Auscultate

ISSN 2307-2849

IFMSA The International Federation of Medical Students’ Associations (IFMSA) is a non-profit, non-governmental and non-partisan organization representing associations of medical students internationally. IFMSA was founded in 1951 and currently maintains 117 National Member Organizations from more than 100 countries across six continents with over 1,3 million students represented worldwide. IFMSA is recognized as a non-governmental organization within the United Nations’ system and the World Health Organization and as well, it is a student chapter of the World Medical Association. For more than 60 years, IFMSA has existed to bring together the global medical students community at the local, national and international level on social and health issues.

Imprint Editor in Chief Tade Adesoji - Nigeria Content Editors Dorcas Naa Dedei Aryeetey - Ghana Wahida Jasmine Mtiro - Tanzania Proof Readers Helena Chapman - Dominican Republic Victor Animasahun - Nigeria Franklin Chilaka - Nigeria Layout Designer Noah Okiror Emokol - Uganda

Publisher This is an IFMSA publication © Portions of this publication may be reproduced for non political, and non profit purposes mentioning the source provided.

Disclaimer This publication contains the collective views of different contributors, the opinions expressed in this publication are those of the authors and do not necessarily reflect the position of IFMSA. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the IFMSA in preference to others of a similar nature that are not mentioned.

Notice: All reasonable precautions have been taken by the IFMSA to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the IFMSA be liable for damages arising from its use.

Some of the photos and graphics used are property of their authors.

We have taken every consideration not to violate their rights

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 Homepage: www.ifmsa.org

Contacts

publications@ifmsa.org

Contents

www.ifmsa.org

words from the editor in chief

E DI TO RIAL

02

RC’s M essa ge words from the regional coordinator - Africa

04

Human Resources for health

09

Repor ts on Previous ARM

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a foundation for universal health coverage articles on the theme of the ARM 2014

ARM2013 ETHIOPIA

9th African regional Meeting Addis Ababa

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editorial Dear friends, The World Health Report in 2006 estimated a shortage of about 4.3million health workers worldwide and this prompted the need for a Global forum on human resource for health.1 The first of its kind was held on African soil – Uganda. Since then, light has been shone to the role of human resources in optimizing health care delivery and achieving universal health coverage.

The third Global health forum just concluded in Brazil with over 1800 participants from 93countries formally adopted the Recife declaration on human resource for health toward 2030. The declaration established the importance of human resource for health in ac ieving universal health coverage and emphasized the vision that everybody must have access to a skilled, motivated and facilitated health worker amongst many other things. 2 Humans form the principal resource of health and that is the message we intend to pass across during the African regional meeting in Uganda and in this edition especially to African medical students and young doctors. We spend so much energy looking for other resources failing to maximize and properly develop the most important resource. Medical education standardization and reform should be top on the to-do list of any government hoping to achieve universal health coverage.

You would be seeing through the eyes of medical students and young doctors in Africa and South America as they discuss how they see human resources for health and also through the heart of a senior consultant pediatrician with a law degree, how to develop our human resource for health.

It has been a wonderful time working with the most amazing publications team in the World; their sleepless nights brought this dream to reality. I hope you enjoy it as much as we enjoyed putting it together.

I would leave you with the words of Timothy Evans, Director, Health nutrition and population of the World Bank; The World is now at a critical juncture and an acceleration of efforts to develop human resources for health is key to achieving universal health coverage.

Cheers,

Tade Adesoji

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medical students worldwide | www.ifmsa.org

Development Assistant

Publications Africa

Tade Adesoji Editor in Chief References 1. WHO. Health workforce. The world health report 2006 – working together for health. [Online] [Cited: 30 July 2013] http://www.who.int/hrh/whr06/en/ index.html 2. Global Health Workforce Alliance. Human Resources for health a foundation for universal health coverage and post 2015 development agenda, report on Third Global Health Forum on Human Resources for health,(Nov 2013) Recife, Brazil. [Online]Switzerland: WHO press, 2014. Available from http://www.who. int/workforcealliance/knowledge/resources/report3rdgf/en/ [Accessed: 24th July 2014]

editorial

team

Franklyn - Nigeria

Helena- Dominican Republic

“We have to keep moving, keep loving people and doing what we love to do with compassion because the earth won’t wait, it would keep moving round the sun even if we refuse to. Make a move today.”

“Never doubt that a small group of thoughtful, committed people can change the world. Indeed, it is the only thing that ever has.”

-Margaret Mead

Tade- Nigeria “The heights that great men attained was not achieved by sudden flight, but they while others slept were toiling in the night.”

Dorcas - Ghana “... pressing on.”

Noah- Uganda

“Whatsoever thy hand findeth to do, do it with thy might...”

Victor - Nigeria “Anyone can teach what they have learnt but only special ones can teach what they are learning.”

Wahida - Tanzania “Success is not a destination, but the road that you’re on. Being successful means that you’re working hard and walking your walk every day. You can only live your dream by working hard towards it. That’s living your dream.” -Marlon Wayans

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Regional Coordinator Africa

The African medical students’ community has come a long way in its quest to develop into elite medical professionals that would contribute more effectively to a better developed Africa in health.

Through this latest edition of the African Auscultate magazine that looks more into the Human resource for Health (HRH) and Universal Health Care (UHC) situation in Africa, we hope that your hearts will be touched and feel contributory towards a positive change in this regard. Africa continues to be burdened by the shortage of skilled health professionals especially in rural areas.

Much as the majority of the African communities are impoverished with limited access to health care, UHC for all stands as the best option that would ensure the accessibility of the poor majority to adequate health care.

In our capacity as medical students, we are privileged and blessed in the sense that we still have the opportunity and responsibility to improve both the access to and quality of health care delivery on our African continent and make it a much better place to live in with a much less disease burden. I would therefore wish to call upon all of you who are struggling just like me to become health professionals of our dear continent to work harder and achieve our much desired goal of beefing up the number of health professionals on our continent.

Yours sincerely,

Gerald Makuka IFMSA-Africa Regional Coordinator 2013-2014

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medical students worldwide | www.ifmsa.org

Gerald Makuka IFMSA Regional Coordinator Africa

ARM 2014 UGANDA

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Chair Person OC ARM 2014 a word

Dear IFMSA-Africa, Advocacy like never before has become a very important tool through which we can create the world we want. The Organising committee of ARM 2014 has been working tooth and nail to hold this special meeting in Kampala Uganda come December. We believe that joint advocacy platforms that address health challenges in the region will go a long way in achieving the much desired future of health for all. To Uganda, hosting a Regional Meeting is a great opportunity for the medical students to share their culture, and also to learn from our large IFMSA family. It is, therefore, with pleasure that I write to welcome you to the pearl of Africa for the 10th African Regional Meeting; ARM 2014 Uganda.

This African regional meeting is symbolic and a sign of commitment to us the IFMSA family towards Human Resources for Health campaign. From adopting a policy statement to standing in solidarity with the most affected region so as to engage the future physician from the region to discuss the state of the health workforce and how to build a foundation to universal health coverage.

Sub-Saharan Africa is a region with great potential, but with a number of challenges. Among these challenges is a disease burden that is disproportionate to its population size and number of healthworkers. Indeed the health workforce crisis is so evident in Africa.

The theme of the African Regional Meeting; Human Resources for Health: a foundation for Universal Health Coverage; was a carefully chosen theme that concerns not only the citizens of Africa but also the friends of Africa.

A well trained and motivated Workforce is a key component of any strong and efficient health system. In addition, the health workforce plays an indispensable in attaining international goals such as the Millennium Development Goals. The shortage of health workers coupled with the unequal distribution of human resources between and among countries further weakens access to comprehensive health care in Africa.

The provision of and access to quality, comprehensive health services is a vital component of efforts to maximize good health outcomes for everyone at all stages of life. The concept of Universal Health Coverage is built on social justice, and Universal Health Coverage is a right in and of itself. Moving towards the universal health coverage requires a strong, efficient health system that can deliver high-quality services on a broad range of national health priorities.

At the centre of such a robust health system should be a skilled and motivated health worker, access to essential medicines, supplies and equipment.

Uganda is one of countries shortlisted with a severe shortage of health workers, and Kampala city was the host of the first meeting of World Global Health Workforce Alliance that resulted in the Kampala Declaration. It is a sweet accident that the future physicians of Af-

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medical students worldwide | www.ifmsa.org

Ivan Lumu Chairperson OC

NMO: FUMSA Uganda

rica are also gathering in the same city to discuss Human Resources for Health in Africa especially at this time as we near 2015.

The ARM 2014 will afford you the opportunity to explore the topic of Universal Health Coverage and Human Resources for Health. You will hear and learn from the experts as well as your peers about the concept of Universal Health Coverage and how Africa is preparing to move forward after 2015.

In addition, you also have a golden opportunity to discover and explore Uganda’s natural beauty and breathtaking sceneries. The gorgeous Lake Victoria, the Nile, the beautiful sunny tropical weather and the warm hearted people are the other reasons you should visit Uganda. The organising committee is looking forward to hosting you, not just for the ARM but for Christmas as well.

Acknowledgements I would like to give sincere thanks to FUMSA Uganda our host, the entire national organising committee and the international organising committee that are spending plenty of effort and time to make the meeting possible.

We also thank all the externals and our guests for sacrificing time to attend our regional meeting. We are grateful to host you at this 10th universally of the IFMSA-Africa.

Sincerely, Ivan lumu Chairperson OC ARM 2014 UGANDA

Recent Innovations: in Health Care Delivery :

The story of ỌMỌMI

minder alerts to the mother or guardian. As a back-up reminder, it will also alert one other registered relative by SMS text messaging when the immunization date approaches.

“ ỌMỌMI is a Yoruba

word that means, “My Child” NMO

eme Edikan Odiawa Ijew Benin University of

: NiM S Niger A ia

Once upon a time, in the ancient city of Benin in Southern Nigeria, a young man thought of an idea that could radically reduce maternal mortality and improve maternal and child health in his country and all over the developing world. His name was Charles Immanuel Akhimien. Charles co-founded Mobicure, a mobile health company that specializes in using mobile technology, such as smartphones, and tablets, to assist expectant and breastfeeding mothers in caring for themselves, their unborn fetuses and their infants, respectively. Their flagship product, ỌMỌMI, was launched in early 2014, reaching 200 downloads in the first two weeks.

”

In addition to this primary function of ỌMỌMI, this app provides other key features for the child’s development. First, the app has the ability to calibrate the infant’s progress to attain the developmental milestones. This allows parents to easily monitor their child’s growth rate with parameters, including height, weight, and occipital-frontal circumference, and compare these values with current standard figures. Thus, any congenital defects or developmental abnormalities can be observed early.

Second, the global positioning system (GPS) locator can provide directions to the nearest healthcare facility in the case of an emergency. Third, the app contains tutorials on proper breastfeeding methods, preparation of oral rehydration solutions, and family planning methods. One special feature, “The Mothers’ Community”, serves as an interactive forum, where mothers from all over the world can ask questions and receive answers, encouragement and advice from other mothers as well as healthcare professionals.

However, although ỌMỌMI shows incredible potential, this app is still early in its technological development, receiving continued updates and improvements, such as the recent inclusion of “The Mothers’ Community”. ỌMỌMI was designed to care for the health of the infant as well as the prenatal, intrapartum and postpartum health of the mother. One day, this simple app may become as widespread and popular as baby diapers!

Since ỌMỌMI is a Yoruba word that means, “My Child”, this product was designed with the child in mind, especially those children under five years of age. As an easy-to-use tool, it serves as the first worldwide app that incorporates all of the World Health Organization (WHO) childhood survival strategies. After downloading the app and typing in some details (e.g. child’s birthdate), the app will synchronize with the calendar on the android device, compute the child’s immunization schedule, and provide immunization date re-

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The Reality of The Investment In Health: Challenges of a Third World Country

May is here, which for me means the beginning of a whole new rotation as a medical student intern. However, I cannot help but feel dual emotions.

The fact is that although I absolutely want to practice my capacity to learn and help others, the reality in a third world country invites me to feel a bit discouraged.

The investment in health in my country is a subject that I describe as sensitive. As a student and future physician, it is difficult to imagine a future in health when standing in front of multiple challenges that started decades ago. By watching the news and reading scientific literature, I have been able to acquire more information about how the health system works, including the inappropriate distribution of government resources, evidence of limited resources in health centers, and delivery of resources to the health system. The reality is almost hopeless when you stand before a country that invests little in the education of their citizens.

Living in a low-resource country has taught me that a significant part of your daily life as a health professional student is learning how to effectively utilize your resources at hand. First, I have heard anecdotes from my colleagues, who have rotated in a high-resource country, describing their shock at the availability of hospital resources. Second, my experiences with limited natural resources, including access to water or electricity, require daily adaptations in lifestyle. In the book, “Revolution in World Missions”, author K. P. Yohannan relates his comparative experiences when he traveled from his home country of India to the United States. He encountered a different economic situation and described his amazement about how “Americans are more than just unaware of their affluence – they almost seem to despise it at times”.1 Yohannan states that “what impresses visitors from the Two-Thirds World are the simple things Americans take for granted: fresh water available 24 hours a day, unlimited electrical power, telephones that work and most remarkable network of paved roads”.1 However, these geographic disparities in access to resources make me reflect: What would be possible if all those resources were available in your country? Although I do not suggest that the availability of resources is wrong, I describe my desire to work today so that the next generation will not have to face my reality.

Challenge #1: To offer a dignified health system One of the main challenges that we face in our countries is to properly distribute the resources that exist, but cannot be reached. We lobby to increase federal compliance to the laws and delivery of resources to the respective individuals. We must remember that these resources come from the people and are destined to benefit the country.

Challenge #2: To provide capacitated human resources In a low-resource country, it is important that administrative personnel appropriately manage the resources, through the establishment of protocols and criteria, knowledge of health system infrastructure, and ability to adapt resources as required by the existing health priorities in the country.

Challenge #3: To effectively utilize our existing resources As health professional students, we should live in the present and fight for a better future. We must work with our present conditions and always aim to provide the best health care services to our patients.

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Nauri Abreu Roa Iberoamerican University

NMO: ODEM Dominican Republic

In summary, national changes in the health system cannot occur over a short period of time. Nonetheless, we must be aware that we are part of the advancement of a third world country, where the leadership must analyze how to properly utilize resources and demand its rights. Since the health discipline is just one part of the whole scenario, it is our moral obligation as future physicians to lead the way with what we know is ethically correct. We must remember our reality and desire to change our future picture.

As medical students, we must remember one final reflection regarding our investment in health: “Where governments fail to live up to their obligations under international law, we have to remind them to do so” Ban-Ki Moon, Secretary General of the United Nations. 2 References: (1) Yohannan KP. Revolution in world missions. Carrollton, Texas: GFA Books; 2010.

(2) Nesirky M. Highlights of the noon briefing. In Strasbourg, Secretary-General speaks to Council of Europe’s World Forum for Democracy. 2012. Retrieved from: http://www.un.org/ sg/spokesperson/highlights/index.asp?HighD=10/8/2012&d_ month=10&d_year=2012

The medical Brain Drain:

An obstacle to the achievement of the millennium development goals in Africa.

For many African countries, it would be hard if not impossible to achieve the millennium development goals by 2015. The key obstacle is now recognised as the lack of a stable human resource base in the health sector1 WHO recommends a minimum of 2 physicians per 10,000 population; 29 of the 46 sub-Saharan countries are below this level, and an additional 7 are at a bare minimum; only 10 are above. Interestingly 4 of the 5 North African countries are above the WHO minium.

It is estimated that in order to meet the millennium development Goals in subSaharan Africa by 2015 an additional one million health workers will be required.

The already inadequate health system of Africa has been badly damaged by the migration of health professionals. They leave the severely crippled health system in a region where the life expectancy is only 50 years, 16 percent of the children die before their fifth birthday and HIV/AIDS continues to burgeon.

Africa faces a health crisis occasioned by the number of important factors that have risen over the past two decades, most importantly being the HIV/AIDS epidemic, the emergence of old communicable diseases like tuberculosis, malaria, cholera not to mention the concurrent increase in the level of non communicable disorders (diabetes, stroke, and hypertension). Africa’s burden of disease is disproportionate to its population size. With 11 percent of the world’s population Sub Saharan African accounts for 49 percent of maternal deaths, 50 percent of under five child deaths and 67 percent of HIV/AIDS cases6. It is unfair that only 1.3 percent of the world’s health workers care for people who experience 25 percent of the global burden of disease.

There is a considerable amount of literature testifying to the fact that the migration of skilled professionals from developing countries is large and increasing dramatically. The world health organisation found that a quarter to two third of the health workers interviewed in a study expressed intention to migrate. Developing countries are hit hardest by the brain drain as they lose sometimes staggering portions of their college educated workers to wealthy countries. The problem is that the rate of loss often outstrips the production and production is often inadequate to meet the countries’ needs. In recognition of the enormous challenge posed by the international migration of health personnel to health systems in developed countries, the World Health Organization has proclaimed 2005-2015 the decade on human resources for health (HRH).

The rate of loss of doctors, nurses and other health professions by migration has exacerbated the severe shortage of health workers. According to the World Health Organisation, this shortage has affected the basic services such as immunisation, childbirth and HIV care and treatment of disease. The medical brain drain has meant not only the exodus of human capital, but also financial resources as well, as the African health care professionals left their countries with their savings. The United Nations Conference on Trade and Development estimated that each migrating African professional represents a loss of 184,000 dollars to Africa. The migration of health workers provides a substantial financial benefit to the economy of developed countries, the UK and Canada save about 200,000 pounds and 800,000 dollars respectively from every doctor that moved from Africa. Investing the lost dollars in Africa’ health systems would accelerate economic development, contribute to saving millions of lives, and move countries to closer to achieving the millennium development goals.

Published literature on the migration of health professionals document the push and pull factors which include the lack of opportunity for postgraduate training, underfunding of health services facilities, lack of established post career opportunities and poor remuneration among other reasons. Although countries in Africa have attempted to mitigate the problem created by the brain drain, a lot of effort

Ivan Lumu Immediate Past President FUMSA

NMO: FUMSA Uganda

is needed to retain home graduates and to train more health professions to solve the shortage of health workers in Africa. Despite the establishment of The WHO Global Code of Practice on the International Recruitment of Health Personnel in 2010, its application in reality is still far away from the creation of a concrete impact.

Addressing the inequity in the distribution of health workers requires the efforts of institutions, the governments of both the country of origin and destination and efforts of international organisations.

In conclusion, Africa’s increasing exodus of human capital will leave it empty of brains in years warns Dr. Lalla of the UN Economic Commission for Africa EAC.The Medical brain drain poses a threat to the already collapsed health service delivery and is a major risk to the health of Africa’s poor. African countries must take steps to strengthening of the health workforce otherwise building a foundation for universal health coverage and equitable access to health will be impossible.

Adapted from the report The State of the Health Workforce in Sub-Saharan Africa: Evidence of Crisis and Analysis of Contributing Factors by Bernhard Liesabout Available at http/www.state of the health workforce in subSaharan Africa. 64)

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EBOLA &

it’s lingering presence in West Africa Brief History Ebola virus disease first surfaced in 1976 both in Sudan and Democratic Republic of Congo. Both cases seem to have been of relevance. With the case in Democratic Republic of Congo taking place close to the Ebola River; hence the virus was named Ebola. While more importantly the case in Sudan involved a school teacher who was thought to have malaria; but surprisingly had the same ‘Malaria’ transmitted to fellow patients who used the same needles used in treating him.

The virus is zoonotic and alleged to have fruit bats as its natural host. It is classified under the Filoviridae family with five (5) subspecies.

Four of the five have caused disease in humans: • Ebola virus (Zaire ebolavirus); • Sudan virus (Sudan Ebola virus); • Taï Forest virus (Taï Forest Ebola virus, formerly Côte d’Ivoire Ebola virus); and • Bundibugyo virus (Bundibugyo Ebola virus).

The fifth, Reston virus (Reston Ebola virus), has caused disease in non-human primates, but not in humans. Several workers who came in contact with the monkeys underwent seroconversion, no illness followed infection.

Transmission of the virus into the human population is through close contact with the blood, secretions, organs or other bodily fluids of infected animals.

Documented infections occurred after the handling of infected non-human primates and other animals found ill or dead or in the rainforest. Transmission with the human community, via human-to-human transmission, involves direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, even semen up to 61 days after onset of illness and seven (7) weeks after recovery from the disease.

Indirect contact with environments contaminated with such fluids. There is an incubation period of 2 to 21 days.

EVD is often characterised by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding. A good history is important for the exclusion of other conditions that share the same presentation. Very essential is travel, occupational history as well as exposure to wildlife.

With the clinical features of the disease being similar to those of other endemic conditions and even other haemorrhagic fevers would mean excluding differentials. Fortunately, definitive diagnosis can be made by use of antibodycapture enzyme-linked immunosorbent assay (ELISA), antigen detection tests, serum neutralization test, reverse transcriptase polymerase chain reaction (RTPCR) assay, electron microscopy and virus isolation by cell culture. During an outbreak, PCR and ELISA are preferred for field work.

Present Status There have been sixteen (16) outbreaks of EVD over a period of nearly four decades. An epidemic of Ebola virus disease broke out in February, 2014 spreading throughout Guinea and beyond the nation’s borders in West Africa.

The epidemic is on-going and at least 1048 infections and 632 deaths have been reported in Guinea, Liberia and Sierra Leone as at July 20, 2014. Given the number of cases, fatalities as well as how long the epidemic has lingered; it has earned it place as the worst outbreak of EVD. The on-going outbreak has caused closure of the Senegal –guinea border thereby hampering trade and migration. In Sierra Leone closure of schools, markets, banks and stores.

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EBOLA: Sierra Leone doctors at battle

Various international organizations are putting in resources to counter the outbreak. However, despite efforts by government and non-governmental organizations the condition is getting worse as communities affected seem to be shunning treatment out of the lack trust in the efforts by indigenes. High fatality despite hospitalisation is not a farfetched reason. There are records of two (2) persons surviving out of (10) admitted. The communities are beginning to believe that sufferer would die even when medical intervention is sort.

There have been reports of hostilities from communities and refusal of screening. There is anger that those that are screened are taken away and never come back. In contrast, communities where there is cooperation have recorded good results.

One of such is in Telimele, north of guinea where there is a record of over 75 per cent recovery rate.

On other hand, there is recent discovery by Canadian scientists of the deadliest form of the virus that can be transmitted by air between species. There is an account of transmission from pigs to monkeys without any direct contact. Pigs have been seen to show the disease clinical while dogs are asympytomatic. None the less, news of isolation of Zaire and Reston Ebola virus in fruit bats in Bangladesh spells the potential of having presence of the filoviruses and their hosts in Asia. Thus, there is fear of possible outbreak in the Asian continent.

Public Health Importance The outbreak of Ebola has taken its toll on social habits and is creating fears. Residents are wary of contact and prevent bodily contact while exchanging pleasantries. With the tradition of African buri-

als where mourners have direct contact and there is washing of the deceased, which can also play a role in the transmission of Ebola, proper disposal of remains is a challenge. The responsibility of ensuring that there is restriction of the spread/further transmission is going to demand a lot.

With no vaccines available, prevention of further outbreak would be achieved with vigorous general health promotion as well as enlightenment on the disease condition and the compulsory control measures.

Such measures include: • Placing a ban on wildlife hunting, especially bats.

• Bush meat consumption for the time being needs to be avoided.

• The regulation of migration as well teaching of transport company attendants how to spot passengers with symptoms.

• Proper screening of population especially those at risk of exposure.

•Quarantine travellers suspected of the infection.

There is need for government assistance in the execution of the above and even more. And the involvement of community heads so the message can be accepted by residents without fear and revolts. Control of the epidemic is being seriously hampered by communities turning to ignorance out of fear and superstition.

In treatment centres: • Patients should be nursed in isolation.

• Sharing of needles should be discouraged.

• The healthcare provider in proper protective apparels and other private protective equipment. Regular hand washing at the hospital and at home while caring for ill persons.

• Added to this is need for disease surveillance as well as prompt response to quarantine areas affected.

• There is a serious need for the proper disposal of human and animal secretions, as well as the remains of dead victims.

Vaccines are being developed and have been tested on non-primate with good results. However, for the individuals exposed to the risk factors, screening and prompt treatment should be the mainstay. After which those who recover are rehabilitated as it is often difficult to add on needed weight. Given that the virus is present in semen after weeks, sexual activities should be discouraged.

“ there is recent discovery by Cana-

dian scientists of the deadliest form of the virus that can be transmitted by air...

Way Forward

”

With EVD being unrelenting for over four decades, it just seems like it is not being adequately tackled. Despite the continued outbreak, records of little successes give hope and bring us closer to a cure. None the less, this can be achieved faster by cross-sector collaboration and integrated research. The handling of Ebola should go beyond medical intervention when there is an outbreak. There is need for a collaborative effort by scientists from all sectors of life sciences and even the social sciences so that a holistic understanding of the disease and its effect can be gotten. On the part of the public, involvement in mapping out affected person without any form of stigmatisation would be most helpful. This can only be achieved if there is proper public sensitisation by local NGOs and local authorities so that the populace can understand the gravity of the disease and play their part in its control.

NMO: NiMSA Nigeria

Franklin Chilaka Lagos State University There is need for political will and zeal from the governments in the West African region.

In the treatment centres, all hands should be on deck and even so more hands brought in so that the work can be handled more effectively and the best of care can be given.

References - Ebola Virus Disease Fact Sheet N°103. World Health Organization. Updated April 2014. Retrieved on July 14, 2014 from: http://www.who.int/mediacentre/ factsheets/fs103/en/ - Ebola Haemorrhagic Fever. Centers for Disease Control and Prevention (CDC). Updated on May 27, 2014.

Retrieved on July 13, 2014 from: http://www.cdc.gov/ vhf/ebola - Fruit bats may carry Ebola virus. BBC News. 2005-1211. Retrieved on July 14, 2014 from: http://news.bbc. co.uk/2/hi/health/4484494.stm - Saliou Samb and Adam Bailes: As Ebola Stalks West Africa; Medics Fight Mistrust, Hostility. Reuters United Kingdom. Retrieved on July 15, 2014 from: http:// uk.reuters.com/article/2014/07/13/us-health-ebolawestafrica-idUKKBN0FI0P520140713 - http://www.afro.who.int/en/clusters-a-programmes/ dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4225-ebola-virus-disease-west-africa18-july-2014.html

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E-Health :

Technology based medicine bringing the future into the present In Tanzania, it has been almost more than a year since the transition from analogue to digital media in health care delivery and this has contributed to great improvement in broadcasting health related information.

A number of things have changed in our country parallel to a general change in the whole of Africa with regards to health care services and delivery. Changes have been seen and realized as we dawn into each new day. A trip on a time machine will help us connect the era of the early stone age, where great changes occurred especially in the discovery of iron to our present break through; the leap into e-health.

E-health as the cost-effective and secure use of information and communication technologies (ICTs) for health and health-related fields is also an umbrella term that covers a variety of areas such as health informatics, digital health, telehealth, telemedicine, eLearning and mobile health.

Today, in the African continent, we need to accept changes in our health system, we need a transformation in health care services and delivery in Africa; we need to see our future today. Some countries in Africa like Cote d’Ivoire, Ethiopia, Ghana and Kenya, have started to adopt these changes already and we seek to see this reverberate across the continent.

Major e-Health projects in the regions which have had great impact on health activities in Africa include Telemedicine Network for Francophone African Countries, Access to Research Initiative (HINARI), ePortuguese Project and Pan African, eNetwork project. Some of these projects use mobile phones as a means to; support the delivery of health care, provide awareness, education, remote data collection, remote monitoring and home care, communicate treatment to patients; report and respond to disease outbreaks and emergencies. Others use satellite technologies as a means of broadcasting health promotion to patients and health workers in hospitals and clinics.

E-Health in Africa can contribute to health systems strengthening in several ways; by improving the availability, quality and use of information as evidenced by strengthened health information systems and public health surveillance systems; developing the health workforce and improving performance by eliminating distance and time barriers through telemedicine and continuing medical education; improving access to existing global and local health information and knowledge; and fostering positive lifestyle changes to prevent and control common diseases.

E-health will also link hospitals and other medical institutions resulting in an overall improvement of health care services, efficiency and proper monitoring of patients. Furthermore, it will lead to improvement in the cost or speed of data handling together with quality in health management.

However, we need to work on political barriers where there is lack of vision and insufficient political will. We also need to train our people to fill

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Marko Hingi & Ulumbi Ezra

NMO: TAMSA Tanzania

Catholic University of Health and Allied Sciences Bugando

the gap with regards to the lack of e-health experts and leaders to champion e-health projects. Thus, the integrated efforts of liaising, the ministries of health, science and technology and employment cannot be overemphasized to achieve this goal. We also ought to stamp out corruption as it constitutes another barrier to the development of e-health. Taxes need to be reduced on ICT equipments and leaders should be educated on the need for this.

We all to move up with the new idea of investing in e-health. Like we say in Sub-Saharan Africa, a single ant cannot carry the grass; working on our own is not and will not be effective. Therefore, we need to invest in infrastructure development, poverty alleviation and manage the use of assistance from donor organizations appropriately. Provision of education, digital devices and tools and the use of ICT in public services must be part of our mission to birth Africa into ehealth.

Now is the time for serious leadership to get us started down the lane of e-health system in Africa. We need not delay any longer. I hope some of these ideas can serve as a basis for this call and members of African countries at all levels of government can come together in the near future to launch a clear e-health system in Africa .

References 1. Resolution WHA.58.28: eHealth. In: Fifty-eighth World Health Assembly, Geneva, May 2005, World Health Organization; http:// apps.who.int/gb/ebwha/pdf_files/WHA58/WHA58_28-en.pdf.

2. Oh H et al, What is eHealth: a systematic review of published definitions; J Med Internet Res, 2005, 7(1) http://www.jmir. org/2005/1/e1/.

Quality Health Care:

Here, There, Everywhere What gives health care quality? Some algorithms could give us an idea based on patient safety, morbidity/mortality rates, risk management, etc. However, the question remains: Is it okay to categorize health care as poor, medium or high quality?

As human beings, we all have the right to receive health care services, no matter who or where we are. When asked, “How can we make quality health care accessible in both rural and urban areas?” the first thought that may enter our mind may be: to build more hospitals and bring modern and novel equipment to the communities in need.

We would require every organization on Earth to spend hundreds of thousands of dollars to create an appropriate infrastructure to support it, which may end up being useless, in the future, either because of limited funds or workforce for maintenance and sustainability issues.

As we observe globally, in matters of health we cannot count on magic wands or wishing wells. We can, however, count on ourselves. Even though we have limited financial resources, we do have valuable human resources. We are all responsible for that said ‘quality’ of health care services. From the sub-specialist, to the general practitioner, nurse, medical student, and even the patient, we can all make quality health care accessible in any area of the world.

Medical interns who study hard enough, become excellent doctors. In developing countries, excellent doctors have the duty to understand their communities’ needs and learn every strategy for optimal medical practice and patient education in their environments.

Since Sir Francis Bacon stated that “Scientia potentia est”, or “‘Knowledge is power”, we acknowledge that education is the foundation of quality health care. Patients who understand their disease and the kind of behaviors that promote or hinder health and well-being can contribute to the improvement of health care. For example, children who understand the importance of hand washing and the implications of inadequate hand washing, contribute to the improved hygiene practices that advance health care. Thus, education, in the end, is a critical component of our health care programs.

NMO: ODEM Dominican Republic

Heidy Cos Felipe Iberoamerican University School of Medicine In conclusion, as medical students, we are the individuals who can impact the quality of health care, whether poor, medium or high quality. So, we have to prepare ourselves by reading, studying hard and learning as well as teaching our colleagues and community members.

Let`s spread the knowledge, spread its power, and spread quality health care that we all need here, there, everywhere!

“ ...education, in the end,

is a critical component of our healthcare programs.

”

By facilitating access to books, videos, and evidence-based information as well as implementing educational activities across each community level (e.g. age group, educational levels), knowledge gained by these community members will give them the power to make educated, high-quality health decisions. In turn, this will increase quality to the health care services provided.

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Achievement of health related goals: Quantity or Quality?

Human resources refer to the people who work in an organization.

The shortage and inequitable distribution of healthcare professionals is recognized as one of the fundamental constraints to achieving progress on the current health-related Millennium Development Goals, as well as realizing Universal Health Coverage, as a key component for health and the post-2015 development agenda discussions. The ability of a country to meet its health goals depends largely on the knowledge, skills, motivation and deployment of the people responsible for organizing and delivering health care services. Many countries, however, lack the human resources needed to deliver essential health interventions for a number of reasons, such as limited production capacity, migration of health workers within and across countries, poor mix of skills and demographic imbalances Many countries have implemented strategies to increase their human resource capacities to ensure effective health care delivery and the realization of the MDGs which will end next year. But is the answer really an inflation of the numbers and will the numbers translate to effective healthcare delivery? Do we have a problem with quality of quantity?

The MDGs 4 and 5 for instance, relate directly to implementing specific measures aimed at curtailing infant mortality and maternal mortality respectively. But let us critically examine some of the root causes of death of women and children in our community.

There are untold stories of young women and men all over the continent being denied access to reproductive health services including family planning and safe abortion services, by health service workers, basing their decisions on deeply entrenched cultural and religious values. These young people whose rights are clearly being trampled upon are forced to resort to a cohort of untrained, unskilled and unqualified health workers who often render these services at very exorbitant prices, clearly preying on their vulnerability and desperation. Of the 6.4 million abortions carried out in Africa in 2008, only 3% were performed under safe conditions, leaving a whopping 97% of unsafe abortions and its intended complications which include sepsis and death, contributing to maternal mortality.

The World Health Organization estimated in 2008 that 14% of maternal deaths (29,000) in Africa were due to unsafe abortion. Post-abortion services are of very poor quality in Sub-Saharan Africa. Common shortcomings include inadequate access to services, delays in treatment, shortages of trained health workers and medical supplies, use of inappropriate procedures, judgmental attitudes among clinic and hospital staff, and high costs for patients. An increased unmet need for contraceptive services especially among young people compounds the problem of unwanted pregnancies leading to unsafe abortions, truncates the education of women, limiting their capabilities and affecting their livelihood.

Young people in some communities in Africa are married off at very tender ages of 11 to 13, are forced to bear children and suffer the complications of delivery at that age. Children born to such mothers

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are also at increased risk of congenital abnormalities and birth injuries, increasing morbidity and mortality.

Harmful cultural practices such as FGM are still being practiced in some localities in Africa. Victims of such acts apart from being traumatized by such events, suffer an added complication of infections, pregnancy related complications and traumatic deliveries often leading to death of mother or child or both.

The above scenarios and examples clearly indicate the need for action at the local level to influence decision making and help abolish these sometimes inhumane acts. Key among players at the local levels are the healthcare workers. Health workers are either directly linked to some of these root causes via denying services, or indirectly linked to these via patients who report with complications of these acts, requiring more skilled resources and personnel, often unavailable at the community level. By either acts of commission or omission, some health workers instead of promoting safe reproductive healthcare delivery, rather deny these services, stigmatize and discriminate against people who seek these services especially young people. The ability of a country to meet its health goals depends largely on the knowledge, skills, motivation and deployment of the people responsible for organizing and delivering health services.

“The ability of a country

to meet its health goals depends largely on the knowledge, skills, motivation and deployment of the people responsible for organizing and delivering health services.

�

We should not be in a haste to increase our health workforce to the detriment of quality of service delivery. We should rather focus on training the current workforce, both in school and on the job, to offer reproductive health services especially in a youth friendly non-discriminatory manner. We should train a human resource that imbibes principles of privacy in health care delivery, respect for rights of patients including the right of

choice, committed to ensuring that all women have access to reproductive health services and more importantly, advocate for the abolishment of harmful cultural practices within their communities. It is only when we are pro-active; it is only when we actively and positively influence policies within our communities; that we can consciously contribute to the attainment of our health related goals at all levels.

References World Health Report 2006. Working Together for Health. (http://www.who.int/whr/2006/ whr06_en.pdf ) World Health Organization (WHO), Unsafe Abortion: Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2008, sixth ed., Geneva: WHO, 2011 Facts on Abortion in Africa. Guttmacher Institute, Advancing sexual and reproductive health worldwide through research, policy analysis and public education. (http://www. guttmacher.org/pubs/IB_AWW-Africa.pdf ) Speybroeck N et al. Reassessing the relationship between human resources for health, intervention coverage and health outcomes. Background paper prepared for The world health report 2006. Geneva, World Health Organization, 2006 (http://www.who.int/hrh/ documents/reassessing_relationship.pdf ).

Human resources for health. Toolkit on monitoring health systems strengthening. WHO. May2009.(http://www.who.int/healthinfo/statistics/toolkit_hss/EN_PDF_Toolkit_HSS_HumanResources_oct08.pdf )

Cephas Ke-on Avoka, Regional Assistant - SCORA Africa

Kelly Thompson, Liaison Officer, Reproductive health and AIDS

A hospital in Central African Republic

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Most Wanted:

Computed tomography scans for suspected cerebrovascular accidents While studying medicine in the Dominican Republic (DR), members of my clinical rotation group and I were assigned to the main hospital in the capital city. The hospital was advanced in infrastructure, facilities, medical technology, and healthcare services. However, as in many other parts of the world, this is not reality in majority of public DR hospitals. On visiting anyone of these health centers, one would observe limited electricity and water, challenges in hygiene, hospital supplies without vaccines, and even a myriad of full-term pregnant women waiting on the same bed for labor and delivery. In this article, we are going to describe the desperate search for imaging studies, including the computed tomography (CT) scan of the brain.

During my night shifts at the emergency room of our assigned hospital, it was typical to meet with families who accompanied their relative from other health center with medical orders for a CT scan of the brain due to a suspected cerebrovascular accident (CVA). In many small health centers as well as tertiary care hospitals, CT scan machines are inaccessible either due to being temporarily out of order or in the worst case scenario unavailable all together, thus hindering appropriate medical diagnosis for the patient.

“In many small health centers as

well as tertiary care hospitals, CT scan machines are inaccessible either due to being temporarily out of order...

”

With evidence that supports, “Time is Brain”, various scientific studies confirm the importance of commencing treatment of CVA patients as soon as possible in order to reduce neurological damage, disability and mortality. Nonetheless, with the dearth of CT scan machines, the patient is transferred from one center to another center in search of the appropriate diagnostic technology. To make matters worse, rather than in a hospital ambulance, families often transport the patient in a taxi, during the midnight hours, even assisting the patient in mobility due to physical deficits. In addition, our attending DR physician shared experience of cases where imaging studies can be completed on time but one would be faced with the appropriate treatment options, such as intravenous tissue plasminogen activator (tPA), not being available.

This situation represents almost a mirror image of events in sub-Saharan Africa. Dr. Jerome Chin, President and Founder of “Alliance for Stroke

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Awareness and Prevention Project”, stated that when he visited Mulago Hospital in Uganda, he observed that the hospital received about twenty-five (25) CVA patients each month, accompanied to the emergency room by family members who travelled long distances on public transportation.2 Sadly, several days after the CVA onset, some patients are admitted to Mulago Hospital, as the only government hospital in Uganda with a CT scan. However, most families cannot afford this critical diagnostic test. More so, Dr. Chin reported that in Mulago Hospital, treatment options are very limited as thrombolytics or intravenous heparin are not available.2 The Center for Disease Control and Prevention (CDC) estimated that more than 795,000 people suffer a CVA each year, killing almost 130,000, as the leading cause of serious longterm disability.1 These alarming statistics provide an estimate of the magnitude of this health concern and importance to assist patients as quickly as possible across the world.

Although there are minimal statistics in the DR and sub-Saharan Africa, both geographical regions share the same risk factors for CVA as the United States, but have more limited access to quality health services.

Previously, the DR health budget has been criticized as it represents the lowest in the Pan American region when compared to the Gross Domestic Product.3 While members of the political parties reside in mansions, buy designer clothes in malls, and travel around the city with bodyguards and luxury cars, the majority of the population remains in poverty and limited access to quality health services. Similarly, in Africa, 13 years after the Abuja Declaration, where the African Union countries pledged to increase government funding for health to at least 15% as well as improve health services for the population, the vast majority has not been fulfilled in the midst of allegations of government corruption (Management Sciences for Health, 2013). There are still many countries in

the world where wealth is poorly distributed and population health, as one of the pillars of society, remains neglected.

In summary, I am not suggesting that the expensive robot for minimally invasive survey, the da Vinci, should be available at each hospital. However, I do believe that every global citizen should have access to quality health services, including the necessary diagnostic tools that guide clinical management and improve health status and quality of life of patients. After all, access to a CT scan to diagnose a CVA should not be a difficult task.]

References: 1. Centers for Disease Control and Prevention. Stroke facts. 2014. Retrieved on May 10, 2014, from: http://www.cdc.gov/stroke/facts.htm 2. Chin JH. Stroke in sub-Saharan Africa: an urgent call for prevention. Neurology. 2012; 78:1007-1008.

3. El Día. El presupuesto de salud de República Dominicana es el más bajo de América Latina en relación con el PIB. 2010, January 8. Retrieved on May 10, 2014, from: http://eldia.com. do/el-presupuesto-de-salud-de-republica-dominicana-es-el-mas-bajo-de-america-latinaen-relacion-con-el-pib/ 4. Management Sciences for Health. Abuja +12 Summit: African civil society pushes for universal health coverage, increased funding for health and accountability. 2013. Retrieved on May 12, 2014, from: http://www.msh.org/blog/2013/07/08/abuja-12-summit-african-civilsociety-pushes-for-universal-health-coverage-increased

NMO: ODEM Dominican Republic Josue Devarie Gonzalez, MD Iberoamerican University

Photo reference: •Training healthcare leaders in Africa. 2010. Retrieved on May 10, 2014, from: http://www. medshare.org/media/news/118

Cynthia Then Morlas Universidad Nacional Pedro Henriquez Ureña,

NMO: ODEM Dominican Republic

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Interview Dr. (Mrs) Gyikua Plange-Rhule BSc, MBChB, FGCP, DPDM, LLB, BL

Dr. (Mrs) Gyikua Plange-Rhule is a senior lecturer in the department of Child Health at the School of Medical Sciences, Kwame Nkrumah University of Science and Technology, with a specialization in Paediatrics. She earned her BSc and MBChB from Kwame Nkrumah University of Science and Technology in Kumasi, Ghana.

Dr. (Mrs) Plange-Rhule is a member of the West African College of Physicians and a Fellow of the Ghana College of Physicians. She also holds an LLB and BL from the Ghana School of Law and was called to the Ghanaian Bar in October 2012.

This interview was conducted by Adesoji Tade and Victor Animasahun and completed after her lecture on the medico-legal twists of Assisted Reproductive Therapy (ART) during a Continuing Professional Development (CPD) program organized by the Ghana Medical Association in Kumasi, Ghana. Dr. (Mrs) Plange-Rhule discusses her motivation to study law and her thoughts about managing human resources for health in Africa.

Can you please describe your current position?

I am a general pediatrician with a specialization in new born care. Currently, I serve as head of the New Born Care Unit (NBCU) of Konfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana.

Why did you choose Paediatrics?

Well, one develops sub-specialization while in medical school, as at when I was to choose, there were not so many options. It was mainly internal medicine; which some people found interesting, Surgery; which was too hard (laughs), Obstetrics; which was too bloody, So I was left with paediatrics, which I loved the most.

If not Paediatrics, what would you have selected?

Obstetrics

If you had to choose today from the current and available specializations, which specialty would you have chosen?

It would be family medicine, but it is too late (laughs).

Why did you go back to school for a law degree?

It was mainly because of the medico-legal confusion. I currently sit on the Medical and Dental Council of Ghana, before I got the Law degree, we worked with a lot with lawyers. Many of them did not understand the medical issues, and many doctors did not always understand the legal issues.

There are too many wrong things happening and nobody seems to know what to do about it. Law is a big part of medicine, doctors have potential to do a lot of good and a lot of evil, the laws restrain us.

Medical students have commented that you are a great teacher who is very passionate about her work. We would love to know what drives this passion.

‌.. (smiles) that is a very nice comment from my students. I basically just like teaching. I believe whatever knowledge or experience you have acquired should be passed on. Clinical medicine is so exciting, every ward round is different. Neonatal medicine is very challenging. It is nice to do a ward round and at the end realize you have solved some if not all the problems. You get tired and go on leave and yet you still miss the wards. You just feel you are solving problems, especially of people who cannot give back to you.

Continuing on to our Auscultate theme, what do you think are the basic resources that must be on ground to achieve universal health coverage?

Well, it is predominantly human. Every health worker should be well trained and must be able to work in any environment he/she finds him/herself. Knowledge is, however, key to achieving that. Every health worker should be innovative, creative, dedicated and care about patients. Ofcourse, patients are also a huge resource.

Most people spend a lot of time wishing they were somewhere else or that they had what other people have but we don’t, so that we can and should work within the resources we have available accepting that we can improve.

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In what specific ways have you contributed to universal health care in Ghana and abroad?

I have contributed largely at home. Most of my contribution has been with teaching undergraduate and postgraduate. I have been teaching at the medical school for about 15years now. I have also been on the Medical and Dental Council of Ghana for 10years setting standards and policies for doctors in Ghana.

Do medical students have roles in achieving universal health care? What are these roles?

Oh, absolutely! Medical students have roles to play.

Once you enter a medical school, you are a health worker and the society sees you as such, and they probably start calling you doctor from the first year (laughs).

I feel that student’s roles are in education and advocacy in their respective communities, either directly with people or organizing programs on radio. Also, medical students should contribute to medical education, as it is those on the receiving end that should strive to make it better.

Medical students should also be concerned about ethics. It is the early years (first 7years) that attitude to money and some basic structure about one’s practice is formed, so learning from school would help build those years.

Looking at the existing dichotomy between medical students and their teachers, are you sure that medical students can contribute to medical education? Is there a forum in Ghana where medical students have a role in curriculum development?

Well… it is not great. I can speak of Kumasi, medical students are represented on the academic board. We also encourage students to assess lecturers by using a questionnaire/form. Unfortunately, it is ALWAYS initiated by the medical school, rather than the students, although it is a big opportunity for the students to contribute. When these assessments are done, it gets to the Vice Chancellor and the lecturers receive feedback, such as “the students said you are lousy”, “the students said that you do not bother to use information technology” and it does touch the lecturers and they make amends.

I think medical students should contribute more to the quality of education they receive.

In our brief interview, we have been held spell bound and enlightened. Do you have any closing remarks for IFMSA Africa and young doctors in Africa?

You are very blessed because the opportunity to study medicine is something many people would die for but big blessings come with big responsibilities.

Even through your counterparts outside of Africa are blessed with many learning and teaching aids, you have access to patients in ways they do not and so you have huge opportunities to develop your clinical skills and those are the skills you’d use as a doctor. Let’s take the opportunities we have and to build our clinical skills so that we are practitioners who can practice even when technology is not there.

Medical students should take advantage of what they have and not worry about what they do not have.

Auscultate team with Dr. Gyikua

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Open Access Open Access (OA) is the free, immediate, unrestricted availability of highquality, peer-reviewed scholarly articles over the Internet combined with the rights to use this information to its fullest possible extent.

Open Access is a concept that seeks to spread knowledge and allow that knowledge to be built upon. Pay walls and price barriers have prevented students, teachers and researchers from getting access to research they need.

As students, we are gradually losing already limited access to core academic research – research essential to a complete education. We run into access barriers, forcing us to settle for what we can get access to, rather than what we need most.

Outside the classroom, limited access to research has a tremendous impact on people’s lives. When doctors are denied access to medical research, patient outcomes suffer - especially in developing countries where medical professionals have even fewer resources to commit to research access. Even in business, small companies in cutting-edge fields lose opportunities to innovate when they don’t have access to the most up-to-date research upon which to build.

Open Access has some closely related subsets, they include; • Open Educational Resources (OER), which focuses on increasing access to tools students use to learn from textbooks to even entire lectures.

• Open Data, which focuses on making data from research openly available for others to download, copy, analyze, reprocess or use for any other purpose without financial, legal or technical barriers.

• Open Science, which focuses on open access to the results of research as well as access to research tools like cell lines, reagents and DNA samples.

BENEFITS OF OPEN ACCESS As an author You will have a larger potential audience than any subscriber-restricted journal can give you. Open access can increase the impact of your work, shorten the delay between acceptance and publication, and make your articles more effective by making them easier to find and use. Your work will be visible to every search and retrieval tool.

As a reader You will have free online access to the literature necessary for your research.

As a teacher You will have access to up-to-date cutting edge technology and most recent information to have best impact on your students. Your students would also have convenient access to the information they need. With open access literature, the author or copyright holder has given permission in advance for making and distributing copies.

As a scientist or scholar Better visibility and higher impact for your scholarly article. Studies have shown a significant increase in citations when articles are made openly avail-

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able. Astronomy researchers who made their Astrophysical Journal article open access using the arXiv. org e-print server doubled the citation rate of their articles. Text mining, a subset of open access is very beneficial giving researchers an over-arching view of a particular field and uncovering trends and connections within their own field and between seemingly unrelated fields that no human researcher could discern. However, when many articles are inaccessible due to subscription barriers or being posted in non-computer-readable formats, these tools cannot reach their true potential.

As a doctor More knowledge leads to better outcomes. Opening access to research will allow doctors access to all relevant information, enabling them to make better decisions - decisions based on the most upto-date medical knowledge, leading to more effective treatment and better outcomes.

STRIDES IN OPEN ACCESS ADVOCACY •OPEN ACCESS BUTTON The Open Access Button is a browser-based tool that was developed by 2 British students - Joseph McArthur and David Carrol. The button tracks and maps incidence of people hitting paywalls, builds support and awareness for open access and helps people get the research they need.

The tool helps you get for free, an author-deposited version of a research paper that is being hidden behind a paywall. If that is not possible, it gets you a

close substitute that is freely available online.

Joseph and David developed this tool in response to the plight of graduate and undergraduate students, as well as researchers from all over the world who are being denied access to the research that they need. For more on the Open Access Button, visit www.openaccessbutton.org •The World Health Organization has also enacted a robust open access policy that took effect from July 1, 2014.

BE A PART OF THE TEAM •Join the Open Access Coalition, visit http://www.righttoresearch.org/ and join as a student. You can also get your University to join the over 200 that has adopted the Open Access mandate.

•Create awareness among your colleagues, educate them and begin advocacy groups.

•Submit your work only to open-access journals. There are over 1000 peer-reviewed journals listed in the Directory of Open Access Journals (www.doaj.org), and new journals appear online every month.

BIBLIOGRAPHY •Right to Research Coalition. R2RC: learn. [online]. Available from http:// www.righttoresearch.org/learn/problem/index.shtml [Accessed 14th August 2014] •Stevens-Rayburn, Sarah. Account of 2003 AAS Publication Board meeting email to PAM electronic discussion list, November 13, 2003. http://listserv. nd.edu/cgi-bin/waA2=ind0311&L=pamnet&D=1&O=D&P=1632

NMO: NiMSA Nigeria

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STRIKING HEALTH WORKERS

Should Medical Doctors Embark on Strike?

Historical events describe instances when social institutions have created inequalities and deprived populations approached the perpetrators without fear, forcefully demanding retributions. From the French Revolution, through the African decolonization to the anti-apartheid in Madiba’s South Africa, these vulnerable and deprived populations fought for what was due to them. In line with the famous quote by Victor Hugo, “No army can withstand the strength of an idea whose time has come”, these affected individuals waited for the indicative time to “fly like a butterfly and sting like a bee” (Mohammed Ali).

the medical profession, as described in the Hippocratic Oath in that, the striking physician is no doctor at all and cannot be called a noble member of the medical profession.

However, on the other side of this debate, some people believe that physicians are dedicated to their profession and this dedication should be repaid. They think that their families should not also be sacrificed in the abattoir of irresponsible institutions/ employThese events can occur in a diversity of disciplines. It is however popular ers who are supposed to appropriately respect their on the political platforms where it is sometimes milder and constitutional rights. and also on employer/employee platforms. In the latter, when trade unions and workers’ associations feel the basic employer’s responsibilities are not In addition, when hospital supplies are limited, some performed and the employee’s needs are not considered and met, they doctors embark on strike actions for the sake of may appeal to their employers and other stakeholders for justice. Physi- their patients, demanding an increase in the hospicians, whose principal responsibility includes patient care - a matter of life tal budget in order to ascertain that these life-saving and death, may engage in similar appeals for justice by demonstrations or items are available. strikes. However in Ghana, physicians are more active in strikes than demIn fact, each perspective has unfavorable conseonstrations. quences which may present if one side is fully emThis article focuses on the debate of physicians’ participation in strikes and ployed. If physicians are encouraged to strike in order to meet their demands, some patients may present discussions on methods to salvage the situation.

A few popular questions that find themselves at the heart of the debate fatal complications during the medical strike. Whether the individual is a physician or a patient, all lives are: are equal. As strike actions continuously become the 1. Can physicians go on strike? habit of the medical profession, some patients will 2. Should physicians go on strike? lose confidence and no longer trust the healthcare 3. Are there any justifiable reasons for physicians to go on strike? system. Without the guidance of physicians for care4. Is it right for physicians to go on strike? fully selected treatment, patients may resort to other 5. Does the striking physician have any moral values? medical interventions which may have long-term detOver time, a myriad of individuals from different disciplines have contrib- rimental effects on their lives. These consequences uted in providing arguments that aimed to answer these five questions may be considered the signs of health policy failures pertaining to physicians and strikes. Students on all levels of education in- where institutions cannot protect the lives of the popcluding medical students, politicians, other intellectuals and the physicians ulation that they serve. themselves have engaged in these debates formally or informally during their lifetime. Each individual has deep beliefs, thoughts and convictions On the other hand, if physicians were bound by all legal and ethical measures without the ability to emabout whether physicians could or should embark on strike actions. bark on strike actions, our society would face hypocOn moral responsibility, some believe that when physicians go on strike, risy. Physicians have worked tirelessly improving the patients have increased risk of mortality. In addition, some advice physi- health and quality of life of their patients, and so it cians, whose responsibility is to protect the lives of their patients, not to is only fair, that they be repaid. This sentiment is reflected in the popular Akan adage “ͻsεnkafoͻ didi sacrifice human lives based on selfish financial gain. n’edwuma ho” (The preacher man makes a living from On economic stability, many feel that medical doctors are already finan- what he does daily). cially stable and they should not complain about their salaries, since a significant portion of the population live in poverty and need more attention. If an institution anticipates a delay in salary reimOn social responsibility, others believe that since the taxpayers’ money in- bursement, then the appropriate procedures should directly funds the training of a medical doctor, a medical doctor who em- be taken to inform them and make provision or alternatives rather than wait for strikes or future litigabarks on strike actions is not diligently performing his or her social roles.

Another commonly raised argument is on ethical principles and spirit of tions.

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In public healthcare delivery, the government is responsible for physicians’ salaries and demands. Previously, this debate had only considered two stakeholders – the physician and the patient. By excluding the government the debate remains incomplete.

Overall, the two appropriate questions to be asked are: 1. Should physicians be provided with reasons to consider strikes as an option?

2. How can society and the stakeholders together eliminate strikes as the only option available to physicians?

These two questions are complete and have taken into consideration all the stakeholders involved in the issue of physicians and strike actions.

Stakeholder 1: The employer (Government) Often, the reasons for physician strikes are mostly provided by the employer (the government). Their actions and comments as well as their failure to act all come together to incite the whole thought process of considering strike action by the medical doctors.

Stakeholder 2: The physicians.

Physicians have genuine concerns that need to be addressed and appropriate measures implemented. These questions also remind physicians of the nature of their selected profession. This sentiment can be summarized in the words of American physician Carola Eisenberg, former Dean of Harvard Medical School: ‘It is still a privilege to be a doctor’. But to lose sight of just how lucky we are to have a profession in which we do well for ourselves by doing well for others reflects a puzzling loss of perspective. The satisfaction of being able to relieve pain and restore function, the intellectual challenge of solving clinical problems, and the variety of human issues we confront in daily clinical practice will remain the essence of doctoring, whatever the changes in the organizational and economic structure of medicine.

Anthony Gyening-Yeboah University of Cape Coast

NMO: GMSA Ghana

Stakeholder 3: The patients.

As the unfortunate victims of the misunderstanding and mistrust between government and physicians, they face detrimental effects by strikes. A strike that results in increased patient mortality is a sign of a failed healthcare system.

In conclusion, this debate should no longer be a blame game but rather the debate should be on how the stakeholders can become more effective in playing their individual roles in the whole healthcare delivery process.

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Report : ARM 2013

Addis Ababa Ethiopia Every year an annual IFMSA meeting takes place in Africa. The African Regional Meeting is a unique event where medical students from Africa meet to discuss causes concerning the health in the continent. In addition, they receive remarkable and globally standard materials; all for the sake of improving the health standards in the African community.

This passing year, our annual meeting took place in Addis Ababa, Ethiopia. With great hostility and generosity at Wabi Shebele hotel, both, the international and national organizing committee held back no effort to ensure a memorable event is concluded.

Similar to every IFMSA meeting, a pre-ARM took place from 15th to 18th of December. Projects are the skeleton of IFMSA and trainings are the backbone of the association; for this, training is another important part of the regional meetings.

The Pre-ARM is the part of ARM where internationally certified trainers and alumni trainers deliver personal development skill trainings so as to assist student leaders in their work and equip them with the necessary skills to represent student bodies at different levels consequently nurturing the future generation of global health advocates and leaders. In the pre-ARM, the following workshops took place: a Training of new Trainers (TNT) Training of old trainers (TOT), 5 stars Doctor and IPET\IPAS Maternal health and mortality. All is of great relevance to our health situation in Africa.

Via the previously introduced workshops we produced new generation of African trainers, enhanced and more experienced old trainers and future physicians aware of the important skills to become globally stated physicians with sufficient knowledge of the common problems in our region. Thus, we fulfilled the title of the pre-ARM “For better future physicians”.

The theme of the 9th regional meeting was “health care in Africa”, a look back to the 50 years old African Union placed in Addis Ababa. With honourable guest speakers who reflected the main challenges we-as future health professionals- are and will face such as the weak and fragmented health systems, inadequate resource for scaling up proven interventions, limited access to available health services and technologies, poor management of human resource for health, weak application of policy action to health determinants, limited intelligence for decision making and extreme poverty. The aim of the theme event is to come up with a number of suggestions and recommendations that will help establish better health care delivery system in the Region through our political governing bodies. However, a complete understanding of this solution includes continuous follow up and study of each country’s policy.

Throughout the ARM, the attendee’s now understand the current health situation of the region.

Remarkably, the standing committees held their sessions fruitfully, achieving the objectives they previously set. There was a Think Global Initiative introduction lecture by the African representative for Africa. The IFMSA VPI Dimitris Stathis, SCOME director Stijntje Dijk, SCORA LO Kelly Thompson and Asia Pacific

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medical students worldwide | www.ifmsa.org

Rasha Osama Alkashif Regional Assistant SCOME - Africa

NMO: MedSIN Sudan

RC Bronwyn L worked with the IOC and the NOC to ensure that the meeting is running smoothly.

The meeting passed so fast, delegates created beautiful memories, on and off work time, at cloud nine during meals and at unique social programs. (Africans know best when the beat drops) As the meeting came to an end, the post-ARM matched the Christmas eve’. Roaming the historical sites of the country and the great natural sceneries with the scent of aromatic Ethiopian coffee, accompanied with extraordinary colleagues from EMSA (Ethiopian Medical Students Association), the 9th ARM was definitely one to remember.

ARM 2013 PICTORIAL

auscultate| Aug 2014 | ARM 2014 Uganda

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