether or not we co-operate globally to reduce greenhouse gas emissions, the polar ice-caps are melting, glaciers are retreating, and the Greenland Ice Shelf is at serious risk. Apart from regional effects on arable land and the consequent effects on world food supplies, population in low-lying areas will be profoundly affected by rising sea levels. A sea level rise of two metres will displace tens of millions of people around the world. Pacific islands present a special challenge. Many of them already have fragile economies. Many of them are low-lying. As a matter of certainty, a number of them will disappear or become unviable if sea levels rise several metres. Their inhabitants will look to Papua New Guinea, Indonesia and especially Australia.
global warming and human responsibility
refugees because of the obvious analogy between their position and that of other refugees. Will we respond to the wretchedness of their circumstances, or will we turn them away and let them drown? The civilized nations of the world should accept the fact that environmental refugees are human beings who deserve a place to stand and a chance to survive, especially since the wealth of the developed world was created by the very activities which have caused global warming. The conditions we enjoy today came at a price: we cannot expect the Pacific Islands to pay that price for us. If the population of low-lying islands in the Pacific are forced to move because their homeland becomes uninhabitable, or because it disappears, the scale of the problem is one which Australia can manage, and the nature of the problem is one which Australia ought to manage. We should be prepared to recognise them as people who deserve protection, and grant it to them without resentment. Apart from all the other steps which need to be taken, we need a new international treaty which recognizes environmental refugees as people who are entitled to protection. It is a global problem and calls for a global response. This is your great challenge, and your great chance.
Although we think of them in prospect as ‘environmental refugees’, this is not accurate as a matter of law. They are not refugees within the definition in the Refugees Convention. But we refer to them as
training new trainees (TNT) program
Julian Burnside QC www.thejusticeproject.com.au
International Federation of Medical Students’ Association (IFMSA)
“What are the needs of the other side? Our facilitator drummed this chant into us during our three days of TNT. We were learning about conflict resolution and as I recall- we were all synchronously chanting these words to each of the case scenarios which we were presented with. This was just one of many topics we covered at the IFMSA’s inaugural TNT program. Held over three days prior to the GHC, we were taught the elements of preparing a successful training session. That it wasn’t just about picking the right date, time or venue; or about the right content but… audience response was approximately 7% to content, 55% to body language and 38% to the delivery. So we learnt how to put together storyboards, the importance of choosing focused key messages and practised some public speaking. On Day 3, everything we had learnt was put to the test. As part of our formal accreditation process, we were required to deliver a training session to general delegates of the GHC. As well as being a great teambuilding exercise for us, it gave us a great chance to put our theory into practice, as well as impart some knowledge on various Project GHC2008 was about many things; as discussion of one pressingly important issue concluded, another began. It was overwhelming as well as inspiring. It reminded us that these were in fact important issues. It reminded us not to become complacent. Our job was then to take away from inspirational speakers what good work one person could do. Start with the little things, and change will come.
Management topics. Participants for the three day training course came from medical schools throughout Australia and New Zealand and were joined by delegates from the Asia Pacific region. So as well as gaining valuable skills during the training, we met some fantastic people, learnt a little about their cultures and discovered the many wonderful health initiatives already underway. Furthermore, the TNT program aimed to upskill its selected delegates to empower medical students to contribute to the variety of challenges that they will face in the future global healthcare environment. Linny K. Phuong The University of Melbourne
not in my backyard... or is it?
Even after five years of medical school, I was almost surprised to see Indigenous Health on the list of topics we would cover. Not because it wasn’t an important issue, but simply because I was expecting to hear about places far and wide – not home. A number of students at the Indigenous Health workshop had had very little practical experience with indigenous health. We discussed our preconceptions and those that we knew were prevalent in the community in an attempt to break down the ‘us/them’ mentality and become better educators and advocates. We talked about barriers to AMSA GHN, Vector Issue 8, October 2008 2
access and how to overcome them (or more realistically, minimise them). We talked about mistakes in the past and how we could learn from them. We heard from Aboriginal leaders who had the enormous responsibility of being spokespeople for the indigenous community and role models within their community purely because of the combination of their success and the colour of their skin. We heard from doctors and lawyers and social justice advocates and armed ourselves with that oh-so-powerful knowledge. One of the most important things I learned during the conference is that building bridges is key. Two simple ways in which we can make a difference: Educate – opening dialogue with your friends, colleagues, family, and patients will be something all parties learn from. Get involved – take advantage of rural terms, electives, Indigenous walked out of the final GHC plenary session with the strains of IGloria Estefan’s “Reach” ringing in my ears. With all this new infor-
mation, I wanted to be that generation Nelson Mandela was talking about. But things like volunteering for MSF and becoming Secretary General of the UN, they take time. I wanted to put my thoughts into action now! Although it may not be immediately obvious, the ‘global issues’ discussed at GHC are intimately linked with the decisions we make in our lives, the most obvious being the food we eat. I had no intention of becoming an instant vegan, freegan, locavore. Yet, to have an awareness of the origins of what we consume and it’s implications for the natural world and our fellow human beings is reasonable, worthy even? So what exactly is organic? And why is it a better choice? According to the Australia Certified Organic website, the standards cover all aspects of farm management to ensure a sustainable farming system. Organic farming bans the use of synthetic fertilizers, which require fossil fuel energy to produce. But here’s the issue that really hits home, how much more does it cost
health placements and the like to learn different communities and what you need to know about them before you can be a valued member within them; be culturally aware and remember that even as a student, you are a contributing member of the health care team! I believe that we have a moral responsibility to ourselves and the other members of our global population to be aware of the big issues, and pursue our role in them. Each and every one of us has a part to play. I urge you to remember that responsibility: take it on, pass it on and be relentless. If there’s one thing worth giving a damn about, it’s your fellow human beings. Sobana Thillainathan University of New South Wales
food for thought
to eat organic? There is definitely a price difference, but one that is lessening. The real cost it should be weighed against is, I guess, the cost to the environment. And what about fair trade? In an excellent article in the conference handbook, Khai Lin Kong discusses the ethics of fairtrade coffee and describes it thus: “Fair trade is a social justice movement aimed at alleviating poverty among small-scale farmers countries by setting a fixed minimum price for the sale of coffee beans.” These issues are clear and simple to list on a page, but standing there in the supermarket aisle, staring at sleek designs, glossy attractive images and catchy names, the decisions become more difficult. I stand transfixed before the shelves of tea. On the one hand, with the Scarborough-brand Fair Trade tea I had the potential to “alleviate poverty” and on the other, by buying Nerada Organic, encourage a more sustainable world. No-one said this was going to be easy. Jocelyn Chan The University of Melbourne
prodding the leftovers
Bright-eyed, or jaded from over the seas, or under the influence. I can barely stand the eagerness ... At least there’s instant coffee to go with my cynicism. Bring on the potato curry, and your tales of circumcision. Meanwhile, a stream lecture is cancelled: the speaker’s wife is in labour. Sweet things in a sickening climate. That reminds me: it’s a strange world out there, with strange social cures. Like dancing to drums and eating tortellini out of Chinese noodle boxes. I chew on my butter chicken and think of the starving children Change comes, you know, but it takes parties and a conference fee to prod me into contemplating it. Alyssa Chan The University of Melbourne AMSA GHN, Vector Issue 8, October 2008
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introducing the GHN
s some readers will be aware, another event exploring student inA volvement in global health was convened in the days leading up to the
Conference: the AMSA Global Health Network (GHN) annual meeting. The GHN is an AMSA body made up of Representatives from every medical school in Australia, drawn from, where relevant, the global health group within their university. Key to the GHN’s role is the aim of empowering medical students to create sustainable health improvements world-wide. At the annual meeting, incoming and outgoing GHN Representatives shared the progress made by global health groups at our universities, and committed as a group to our global health objectives for 2008-09. Key among these are our National Project, the Red Party, raising money and awareness for HIV/ AIDS treatment and research; and the development of a national advocacy agenda. This aspect of the meeting was particularly exciting, with the inaugural election of a National Advocacy Co-ordinator, and plans for advocacy activities relating to Australia’s compliance with the Millennium Development Goals.
easy to feel disempowered through lack of time, resources, influence or knowledge. However, as was made clear at the Conference, medi cal students have real power to make effective and genuine contributions to the cause of global health. It is the aim of global health groups, at a university level, and the GHN, at a national level, to provide pathways to student mobilisation in relation to global health. In the coming year, I invite you to be active and intentional in contributing to, and learning about, global health. It is perhaps clichéd and jingoistic to implore you to “be the change” or “be that generation”, but there is true and legitimate substance behind these slogans. It is within your power to join your medical school’s global health group; learn more about the GHN (a great starting point is the GHN website: http://ghn.amsa.org.au); plan, discover, explore, discuss, and create your concept of global health. GHC is over – but your role as an advocate and practitioner of global health is just beginning.
Part of our mandate as the GHN is to empower, inspire and connect medical students with an interest in global health. As students, it is
Tamara Vu AMSA Global Health Network Chair 2008-09 The University of Melbourne
c’mon kevin, let’s go to 0.7! “Sometimes it falls upon a generation to be great. You can be that generation. Let’s make poverty history”. These words formed the central theme for the recent AMSA Global Health Conference in Melbourne. Inspiring words, but often we are left to wonder… How? What can I do? Read on. The Millennium Development Goals (MDGs) are eight globally agreed targets that aim to make poverty history.. Agreed to by 191 nation states in 2000 at the UN Millennium Summit, the MDGs provide a framework for addressing poverty and its causes (http://www.endpoverty2015.org/) Central to meeting the MDGs is ensuring they are adequately funded. The work of economist Jeffrey Sachs showed that the MDG’s could be realised at currently pledged levels of aid contributions. If all of the rich countries fulfilled their agreed commitment to give 0.7% of Gross National Income (GNI), the MDG’s could be fully funded. Australia’s current aid levels are 0.32% with a commitment by the Rudd government to raise that to 0.5% by 2015/16. This is welcomed, but doesn’t go far enough. C’mon Kevin, Let’s go to 0.7. Introducing the Kevin Point 7 campaign. The Kevin Point 7 campaign calls for the Australian government to set a time-line for achieving the 0.7% GNI target for overseas development assistance by 2015, and to direct this aid toward achieving the Millennium Development Goals (MDGs). The aims of the campaign are simple; to increase the level of discussion about the MDGs and Australia’s role in working towards their success. How? Through utilising the passion of people like you, yes you!
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an do now What you c
This campaign is about raising awareness. It is about advocacy. We have created resources that will enable you to be effective advocates for this issue. All of this is available at www.kevinpoint7.com.
.com .kevinpoint7 • Visit www petition • Sign the friends • Tell your n Facebook o s urces • Join u ailable reso v a e th d a lo • Down old a talk an event. H g • Organise ou are doin h us what y etc) s o e id v • Share wit , , stories s to o h p s u (send
At the Millennium Summit the world stood together and in a renewed outpouring of humanity we collectively pledged to “spare no effort to free our fellow men, women and children from the abject and dehumanising conditions of extreme poverty, to which more than a billion of them are currently subjected.” We can be that generation that holds our political masters accountable. Through our collective voice we can ensure that “no effort is spared”. We can see Australia set itself on a pathway to fulfilling its commitments. C’mon Kevin, let’s go to 0.7. What are you waiting for? AMSA GHN, Vector Issue 8, October 2008
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Contact If you have any questions or great ideas, want to volunteer to help spread the word or want to get involved, please get in contact – we would love to hear from you! Fred Hersch Kevin Point 7 Campaign Director Chair, globalHOME (USyd) GMP3 University of Sydney fred@kevinpoint7.com
prize for prose winner CONGRATULATIONS to Jocelyn Chan (The University of Melbourne), Prize for Prose winner from the previous edition “Connections” for her article titled: “Climate Change and its Impact on Global Health” (www.ghn.amsa.org.au/ghn/vector.html).
news review Medical Tourism and public health sector in developing countries
Medical Tourism and public health sector in developing countries S.M. Wolfe argued that medical tourism shifted the focus of health services delivery in developing countries from prevention to treatment, not addressing the health needs of many locals. Full article: http://www.eldis.org/go/home&id=38012&type=Document Other related articles: http:/www.nytimes.com/2008/06/01/weekinreview/01sengupta.html?_r=2&scp=21&sq=heal&oref=slogin http://www.eldis.org/go/home&id=38009&type=Document
Tuberculosis and Diabetes
An epidemiological study in India concluded that diabetes contributed significantly to the burden of TB incidence in India, and suggested that current diabetes epidemic may lead to a resurgence of TB in endemic regions. Full document at: http://www.eldis.org/go/home&id=33977&type=Document
New Rapid tests for drug-resistant TB for developing countries
A WHO news article recently announced an initiative to introduce ‘line probe essays’ for rapid testing of Multi-Drug-Resistant (MDR) TB. It potentially reduces time taken to MDR-TB diagnosis from 2-3 months to 2-3 days. Currently only 2 % of MDR TB cases globally are being diagnosed and treated appropriately. Full article: http://www.who.int/mediacentre/news/releases/2008/pr21/en/index.html
Health care services, discrimination and abuse in the elderly population
A recent HelpAge international document highlighted the discrimination and abuse against elderly women in Burkina Faso. Witchcraft allegation against these women has led to abuse, violence and sometimes murder. Website: http://www.helpage.org/News/Latestnews/lKFm After reviewing elderly populations’ perception on the primary health care services in 5 Asian countries, another article urged for more elderly friendly services in the future. Website: http://www.eldis.org/go/topics/resource-guides/health&id=35089&type=Document
Tackling a global crisis: International Year of Sanitation 2008
UN General Assembly declared 2008 as the International Year of Sanitation. In this year, policy makers and key players at all levels are urged to act towards the goal of ‘sanitation for all’. Individuals (e.g. students) can help by fundraising, advocacy and involvement in NGO activities. Full document at: http://www.eldis.org/go/home&id=38090&type=Document
AMSA GHN, Vector Issue 8, October 2008
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Brain drain hampers effort to fight AIDS
Interview with global public health expert reveals staggering statistics on how the lack of qualified health care workers is affecting HIV-AIDS control in certain countries. Full article: http://www.alertnet.org/thenews/newsdesk/N03409726.htm Khai Lin Kong The University of Melbourne
thank-you
W e would like to say a huge thank-you to Cara Fox, Nicole Sandler and Nadine Ata the previous co-editors and publicity officer respectively. Their dedicated and impressive work saw both the Vector magazine and the website reach new and exciting heights! It is now the role of Nelu Jayawardena (The University of Melbourne) as Editor, Leanne Hoang (Monash University) as Layout Designer and Tharsiga Gnanasekaran (Monash University) as Publicity Officer to continue the legacy of Vector! Vector is the magazine of the AMSA Global Health Network Don’t forget to check out what your University’s Global Health Group has going on at the AMSA GHN website www.ghn.amsa.org.au If you have suggestions, feedback or are interested in writing for Vector magazine in the future we would love to hear from you at vectormag@gmail.com
Editor Nelu Jayawardena The University of Melbourne Layout Designer Leanne Hoang Monash University Publicity Officer Tharsiga Gnanasekaran Monash University
AMSA GHN, Vector Issue 8, October 2008
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