Auscultate

ISSN 2307-2849

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THE OFFICIAL IFMSA PUBLICATION FOR THE AFRICAN REGION

IFMSA was founded in May 1951 and is run by medical students, for medical students, on a non-profit basis. IFMSA is officially recognised as a nongovernmental organisation within the United Nations’ system and has official relations with the World Health Organisation. It is the international forum for medical students, and one of the largest student organisations in the world.

editorial team Editor-in-chief Tade Soji

Layout/design Akinwunmi Temidayo, Nigeria temidayoakinwunmi@gmail.com +234 802 269 0112

Content editors Animasahun Victor, Nigeria Biniam Melese, Ethiopia Poonanm Loyal, Kenya Abass Abdullah, Ghana

Proof-readers

The mission of IFMSA

Ajayi Tunde, Nigeria Helena Chapman, Dominican Republic Hollo Sondi, Tanzania Mead Elsharif, Sudan

is to offer future physicians a comprehensive introduction to global health issues. Through

Photographic editor Moiz Adamaji, Tanzania

publisher

students of medicine, intent on

International Federation of Medical Students’ Associations general Secretariat: IFMSA c/o WMA B.P. 63 01212 Ferney-Voltaire, France phone: +33 450 404 759 fax: +33 450 405 937 email: gs@ifmsa.org

influencing the transnational

homepage: www.ifmsa.org

inequalities that shape the health

contacts

our programs and opportunities, we develop culturally sensitive

of our planet.

publications@ifmsa.org

editorial

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Dear IFMSA Family,

Conflict exists at every level of relationship between humans and the manner it is managed determines the outcome of many things. Conflicts have resulted in deterrent effects on the social, physical and mental wellbeing of those involved which has made them un-healthy by the WHO definition of health.

The theme conflict and health is aimed at highlighting to us what conflict really means and our responsibilities as health care providers in cases of conflict. This edition shows us how as doctors in training we can prevent imminent conflicts, resolve existing ones and cushion the after effects of past ones.

In this edition, reports of sessions held in December 2012 during African regional meeting at Arusha Tanzania and highpoints of the East African culture were included.

I thank the editorial team for working tirelessly in ensuring a standard publication

tade SOJI EDITOR-IN-CHIEF

Regards; Tade Soji Editor-in-chief da.pub.africa@gmail.com

CONFLICT & HEALTH, Are they related? - 4 RAPE, Causes, Consequences &Future Considerations - 5 Conflict of Interest in Health - 6 Leadership & Health crises in Nigeria - 7 MIND MATTERS - 9 Makambo CityFM Studio - 10 Smoking among High School Students - 12 Striking at the expense of the Innocent - 13 Role of Health Workers in Peace - 14 East Africa Culture - 15 Think in earnest of these - 17 African Regional Meeting Report - 18 toonREFLECTIONS - 24 PUZZLE - 26

contents

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injury.

Ibeaja Ikechukwu N.C ABIA STATE UNIVERSITY, Nigeria

CONFLICT &HEALTH are they related

Second, where ideas or beliefs create a conflict among a group of people, it may negatively impact health oF the community members. For example, the tragic fatalities of the Pakistan aid workers in the polio vaccination campaign lead to an increased number of children in Pakistan that became infected with the polio virus.

Third, due to differences in beliefs in the traditional healthcare methods in certain African countries, many patients fail to comply with hospital treatments or take preventive measures for health or illness.

Fourth, we can observe the impact of physical violence and stress, including high-risk groups of commercial sex workers or U.N. health workers in global conflict zones. In addition, the Syrian war has left many families homeless and children orphaned, which has not only resulted in an increased health care burden, but also has negatively impacted the health of health care workers.

Everyone can talk about one conflict or another at any point across the lifespan. Although most conflicts do not lead to physical abuse, other types of conflicts can seriously impact our state of health, including warfare between countries or sects, stressful foreign policy, misunderstanding of beliefs, In general, maintaining health requires a positive or mental and social trauma that result from mindset that exists in peace and harmony with the disagreements. norms and values acceptable to the world. At the same time, positive health can be promoted through We should first define the terms “conflict” and practices that minimize exposure to conflict and “health”. According to Oxford Dictionary, conflict is emphasize healthy behaviors, including routine defined as a “serious disagreement or argument” or medical checkups, lifestyle modification by avoiding “state of mind in which a person experiences a clash tobacco use and excess alcohol consumption, of opposing feelings or needs”, which includes a implementing daily nutrition and exercise and “serious incompatibility between two or more increasing positive interactions with family and opinions, principles or interests” (1). The World friends.

Health Organization (WHO) defined health as a “state of complete physical, mental and social well- REFERENCES: being and not merely the absence of disease or (1) Oxford Dictionary. Conflict. 2013. Retrieved infirmity” (2). on February 1, 2013, from: Since these definitions illustrate the related concepts of conflict and health, we should consider some concrete examples of this relationship.

First, when there is a conflict within the country or between two countries, where the conflict leads to warfare, national citizens may suffer from psychological effects, malnourishment and even

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http://oxforddictionaries.com/definition/en glish/conflict (2) World Health Organization. WHO definition of health. 2003. Retrieved on February 1, 2013, from: http://www.who.int/about/definition/en/pri nt.html

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RAPE!

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Causes, Consequences & Future Considerations

Jaynika Solanki

HKMU , SECOND YEAR MD NOME – IFMSA- TAMSA, TANZANIA

The World Health Organization (WHO) defines rape as the “physically forced or otherwise coerced penetration” (1).

However, some people believe that rape is an act of power, not just about physical pleasure.

Across the world, one rape incident has been reported to occur every 6 minutes. However, statistics on rape incidents vary per country and continent. In the United States, it is estimated that 1 in 5 women is raped at least one time in her lifetime. In 2008, Egypt reported 0.1 rape cases per 100,000 people, whereas Lesotho reported 91.6 rape cases per 100,000 people. In India, with concerning statistics of rape as a common crime against women, 76% of women mention that they were raped when they were children and 40% state that they were raped by family members Question: What are the causes of rape?

How can rape happen?

Although we may never confirm all causes of rape, clothing, lack of education and power play major roles in increased risk factors for rape incidence. First, wearing short clothes as “out of culture”, African men may rape women in Kariakoo of Dar es Salaam, Tanzania. Second, young poor girls are easy targets for intoxicated men who can easily rape them in their huts (2). Third, men who desire power can “gang rape” women in Rukwa-Katavi region. With gender discrimination, husbands can rape their wives and cause women to feel vulnerable and dependent on their husbands.

Question: How can rape affect health status?

Effect of rape on physical and mental health Physical harm may range from mild to severe injury of the genital organs. Psychological harm may include various symptoms, including depression, disturbed concentration, sleeping patterns and eating habits, stress disorder, phobias, anxiety, social isolation, thoughts of suicide, frustration or traumatization. These effects may also affect employment status (e.g. unemployment, entering prostitution), acquisition of sexually transmitted infections (STIs) like HIV/AIDS, unwanted pregnancy, selfblaming as “victim” for rape incident, or stressful situations, including forced marriage to the rapist as per biblical law or to avoid family and social stigma.

Question: What are we doing as a community to increase rape awareness?

How can we help?

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Since many parts of the world never see justice for rape crimes, we all need to raise our voices against rape!

I n Ta n z a n i a Zanzibar, victims of genderbased violence (GBV), parents, and activists joined forces to raise awareness against police and judiciary ostensibly for injustice on sexual abuse cases, including rape. Many community citizens show support and solidarity by organizing community vigils and rape awareness campaigns that target all education levels. Even Rapper Angel Haze composed various songs against rape and sexual abuse for the awareness campaigns.

Question: What are our future considerations?

Reflections With multiple incidents of rape and violence against woman in Africa and across the world, we need to consider rape as a human rights issue. After all, violence does not have class, religion or nationality, but it does have gender since more females are victimised for rape then males.

Since most perpetrators of rape and sexual abuse are men, this does not mean that all men are violent! Men may be abused as children or even raped in prisons. With society's attitudes on homosexuality, many victims choose not to share their experiences. However, we need to promote rape awareness to men and women in our society for optimal mental and physical health.

Spread rape awareness to create peace mentally, physically and socially!

Bibliography: (1) WHO. Chapter 6: Sexual violence. 2002. Retrieved on 01/02/13, http://whqlibdoc.who.int/publications/2002/9241545615_chap6_eng.pdf (2) Pearson L. Tanzanian girls risking rape for an education. 4 Mar 2011.

Retrieved on February 1, 2013, from: http://www.bbc.co.uk/news/worldafrica-12640342 (3) Ministry of Justice. 11th January 2013. retrieved on 20th February 2013, from: . http://m.guardian.co.uk/uk/2013/jan/10/sex-crimes-analysisengland-wales (4) India Tribune. Rape statistics around the world. 29 December 2012.

Retrieved on February 20, 2013 from http://www.indiatribune.com/index.php?option=com_content&view=article &id=10195:rape-statistics-around-the-world &catid=107:coverpage&Itemid=47 (5) Jaba. Daily news, 27th dec 2012, by Jaba, retrieved on 20th February 2013 from: . http://allafrica.com/stories/201212270007.html (6) By Mariam Omar-BBC Swahili Service, 21ST JULY 2005, RETRIEVED ON 20TH February 2013 from: http://news.bbc.co.uk/1/hi/world/africa/4687209.stm (7) Ratsatsi P. 16 March 2007, Retrieved on 20th February 2012 from: http://www.thephora.net/forum/showthread.php?t=25043 (8) Thekaekara MM. Another shocking rape attack in India. 20 December 2012. Retrieved on February 20, 2013, from: http://newint.org/blog/2012/12/20/rape-attack-delhi-india

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Lara Andrade SECRETARY, IFMSA BRAZIL

Conflict of interest in Health

In a trauma hospital usually patients suffering from violent injuries. So it was no surprise at all, when a man was brought ,he has been stabbed on the chest. Obviously, he needed a surgery, which was performed by a great and experienced surgeon.

Being a thoracic surgeon for many years, he knew exactly what to do to save that man's life. Everything went well, until the time came to suture the patient.

See, even a medical student knows that to suture a bone, you must use steel wire. But there was none in the hospital.

“No, you don't have to read it again!.” Says Iara.”Have you understood the situation quite right?”

At a public trauma hospital in Brazil there was no steel wire. And let me tell you, it is sold really cheap.

Now, I can almost hear you asking me “how come?”

See, in Brazil the public health system is called Sistema Único de Saúde – SUS (the translation would be something like “Unified Health System”).

Every Brazilian citizen has the right to go to a public hospital and get health treatment. The State has to provide the treatments, equipments and everything that is needed and it is sustained by taxes paid by people. The money from the taxes goes to Federal Government and gets distributed between states and cities according to their needs and some criteria.

“Beautiful, isn't it?”says Iara. “ Mmmh, I don't know about you, but I just loved the idea of a health system that provides health care for an entire nation, a system that does not make a difference between a homeless person and a politician.”says Iara Well, thank you for the information, but you didn't explain the situation you described at the beginning, Iara.

“I know, I know. Calm down, I'm just about to say it. I told you about health system in Brazil or at least what it was supposed to be like. The problem with many people who supposedly works for the system wants a share of that money. “ Did they earn it? Then why do they need it?

“No, Absolutely no. But they want it anyway! Let's see, for an example, Rosalba, graduated in Medicine and governor of Rio Grande do Norte (RN) state where the hospital I mentioned is located.

None of the governors who came before her had more money than she has done use in public health.

Even though, state hospitals in RN are going through a huge problem. At this trauma hospital, they are missing materials, medication and even a saline.

“Let's get back to that thorax surgery.” says Iara,” You have a patient lying on the table with his chest opened, you have to suture him but there is no steel wire at all. For the surgeon felt he had to do something about it. For a long time now healthcare workers have complained about bad working conditions, organizing strikes. Then he decided to do something different. He turned on a camera and made a video, explaining what was happening. He edited the image so the patient wasn't exposed. That CONTINUED ON PAGE 8

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Njoku Kingsley Kalu1 2 Ugege Princess Omoduwa

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1

final Year Medical Student, College Of Medicine, University Of Nigeria faculty Of Law, University Of Nigeria, Enugu Campus

2

-AN OPINION

LEADERSHIP CRISIS AND HEALTH CRISIS IN NIGERIA The first wealth of a nation is its health. There is empirical evidence that the health of a nation significantly enhances its economic development, and vice versa. It has been said that in all societies but especially in the developing countries, health care is inextricably linked to a nation's political and economic system. Medical underdevelopment is a necessary feature of economic underdevelopment.

Nigeria is a typical example of a developing country.

In Nigeria, there have been a lot of efforts to increase the health indices of its citizens especially with the country contributing almost 10 percent of the worldwide maternal mortality rate.

Worrisome though is the internal crisis plaguing the health care system. It is a notable fact that Doctors are the leaders of the healthcare team. It leaves little to be desired when the leader of the healthcare team lacks the requisite management skills. Corruption becomes easily purported especially with the covert support of the other healthcare team. This individual will thereafter turn to accuse the leadership of corruption and seek to usurp their position.

This has been clearly demonstrable with the internal crisis in the healthcare system. The Nigerian Medical Association is the apex decision making body in matters of welfare pertaining to medical and dental practitioners. Her goal is to reposition the healthcare system in Nigeria by involving the key decision makers especially the Chief Medical Directors of Federal Teaching Hospitals and the legislatures. It is largely believed that the National Health Bill currently before the Legislature which is expected to provide adequate and efficient health to even the poorest Nigerian has a lot of contribution from the Medical apex body. (As a result, other healthcare workers especially the nurses, pharmacist, medical lab scientist assumes overbearing on the part of the medical practitioner) (should be cut out). This was further reinforced by the perceived marginalisation of the other healthcare workers in assuming the role of Chief Medical Directors!

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As harmless as this issue may be, it assumed a national dimension further exacerbating the already existing poor health indices in Nigeria. The leadership crisis became a health crisis. Instead of being involved with providing the needed service to the Nigerian populace, the Joint Health Sector Unions (JOHESU) comprising of Nigerian Union of Allied Health Professionals (NUAHP), Nigerian Union of Pharmacists, Medical Technologists and Professionals Allied to Medicine (NUPMTPAM), Senior Staff Association of Universities, Teaching Hospitals, Research Institutes and Associated Institutions (SSAUTHRIAI), National Association of Nigeria Nurses and Midwives (NANNM), Medical and Health Workers Union of Nigeria (MHWUN) and NonAcademic Staff Union (NASU) massed together against the leadership of NMA in various media and open confrontations. In a statement made available to a leading tabloid, members of the union said the Nigerian healthcare system, as it currently stands, does not favour health professionals, except medical doctors and dentists under the aegis of the Nigerian Medical Association (NMA)

The group reiterated the need for the removal of the current ministers of health and replacement with ministers from both NMA and JOHESU. They accused the minister of seeking to "institutionalize the professional chauvinism of medical and dental practitioners as against international best practice".

Even the National Health Bill believed to help Nigerian Health indices came under attack.

According to the union, "The truth...is that the letter and spirit of the earlier bill have been distorted by NMA and medical practitioners with Prof.

OnyebuchiChukwu (Current Nigerian Minister of Health) as their arrow head, sacrificing well-thought out mechanisms and processes for quality healthcare to Nigerians on the altar of medical doctors "supremacy," It becomes worrisome when industrial actions were CONTINUED ON PAGE 8

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CONFLICT LEADERSHIP CRISIS AND ...CONTINUED FROM PAGE 7

-AN OPINION

of interest HEALTH CRISIS IN NIGERIA in Health

video was seen all over the country and everywhere people talked about it. Of course, Rosalba didn't like it very much.”

Now, you might think she provided the hospital what they needed, since it was all exposed. She came up with some lame excuses for everything. Well, let me tell you now, “ She did two things: 1) she asked the doctor why he started the surgery if there was no steel wire; 2) she decided to report the doctor to medicine council for exposing the patient. “said Rosalba.

According to Rosalba, he was not being ethical when he filmed the procedure.” But I guess too it is not ethical to let the patient die without even trying to help him. “Says Iara.

This kind of situation is common in many hospitals in Brazil. I mean not only this, specifically, but is it usual for the doctors and others health workers (and patients) to live with no good working conditions, lack of material and sometimes no payment at all.

And if the doctor doesn't accept to work in such conditions, people call him' a mercenary'. If he tries to do something, even though everything is missing, and the procedure doesn't end well, then he will be accused of risking the patient's life.

Honestly, it doesn't happen in all public hospitals, but most of them do. And this is how we go on with an eternal battle between health workers and government.

“Now, I'm sorry. This was not much of an article ”says Iara,” I'm not a reporter, I don't know how to write like a professional. I wrote this letter for I'm not only an outraged medical student but also a citizen that can't stand watching patients hospitalized on a chair on the hallway and babies being born on the floor while people dying without the help they need.”

“Doctors are overloaded. I'm doing what I can, locally. But I felt like it is time to tell someone about this reality. Because I think today there's no bigger conflict than this, how much does a life cost? How low can greed take us?” asks Lara.

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embarked upon by this union to the utter detriment of Nigerians. One starts to wonder the trouble with Nigeria. A quick look at the aggrieved party demonstrated that most of these individuals were once persons who could not survive the medical school and was relegated to the paramedical and who have swore to become antagonistic to policies that the perceived emanates from the NMA or her members. This is very evident when you read the profiles of some legislatures who have vehemently opposed doctors simply because of embedded grudge of no reason. In their statement, they exclaim “it is because of structural lopsidedness and the unfair representation of other desirable health professional groups at decision making organs of our health system that Nigerian health services are rated as one of the poorest in the world with the lowest health indices, even in Africa.” Their solution ;“Solution to these problems is a complete transformation of the national health system beginning with the immediate removal of the present two ministers of health”! A study of this statement will reveal to discerning persons that there is a premeditated grudge.

Instead of being engrossed with worries about the leadership of the health care, the allied health care workers should be satisfied with their dignified position in serving as an eye of medical practice instead of battling continued exclusive role of medical practitioners as the Chief Executive of hospitals. They should be proud of their services to the nation and in turn posterity will remember them for their service.

Massing together against the existing structure is certainly not in the best interest of the Nigerian citizens but an attempt to satisfy selfish political desire. The medical and dental practitioner as leaders of health care team should be more proactive. Strong managerial skill should be acquired and the Hippocratic Oath should be deeply honored and applied. They should vehemently shun corruption in all its forms. They should abhor the syndrome of "settlement", but insist on justice and equity and due process at all times, and not allow themselves to be distracted or blackmailed with misguided protests and strikes.

“To whom much is given, much is expected”.“ A stitch in time”, they say, “ saves nine”.

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affected by conflict are not only affected by mental health problems, but have associated dysfunction, which can last up to five years after the conflict. This persistent dysfunction is a constraint in reconstruction and development efforts of a nation.

Meggie Mwoka 4th Year, University of Nairobi The WHO also estimated that, in the situations of Kenya armed conflicts throughout the world, 10% of the people who experience traumatic events will have serious mental health problems and another 10% will develop behavior that will hinder their ability to function effectively.

MINDMATTERS

Therefore psychological intervention is of high With recent cases of crisis in Côte d'Ivore, Libya, importance in addressing mental and psychological Democratic republic of Congo (DRC), Sierra Leone disorders as a result of conflicts as it leads to: and other African countries it would not be wrong to  Empowerment and education of the say that most countries in our beautiful continent community in addressing and recognizing live in constant fear. War and civil strife has and is mental and psychological disorders. destroying and disrupting our communities and  Encouraging communities to form support families and the social and economic fabric of our groups diverse and historical, cultural and resource rich  Promotion of planning and implementation continent. of mental health policies by the government, NGO's and donor organizations Every day the media brings devastating news and  Demystifying mental health images on the horrifying effects of these conflicts;  Coverage of all aspects of health mainly focusing on the physical, social and  Strengthening development and reeconomic effects. Mental health effects which are establishment of various sectors in the important in ensuring holistic health and which is country. one of the most serious accompanying effects of conflicts is not well highlighted.

Violent acts such as targeted killings, gender-based `HEALTH´ is a state of complete physical, mental violence and physical maiming often have long- and social well being and not merely the absence of term psychological effects on those who have disease or infirmity.' (WHO Definition). If we adhere experienced or witnessed them. Widespread to this meaning whenever we deal with health issues insecurity, increased poverty, forced displacement, regardless of the cause we will create a system restricted movement, harassment, intimidation, where there is provision of wholesome and quality lack of basic services such as healthcare, education, health care. housing, water and sanitation, serve as catalysts for References: the emergence of psychiatric disorders that otherwise might have remained dormant  Mental health in Africa: the role of the WPA AHMED OKASHA1

The commonly encountered mental disorders associated with conflicts include Post-Traumatic Stress Disorder (PTSD), anxiety disorders, somatization disorders and chronic depression.

These conditions, in turn, can lead to suicidal behavior, chronic alcohol and drug abuse, interpersonal violence, and other signs of social dysfunction.



Mental health consequences of war: a brief review of research findings R. SRINIVASA MURTHY1 and RASHMI LAKSHMINARAYANA



Conflict and mental health- John Hopkins Bloomberg school



WHO resources

Studies by Mollica et al. indicate that populations

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Marko Hingi

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MD3 Student, Catholic University of Health and Allied Sciences-

BUGANDO-Tanzania

“CONFLICTS & HEALTH Africa”.

TANAPA (sponsor): Serengeti National park, Tanzania's oldest and most popular national park, Announcer: Dear listeners, welcome to your favorite radio station and today we will discuss the located 335km from Arusha, stretching north to Kenya and bordering Lake Victoria to the west. topic: “conflicts and health in Africa”.

Good enough, we have two guests; one from Mlowa University and another one from Ilamba University Announcer: OK let's go on with our discussion. Mr. Basil, what are the enabling factors behind conflicts of Health and Allied Sciences. in Africa?

We have Mr Basil from School of Social Sciences and Ms. Sophia who are students from School of Medicine at Mlowa University and Ilamba University Mr. Basil: emmm… Conflict in Africa is precipitated of Health and Allied Sciences respectively. I am glad by several factors which can be external and internal factors, but today, I would like to concentrate much to welcome both of you to Makambako City FM. on internal factor.

Some of the internal factors which promote conflicts Guest: thanks dear announcer. in Africa include centralization and personalization, TANAPA (sponsor): Tanzania is the centre of lack of accountability, lack of transparency, lack of national parks in East Africa; welcome to rule of law, lack of peaceful transition mechanism Kilimanjaro National park located in Northern together with absence of human rights. There are also environmental problems creating conflicts such Tanzania, near town of Moshi. as water and land shortage and environmental Announcer: May I start with Mr. Basil, can you tell degradation. us what you understand by conflict?

Announcer: hmmm… This is so amazing as internal influences contributing towards conflicts Mr. Basil; Yeah I always love to define conflict as an ongoing process of variable intensity involving are so numerous. multiple interactions over time in which people not Dear listeners, you can send your contribution via only have differing and sometimes incompatible our facebook page at Makambako City FM. views on facts, goals, methods or values but sense Our discussion is becoming so interesting. Let's go interference from one other in the achievement of back again to Basil, as a social science student, can you give us a brief analysis of expenditure during valued outcomes. war times in relation to health expenditure.

Announcer: Thanks for your nice definition. OK, now let's move on to Ms Sophia. How can you define Mr. Basil: I can categorically state that most times during war times, the expenditures are always health? larger compared to health expenditures; there are Ms Sophia: I will love to stick with the definition of some examples which prove this. In 1990, the ratio health by World Health Organisation which says of military to health spending was; 16:1 in Ethiopia, that “health can be defined as the state of complete 10:1 in Sudan and 14:1 in Angola. Another physical, mental and social well being and not amazing example was during the early eighties, Nigeria purchased battle tanks from Britain at a cost merely the absence of disease or infirmity.” that could have immunized 2 million children and provided family planning services to 17 million Announcer: Thanks Ms Sophia. Dear listeners, you are still listening to Makambako City FM 123.8MHz couples. Let me stop there for now. and today's topic is about “Conflicts and Health in

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Announcer: These scenarios are really an eyeopener. Now to Ms. Sophia, please, give us an over view on the health status in Africa during war times

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CONTINUED FROM ....

Ms. Sophia: Thank you. During war, there is increased rate in transmission of sexually transmitted diseases like HIV/AIDS, increased rate of transmission of communicable diseases like malaria. Also, the child mortality rate reaches its peak and disability-adjusted life expectancy drops Announcer: Welcome back dear listeners, Its still significantly. Again, the ratio of inhabitants to doctor Makambako City FM and today's topic hinges on “Conflicts and Health in Africa.” is grossly sub-optimal.

From our facebook page, Cephas from Mwanza Announcer: It is so sad that we have thee great says our discussion is good, also, Tulanukila from Iringa says she is happy to have interesting problems still prevalent in Africa. information from our guests.

OK. Let us take a short break and hear from our Time is running out very fast. Let us begin to sponsors. Please don't touch that dial. conclude today's discussion. After exploring various TANAPA (sponsor) Saadani National park where issues concerning conflicts and war in Africa, the beach meets the bush, located on the north starting with Ms. Sophia what's your final word.

“CONFLICTS & HEALTH

coast, roughly 100km northwest of Dar es Salaam Ms. Sophia: Thank you very much, announcer. Let's as the crow flies. take conflict in the society as a public health issue.

Public health trainees, organizations and Announcer: Ms. Sophia, what are the health effects professionals should acquire skills for conflict of war? mediation and prevention of war through Ms. Sophia: War greatly affects the health of the education, advocacy and direct participation. I community. Apart from death, there is also resultant strongly believe that these can bring about good injury and long term disability, increase in rape, outcomes. torture, post traumatic stress, long term mental Mr. Basil: Thank you very much, announcer. This is health problems. my final submission; if war has begun, we should work to limit the health and environmental Announcer: Mr. Basil, can you please build on consequences and when war ends, we should care these? for victims and strive to minimize the long term health consequences of war. But this can only be Mr. Basil: Other effects of war are as follows: deterioration and destruction of health, social, successfully by employing a multi-disciplinary economic and political infrastructure. This leads to approach as all stakeholders should put all hands reduced access to basic health prerequisites such as on deck to make this possible. food, shelter, clean water, education and health services also also widening of the gap between the Announcer: We have come to the end of today's rich and poor in terms of income, access to health session and I would like to thank you dear listeners for your time. Special thanks to my guests for their care and health status. brilliant contribution together with our sponsor Announcer: There is nothing more to be proud of Tanzania National Parks (TANAPA). like peace. Also, war causes an increase in Say a big NO to conflicts and maintain peace communicable diseases like malaria, meningitis always.

Always keep in touch with Makambako City FM. and typhoid.

TANAPA (sponsor): Ruaha National Park; where game viewing starts the moment the plane touches down, located central Tanzania, 128km west of Iringa.

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TANAPA (sponsor): Kitulo National Park, Kitulo refers to the Kitulo Plateau as “Bustani ya Mungu”The garden of God, located in southern Tanzania, 100 km from Mbeya city.

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prevalence of both smoking trial and continuance among high school students in both genders.

Wala Adil M.A. Salman MedSIN-Sudan

T h e consequences of smoking are underestimated despite the fact that the negative effects of smoking on health are known, and warnings on the cigarette packages are mandatory.

During the last years, the percentage of adolescents that smoke tobacco has increased dramatically.

About 20% of young teens (aged 13–15yrs) smoke worldwide. 80,000 to 100,000 children begin to smoke every day. Half of those who begin smoking in adolescent years are projected to go on smoking for around 15 to 20 years. And a study revealed that 6 out of 10 teenagers that start smoking on regular bases during their teenage years will continue smoking as adults. With the knowledge that very few of them start smoking with the intention to keep smoking, we must draw our attention to the reasons behind their intention to smoke, and then aim at eliminating teenage smoking.

The specific objectives were:- To access the knowledge of high school students on the health effects of smoking.

- To identify the things encouraging high school students to try and continue smoking.

- To measure the prevalence and assess the causes of quitting.

- To measure the average number of cigarettes smoked per day and the places they are smoked.

This study interviewed 400 students, 200 females and 200 males from 2 private and 2 public schools representing the high and low socioeconomic status in the capital of Sudan.

The ages ranged from 15 to 18 years.23.25% of the high school students have tried smoking and 4.5% continued to smoke. Prevalence of trial is higher in public school while the prevalence of continuance is higher in private schools. Both smoking trial and continuance are higher in males than in females.

The commonest reason established for trial, is to live a new experience while the commonest reason for continuance is the relaxing effect of smoking.

Majority of the students tried smoking between the age of 10-15 yrs, with no difference in the starting age for both genders. A smoking family member had a great influence on an adolescent adopting the habit. Most smokers quit smoking, but majority went back to it. Although they did come back to the habit, most believe they are able to quit if they decided to.

The main reason why they think of quitting is the harmful effects of smoking on health. Most teenagers smoke on the street in the absence of parental supervision and where the meet with their peers.

They smoke an average of 0-2 cigarettes per day.

The WHO(World Health Organisation) in 2004 projected 58.8 million deaths to occur globally, from which 5.4 million are tobacco-attributed. 70% of the deaths are in developing countries. By 2030, the WHO forecasts that 10 million people a year will die of smoking-related illness, making it the single biggest cause of death worldwide, with a recent increase among women.

Majority of smokers think they know the effects of smoking on health, but when they were asked to Since smoking is a modifiable risk to health, the mention 3 harmful effects, most couldn't. quality of health and the life expectancy can be Interestingly, the adolescent smokers admit improved by identifying the reason why people start smoking is unacceptable by the society in which smoking and try to stop the initiation. they live, nevertheless, the prevalence of smoking The general objective of the study I conducted in the among high school students still increases. capital of Sudan, Khartoum, is to measure the

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Audrey B. Mwashilemo Catholic University of Health and Allied Sciences (CUHAS-BUGANDO), Mwanza,Tanzania

STRIKING

AT THE EXPENSE

OF THE INNOCENT In early 2012, doctors' strike in Tanzania was as a Tanzania stokes anti-government sentiment, result of failed negotiations between the patients are left unattended to and there is increased mortality rate. government and the doctors.

Also, there is anxiety by the broader public and misunderstanding among the Medical association, Government and other institutions.

The doctors demanded for better payments and improved working conditions in public hospitals across Tanzania, and the failure of the government to meet these resulted into several deaths of common people who have no responsibilities in the course of the strike.

However, despite many efforts, personal opinions remain in each victim of the strike.

The government is responsible for all financial matters concerning doctors' work in public hospitals.

The government must provide resources for doctors to work with so as to enable them provide qualitative health services to the people.

Most people see this move as violating professional vows as the hub of the doctors' strike since they are presumed to get more benefits compared to other civil servants and hence, they are not in the low income bracket.

In cases where the government cannot provide necessary resources for doctors, the quality of services offered to the people on behalf of the government is compromised. Thus, the doctors' ability to act in the best interest of the patients is impaired.

At the same time, science and medical students are demoralized and discouraged from joining the profession as they feel the remuneration is relatively meager compared to the enormity of their task.

We can falsely blame the doctors for their lack of patriotism but we ought to know they are pushing Unfortunately, majority of health care service users for reform in the health sector which has been in Tanzania do not understand this. People think that neglected with impunity. Most of the doctors keep as far as doctors were trained by tax payers' money, lamenting that they have not been able to save lives because of poor facilities. they must provide services regardless the situation.

There is a need for people to understand the In lieu of this, the government should provide relationship between governments, doctors and medical care at an affordable cost to the need and stop forcing doctors to function excellently under the them. sub-optimal conditions.

When strikes are embarked upon as a symbol of solidarity among doctors, the high cost of living in

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Mwongeli Matheka MSAKE(Kenya)

THE ROLE OF HEALTH

WORKERS IN PEACE: Peace through health The World Health Organisation defines health as “not merely the absence of disease or infirmity” but, more holistically, as a “state of complete physical, mental and social well-being”. War or conflict of any kind, thus affects the health of the community and the nation as a whole. Healthcare providers therefore should play an important role in promoting peace. Peace through Health, then, refers to those ways that peace is advanced through work from the health sector. There is a long history of health workers involvement in war and this approach has been tried and tested and proven to be successful in promoting peace.

There are several mechanisms that have been employed in the Peace through Health approach.

They are not unique to health professionals but each is highly suited to health professionals.

Health related super-ordinate goals These are goals which are common and important to the warring parties. Healthcare workers may work towards negotiating a deal between the parties that will help them achieve their goals and foster peace and co-operation. For example ceasefire for immunisation was initiated in El Salvador for 3 days every year from 1985 to 1992 when a peace accord was signed.

Evocation and extension of altruism This involves extension of healthcare to out-groups.

This pushes the boundaries of healthcare and resists dehumanization of the enemy. Healthcare workers from the different parties may work together in providing service to the people. This has been employed by the Palestinian-Israeli Health Services.

Discovery and Dissemination of facts War and conflict in general has been associated with propaganda which further fuels the fighting.

Healthcare providers are in a position to discover

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and make accurate information available to the people.

Redefinition of the Situation War can be portrayed as a game, a contest of egos.

Healthcare workers come into direct contact with the suffering that results from war. They can therefore promote a different understanding of war.

Initiatives such as The Physicians for the Prevention of Nuclear War have been working to redefine war and prevent it.

Diplomacy and Mediation Doctors are at times able to access the highest political offices in a nation while maintaining high credibility with members of the general public.

Doctors may even have a higher credibility rating than politicians. They can therefore be trained to undertake diplomacy, mediation and facilitation of dialogue between warring parties.

Solidarity and Support Healthcare workers are regarded with respect in society. They can therefore draw on their legitimacy, experience and expertise to undertake high level advocacy on behalf of the people. They can also partner with other peace-seeking organisations to provide essential resources and expertise. This linkage may also work in favour of the medical personnel to provide security as they deliver health services.

Dissent and Non-Cooperation Non-cooperation may be in the form of protest, persuasion or intervention of healthcare workers when they are called upon to collaborate in unjust policies that promote or perpetuate war. Again they draw on their legitimacy and expertise. They have the support of international law and declarations targeted at health workers.

As a healthcare worker you could choose to treatonly the problem under your nose—gun injuries, humanitarian needs,health system reconstruction, or hopeless, angry, indigenous youth. Oryou could turn your gaze “upstream” to the sources of the health deficits in the hope of acting preventively.

Bibliography: 1. GreameMacQueen, Joanna Santa-Barbara British Medical Journal Vol. 321 29th July 2000.

2. McMaster UniversityPeace through Health.

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Helga Mutasingwa

3rd year Hubert Kairuki Memorial University (HKMU), Tanzania

Catherine Mbeseni

2nd year Hubert Kairuki Memorial University, Tanzania

Rispah Walumbe Final year University of Nairobi, Kenya

East African

culture Jambo!

Karibu kwetu Africa Mashariki!!

The East African countries are held together like a string of sea shell beads along coastal waters, Tanzania, Uganda, Kenya, Burundi, Rwanda, the countries that primarily make up the Swahilispeaking region of East Africa in a concise manner, though the cultures are diverse all share some similarities, these similarities can be as little as the busy streets with car horns honking to as large as the very heart of what makes us all unique, which is the exquisite food, stylish clothes, the amazing instrumental music & lifestyle.

The Khanga

Matoke

Geography Geographically, the region is bordered on the eastern side by the Indian Ocean though Uganda, Burundi and Rwanda remain land locked. It is well known for its astonishing physical features from the highest peak in Africa Mount Kilimanjaro located in Tanzania, Mount Kenya, to the Great Rift Valley which runs from the north to the south of Kenya, to Lake Kivu in Rwanda (the highest lake in Africa).

The region is also famous for its game reserves located at the Serengeti and Ngorongoro crater in Tanzania and Masai Mara in Kenya. East Africa's governments recognize the value of their natural resources and have set aside large areas as national parks. Twenty-five percent of Tanzania's land is designated as national parks or game reserves.

History According to the theory of recent African origin of modern humans, all humans originate from East Africa. Some of the earliest fossilized hominid remains have been found in East Africa, including those found at Koobi Fora in Kenya and Olduvai Gorge in Tanzania.

The region was colonized by the Arabs, British and Germans; they have influence on our food, music and language.

Language In the African Great Lakes region, Bantu languages like Kikuyu and Kamba, Luganda, sukuma and Haya are most widely spoken; Nilo-Saharan languages, such as Luo, Kalenjin and Maasai, are also spoken in

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East African

culture

complex arrangements of women's hairstyles and khanga's make the East one people. lesser numbers. The languages are slightly similar but are very different. Swahili, with at least 80 million speakers (as a first or second language), is an important trade language in the Great Lakes area, and serves as the national or official language in Tanzania, Kenya and Uganda. French in Rwanda and Burundi remain important in higher institutions.

Swahili is also spoken in Congo, Northern Mozambique and Comoro islands.

Khanga is a versatile fabric that can be worn in many ways at different occasions, it is usually wrapped around the ladies waist, but with upcoming fashion even designers from overseas are using it in their designs. Kitenge is an African garment similar to a sarong, it has the same uses as that of a khanga or a maasai kikoi. Another interesting clothing from the region are the Maasai kikoi worn by the Maasai.

Cuisine

Kiswahili is the Swahili word for the language, it is Ugali (stiff porridge), meat stew, Chapati (round flat widely used in the region and is a mixture of bantu bread almost like a naan), Matoke (cooked and Arabic. bananas), groundnuts, Pilau, and various sea foods are only some of the few out of many food cuisines Music and literature that East Africa has to offer. There is use of several spices ranging from rosemary, cloves, pepper, Poetry & music poetic, musical expressions are also turmeric, cumin and ginger in food for seasoning. an important feature of east Africa. Music is the spice to any event.

Swahili music, Taarab is In conclusion our greatest asset is our hospitality, of poetically rich and soothing. the most important things to us is family, it goes beyond the household and includes the entire The Maasai dance or Adumu ( meaning "jumping community. dance") another symbol of beauty, strength and musical expression. There is also a growing western Our culture is diverse, rich, deep and most of all its classical music scene namely hip hop and funk, beautiful; we are one huge family always working somehow influenced by more traditional African towards embracing each other's differences and music, Kapuka, genge and bongo flava. building on our strengths. Just as in most African societies, the child is raised by the community. We Kenyan literature is also very important to our have a sense of sharing, family and togetherness culture and dates back to before they gained independence in 1963. Renowned authors include Ngugi wa Thiongo, Binyavanga Wainaina and Wangari Maathai who was also a nobel peace prize laureate. Poetry is also very important and more young people are getting involved.

Dressing East African art in most tribes elaborate their beauty in patterned beautiful colorful bead work, the Maasai are masters at this. Style and design in accessories, jewelry, ornaments, embroidery, Masai Kikoi

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THINK IN EARNEST OF THESE Abukari Yakubu Natogmah School of Medical Sciences KNUST Kumasi, Ghana.

Now it is 10pm. With the help of some men around, this patient is finally subdued and given his drug. This lady Doctor now steps out of the hospital, depressed. She doesn’t have a husband to go home to for comfort. Even if she did, what if her husband is also a busy medical Doctor on duty that night too. She has not been paid yet and doesn’t have a car. Her friend who usually drops her off is on leave. Her station’s trotro bus service has closed and her only option is to charter a taxi. Don’t forget the grim risks The weary House Officer, who is scheduled to involved in the taxi service at that time of the leave the hospital at 8pm after a 12 hour duty, is beaming with smiles, for at long last she can soon night and mind you, women are a more preferred prey, because they are more likely to go home and have a good rest. She washes her succumb to a robbery attempt. hands and dries them, picks her handbag and says goodbye to her colleagues and nurses alike.

But before she steps out of the emergency ward, Let’s say she gets safely home at 11pm, but has nurses rush a patient into her cubicle. She cannot to return at 8am the next morning for her weekend duty, I would like us all to search our leave the patient because, she is the only house officer in her group and the Doctor scheduled to hearts for a moment and sincerely answer this take over from her, has not officially assumed full question- Can she naturally keep a smile on her face at work the next morning, after just about responsibiilty.

5hrs of sleep the previous night?. Let’s even However hard she tries to justify her need to step imagine she relies on her depleting energy reserve to put her risorius into action, how long out stealthily and disappear into thin air, her can she keep it contracted? natural instincts overcome her, so she retreats.

“Just this one”, she soliloquizes. So she decides to When she steps onto the ward, this old patient suddenly starts screaming again just at seeing attend to this old man in his late sixties, who is her in the doorway! confused and hallucinating.

The Doctor to take over has by this time arrived In all of these difficulties we shall inevitably face, and donned his scrubs. But this lady Doctor all I hope for is the strength for us to be as cannot leave him without properly handing over human as possible, as feeling for the pain of the this particular patient’s case. So she decides to sick as possible as interested in the plight of the complete her clerking. I put it to all of us, both suffering as possible, so that even if we fail on and naive and experienced that, clerking the old some occasions, and we surely will, we can look is not without its own difficulties. Most are back and say- AT LEAST WE TRIED! genuinely disoriented. Others are garrulous and sometimes to get a simple yes or no answer to a question as seemingly easy as “Please, do you The medical student who recently finds himself/herself on the ward soon identifies good human relations as an easy way to keep patient happy and as a result remain happy. Most cannot understand why some Doctors cannot be courteous to patient and relatives of patients alike. In their minds it is simple- keep a smile on your face and keep your cool always. But this principle soon becomes theoretical.

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African Regional Meeting

2012 Reports THE VOICE OF AFRICAN MEDICAL STUDENTS

IFMSA ARM 2012 ARUSHA DECLARATION

health issues in their framework. The AfriPET, Peer Education Training, workshop developed the students' abilities to plan and lead educational projects, enabling them to organize the ideas circulating in the group.

Following the pre-ARM training sessions, the students then divided into their ARM standing committees Florence Brazio Mwitwa th nd covering various topics (18 - 22 December 2012). The - TAMSA Tanzania committees are the cornerstone for all IFMSA's activities & and they include the Standing Committee of: public Marwa Saleh health, professional/research exchange, reproductive -Qatar health, medical education and human rights and peace.

Through these ARM sessions, students learned to appreciate IFMSA's structure and organization, as well as address health concerns on the respective topics. It was at the end of these day sessions that a small working group of around fifteen students representing various Equipped with their own set of personal experiences, African countries would come together to pen the ARM each student had a unique perspective on the Health Arusha Declaration 2012.

Crisis in Africa, the main theme event of the 8th International Federation of Medical Students Association Through multiple drafts, students began outlining some Africa Regional Meeting, hosted by Tanzanian Medical of the key health issues they witnessed and experienced Student Association (TAMSA).The conference hosted over in Africa. In the initial stages, resources, governance, and 250 medical students from National Member traditional medicine were the top concerns voiced. The Organizations all over and outside Africa. lack of human, financial and facility resources received After a week of trainings, debates, and presentations, great attention, as students recognized their central role students came together to voice their opinions, in advancing African health systems. experiences and hopes through the ARM Arusha Many country- specific examples were given Declaration 2012. This was a product of long nights, demonstrating the burden of the resource deficit in lunchtime discussions and morning reflections on this 9- Africa. Healthcare organizations and institutions were days journey at Ngurdoto Mountain Lodge in Arusha, not functioning at an acceptable standard and one of the Tanzania. main reasons cited was resources.

AUTHORS:

th

th

The first three days (pre ARM 14 -17 December 2012) of the conference students were split into three different workshops training in diverse issues in global health. The training added to the unique experience of the students that came together to summarize the stories heard, journeys shared and opinions voiced under this declaration. The students coming from the Training New Trainers (TNT) workshop brought in their facilitation skills encouraging their colleagues to share their views.

Meanwhile, the Think Global workshop prepped its students to think from the Millennium Development Goals (MDG) perspective, integrating all the pressing

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From this starting point, students then addressed other major issues of concern, such as the need for quality control in health services provided. They also ascertained that this could not be achieved without another key

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health care issue that is research. Research on all levels and in the various health sectors is essential for the systems to advance, and for personal and country experiences to be shared on a professional level. In turn, research will also ascertain the next highly cited issue in the conference of focusing our health efforts on preventive approaches versus curative. This addresses the need to recognize the role of social determinants of health in our systems.

The diseases that influence our populations whether communicable or non-communicable are heavily related to the lifestyle we lead and the living conditions we are subjected to. This illuminates the importance of community education and its role in advancing healthcare. The final point that the students emphasized was governance, with a special note on political corruption and its effect on health systems. Today's medical students are leaders of change and through this declaration they have voiced their concerns in hope thet their governments and other health stakeholders will reciprocate and support their vision.

In conclusion the participants of ARM believe and agreed that:A new definition for a doctor should be promoted in our countries: a doctor is a health activist and advocate (teaching our patients how to get well and to keep well), who should have responsibilities beyond the clinic and be more involved in the community health issues.

Understanding our roles in preventive medicine, we have responsibilities to human health whether it's attending to sick patients or preventing sickness. Thus, more resources and efforts should be dedicated to preventive medicine.

Special thanks to: Arusha Declaration small Working Group, Theme event Coordinators, RC Africa, Organizing Committee, ARM participants and NMO presidents/Head of Delegation for signing the declaration

Jaynika Solanki (TAMSA, Tanzania) At SCORA training session Africa Regional Meeting, Arusha 2012, I presented concepts of HIV/AIDS, with ZohraKhalfan (HKMU-MD2) and Doreena R. Leo (IMTU – MD2). This discussion addressed the following 5 key areas in relation to the HIV/AIDS disease burden:

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THE OFFICIAL IFMSA PUBLICATION FOR THE AFRICAN REGION



Assessment of the other participants on current knowledge and statistics regarding the HIV/AIDS disease burden in Africa.  Highlight transmission, risk factors, prevention and treatment of HIV/AIDS.  Education on proper condom use.  Assess the level of understanding of WAD 2012 theme.  Future undertakings of SCORA projects in alleviating HIV/AIDS. The discussion kicked off with a general question regarding the participants' knowledge on the weighty subject of HIV/AIDS, enriched with an active discussion on the floor.

The participants were next divided into 6 working groups wherein each was required to brainstorm on transmission, risk factors, prevention, post-infection implications and treatment of HIV/AIDS. A time limit of 2 minutes was allocated per subtopic.

Next each groups' points were competitively assessed by the rest hence facilitating a rich forum for peer education on the subject.

The winner group received a packet of swizz candy, which was distributed among all of us showing the love and care we have as a family.

The discussed points on transmission included sexual contact as the virus is present in semen and vaginal fluids, blood transfusion with HIV infected blood, mother to child transmission and higher chances of infection with drug abusers sharing needles.

Potential risk factors in Africa for acquiring HIV/AIDS include polygamy, circumcision, poor medical service, ignorance, poverty, MSM- anal sex, other STD`s and genital ulcers, tattoos and piercings.

Recommendations regarding HIV/AIDS prevention revolved around fostering abstinence, safer sex- use of condoms, regular 3months HIV/AIDS checkups, one sex partner, checking up HIV status before having sex with multiple partners, needle exchange program, RV 144 and HAART.

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Although preventive medicine for HIV/AIDS is still in the pipeline, a treatment of High Active Antiretroviral Treatment (HAART) is available, with 6.6million people in Africa being on HAART by 2010. Although, there is a plausible slow down of disease progression with a reduction of the risk of deaths and complications but the drugs remain too expensive with many side effects.

Finalising with the effect of someone having HIV/AIDS includes illness, discrimination, depression and stigmatisation.

Last but not the least, the floor was left open for discussion on the theme of World AIDS Day (WAD which included Getting to Zero, Zero new HIV-Infections, Zero Discrimination and Zero AIDS-related deaths.

More Hugs SCORAngels Asante Sana!!!!

SCOPE/SCORE SESSIONS

ARM 2012 -Arusha, Tanzania

Erica Twum-Barimah , Ghana (SCOPE, RA-Africa)

SCOPE sessions were spread over a period of 4 days and took the form of interactive discussions (including brainstorming), sharing of experiences from more experienced NMO/NEO/LEO, and training sessions interspersed with games, exercises, energizers.

The session was run jointly with SCORE. The facilitators included, Mr David EkowArku (SCOPE Director), Miss E r i c a Tw u m - B a r i m a h ( S C O P E R A A f r i c a ) , MrAntoinneHabiyambere (SCORE RA Africa) African NMO represented included: Ghana, Sudan, Tanzania, Kenya, Namibia, and Uganda. Non-African

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THE OFFICIAL IFMSA PUBLICATION FOR THE AFRICAN REGION

NMO included Germany. th The sessions were held for 4 days; from 19 December to nd 22 December from 8:30am to 12:30pm. th

DAY 1, 19 December, 2012 The were presentations on 'Introduction to IFMSA 'SCOPE and SCORE' that helped the participants' to know more about the IFMSA and its exchanges. There was a detailed discussion on what conditions a university has to fulfill to join the IFMSA to what SCOPE and SCORE are all about.

The participants were also educated on what unilateral and bilateral contracts are and their significance. Some of the pertinent issues that rose during these discussions included;  Possibility of signing 100% unilateral contracts  Differences between elective exchange and IFMSA exchanges  How to incorporate the IFMSA exchange experience into a CV The participants were also made aware, through discussions in SWG, about the benefits of SCOPE/RE to the individual, to the LC, to the NMO, and to the world at large.

At the end of the day, an assignment on the qualities of a good exchange officer was given to be discussed the following day.

Check out included feedback of the participants on the session which was mainly positive.

DAY 2, 20th December, 2012 Qualities of a good exchange officer were discussed.

Some of the traits included intelligence, problemsolving, approachable, time conscious and most importantly- Accessibility!

After a quick recap of the previous day, the participants were taken through the steps to take in setting up of SCOPE/RE in an NMO and also through some terminologies in SCORE and how to draft the exchange conditions for the NMO. At the NMO level, we discussed things to do such as, setting up of a local committee amongst others.

For SCORE, we also discussed 'Who/How to approach in the setting up of SCORE' such as some research institutions and the use of online resources and physical contact.

To wake us all up during these long talks, we had series of very interesting energizers and a SCOPE/RE dance was learnt.

The discussion on outgoing selection had the NEOs of FGMSA, MSAKE, Medsin-Sudan, Germany and Rwanda

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sharing their experiences on how it is done in their NMOs. Some of the key points raised here included;  Proportional distribution amongst the various LC  Based on a first-come first-serve basis  Point system and merit-based  Call for applications with specific criteria in English proficiency, finances, etc The discussion on the Social program emphasized the importance of a good social program for the IFMSA exchanges and participants went through the art of drawing up a good social program and how to keep to it. st

DAY 3, 21 December, 2012 OUTCOME: Sessions began with a check in and a recap of how to make SCOPE/RE active in your NMO. The presentation by MedSin-Sudan on STEP (Sudanese Tropical Exchange Program), a multi-standing committee project involving lab-works, lectures, clinical works and surgical operations was very informing. For more details on it, visit w w w. s t e p - i f m s a . o r g o r e m a i l medsin.step@gmail.com We had an external speaker- Mr Nick Shockey, Director of the Right to Research Coalition, give us a presentation on Open Access (OA). Participants were beseeched to advocate for OA in their respective NMO and NMO were asked to join the coalition at the national and international level, reach out to professional societies, educate friends, colleagues, professors on OA and also to start OA working groups in the NMOs ( www.righttoresearch.org ) Contracts fair discussion saw us having simulations and role playing and all participants had a go at 'signing' IFMSA contracts. Our Mock contract fair simulated that seen at the IFMSA August meeting and participants were made to play the role of NEOs of the different countries

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who tried to convince other NEOs to sign contracts with them. Need I say, that was a whole lot of fun! We also discussed things that you need to carry with you as NEO to the contract fair;  Adequate contract forms( prefill, sign, stamp to save time)  Country's flag  Souvenirs from country  Stamp There was a joint session with SCOME- A skype session with Dr Adolfo Sparenberg, Director of International Society for Telemedicine and eHealth(an NGO in Official Relations with the WHO). The participants were educated on how technology can improve healthcare delivery around the world: Mobile assistance in India, IT expansion. For additional information, please visit www.isfteh.org nd

DAY 4, 22 December, 2012 Save the best for the last?? It definitely looked like that's what we did because the trainings in the databases were one of the best sessions we had had so far. We came to where the 'magic' actually happens in IFMSA exchangesthe databases.

With SCOPE being in the transition phase of moving from the old to the new database, the training in the database can be said to be the most important session for the ARM for SCOPE! The participants were guided through various aspects of the new and old database (which is still in use mainly for SCORE now) such as;  How to register on the database  Sending contracts  Managing Application Forms  Assigning contracts to students  How to upload a project, among others The RC Africa graced our session with her presence and explained the TAF, its benefits to the African delegates and how to raise funds to pay for the IFMSA meetings and changed the negative mindset of the participants towards international meetings.

The session ended with the participants exchanging addresses and taking a group picture by the poolside fostering stronger bonds of companionship among SCOPE/REans!

SUMMARY On a whole, the sessions were a success! We managed to satisfy the participants' goals of gaining in-depth knowledge of the IFMSA and its exchanges, and at the same time, ensuring that we had lots of fun with some of

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our punishments(There were some really memorable ones) and energizers.

Also, trainings in the databases, especially the new one which has been the cause of a lot of headache, went on successfully.

The participants gained insight into the structure of the IFMSA and its exchange and the interest of the new NMOs in them increased significantly as they listened to their fellow Africans share their experiences We did not encounter many problems due to the highly competent OC and amazing participants. However, one main problem that needed to be tackled was Lateness of participants to the morning sessions. I propose that at the next meeting, more stringent methods(punishments) are put in place to curb that.

As a means of follow up, a mailing list for all the participants of the session has been created for continuous flow of ideas on how best we can improve IFMSA SCOPE/RE. To conclude here, I'd like to say A BIG THANK YOU TO ALL OF YOU FOR MAKING THE SCOPE SESSIONS A SUCCESS! IT WAS THAT AMAZING BECAUSE YOU CAME! ASANTE SANAA!!

SCOME REPORT Medical Education & Change - Ahmad Badr, EGYPT SCOME Assistant for Publications

African NMOs Open Access to Research Students are losing already limited access to core academic research – research essential to a complete education. As a student, it's no secret that academic journals are crucial to our research, our papers, and our understanding of both fine details and the larger, overall picture of everything we study. Yet, students often run into access barriers while to trying to do research, forcing us to settle for what we can get access to, rather than what we need most. Over the past two decades, the price of subscriptions to academic journals has increased tremendously, to the point where they're often out of reach for students, even at the most well-funded institutions. Nick Shockey, joined us in the SCOME session to explain the problem and introduce the Right to Research Coalition, which advocates for Open Access.

Open Access ensures that the results of scholarly research are made available online for anyone to freely use, immediately upon publication, and removes barriers to scholarly and educational re-use. It recognizes that while there are legitimate costs associated with formal publication, these can be effectively covered in ways that do not re-quire toll barriers for users to access an article.

Telemedicine Dr.AdolfoSparenberg joined us via Skype to explain more about the International Society for Telemedicine and eHealth“ISfTeH” . The society aims to facilitate the international dissemination of knowledge and experience in Telemedicine and eHealth and providing access to recognized experts in the field worldwide.

Unequal Social Conditions, limited access to rural areas, long distances, and health assistance shortages make it crucial to implement telemedicine in many countries.

Several working groups are included such as :Education,Students, Nursing, eHealth economics,

During the 4 days of the African Regional Meeting, several SCOME sessions were dedicated to focus on how to make a project relevant to medical education, how to advocate for it , and how to push change especially that change management is a slow and hard process. As medical students we face problems trying to improve medical education because of resisting change by governmental bureaucracy, and obstacles that prevent proper advocacy for medical education issues Throughout various trainings on project management, advocacy and approaching officials, communication skills as well as change management trainings, we tackled all these problems during the SCOME session and discussed how can we overcome them especially in medical education issues that are specific to Africa and

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TeleOphtalmology, etc.. ISfTeH exists currently in over 70 countries. Students are welcome to join for free through www.isfteh.org/members/join Medical Education projects Everyone participated to brainstorm projects that serve medical education based on the problems facing medicine in Africa . An Example is StudentMed, an idea

by Poonamjet Loyal, from MSAKE –Kenya. StudentMed is a SCOME project involving the design of a website to revolutionize medical education. It will have 12 categorized webpages tackling various issues regarding betterment of medical education through a student oriented approach, including: OopsMEd!!! We as medical students have a lot to learn from each other's mistakes . It is a webpage designed for sharing…..Oops! I made a mistake.

CopsMEd!!! The Whistleblower! Did your lecturer just miss a session with you? How many times have you seen malpractice? CopsMed!!! will allow you to bring such disasters to the limelight anonymously.

ResearchMEd!!! andStatsMEd!!!, will allow students to teach and learn from each other the basics of Research and Statistics in Medicine.

QMEd!!! This will be more of an archive holding examination questions for the different faculties in medicine from the different medical schools.

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ChatMEd!!! A facility incorporating chat services and video conferencing to help facilitate group discussions amongst medical students throughout the world.

ExtraMEd!!! For those of us who want distinctions in Med, this will provide the Nice-to-know facts.

ExplainMEd!!! Didn't understand a concept even after you have read and searched hard enough? May be you should post your dilemma on ExplainMEd!!! and see if your colleagues will explain it better.

BlogMEd!!!Will provide medics the freedom to doodle their thoughts….with others. All the fun, depression, frustration etcetc let's Blog it here!!

CultureMEd!!! Medical students- a multicultural society and culture itself plays a big role in medicine. So may be there should be a platform for us to share our rich culture, what do you think?

HelpMEd!!! Ever known a colleague who is about to drop out of Med school due low funds or may be one who is looking for cheaper accommodation etc….HelpMEd is a place where we as medical students can come together and share each other's problems and may be even try to sort them….thereby making a STRONGER and more UNITED future HEALTH FORCE ASANTE SANAA!!

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Jaynika Solanki - TAMSA, Tanzania

toonREFLECTIONS

auscultate THE OFFICIAL IFMSA PUBLICATION FOR THE AFRICAN REGION

PUZZLE From this puzzle, locate the words below horizontally, vertically or diagonally.

HUMANITARIAN

GENEVA

GENOCIDE

CONFLICT

CONVENTION

GOOD HEALTH

MORTALITY

RELIEF

RECONCILIATE

HIPPOCRATIC OATH

DISEASE

TRAUMA

DISASTER

MORBIDITY

EPIDEMICS

MALUNTRITION

SAHEL

PSYCHOLOGY by

Anosike Samuel Chijindu Abia State University, Nigeria

C NFLICT

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