The Medical Student International 30

Page 1




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.

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

Imprint Editor in Chief Diogo Martins - Portugal Content Editors/Proofreading Betty Huang - Taiwan Boriana Gorgieva - Bulgaria Christine Haddad - USA Eman Ismail - Egypt Mariko Kondo - Japan Nina Nguyen - Quebec Nowrus Emad - Egypt Design/Layout Ibrahim Kandeel - Egypt Mohammed Yasser - Egypt Rami Abdallah - Egypt

Publisher

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

5

Editorial

6

Happy 30th MSI!

Words from the Editor in Chief

Words from the Design Coordinator

7

President’s Message

8

The IFMSA We Want!

Message from the IFMSA President

"Big Four" - Recommendations for taking IFMSA to the next level

10

Sustainable Development for the New Era

30

Projects Bulletin

48

SCORAlicious

66

The SCOPHian

78

The SCORPion

90

SCOREview

104

periSCOPE

116

SCOMEdy

Articles on the theme of the August Meeting 2014

Read about IFMSA’s local, national and transnational projects

Welcome to the world of the SCORAngels

Meet SCOPHeroes who save the day through their Orange Activities

Learn about Human Rights and Peace efforts worldwide

Have you ever wondered what SCORE exchanges are all about?

Go travelling with SCOPEans on their professional exchange

The guardians of medical education share their stories


( M S I

5

3 0 )

Editorial Diogo Martins

IFMSA Publications Support Division Director 2013-2014

publications@ifmsa.org

In this very special edition, the Medical Student International (MSI) celebrates 15 years of existence, perhaps even more. When digging up the past of the magazine, one can hardly uncover all the stories it has to tell . But one thing remains the same: after 30 editions, IFMSA still counts on the work of many committed and thoughtful people, from the wonderful contributors worldwide to our persevering editorial teams. And we, IFMSA Publications Team 2013-14, couldn’t be more excited to have made it to this point! Throughout these pages, you are invited to uncover the recommendations for taking IFMSA to the next level ("Big Four") and to meet some of the covers that had been featured over the last editions. You will also be amazed to find out that many topics highlighted back then are still under discussion nowadays. Don’t believe? Check yourself the “Millennium Development Goals” (MSI 12th), “Access to Essential Medicines” (MSI 16th), “Conflicts and Health” (MSI 19th) or even “Youth and the Social Determinants of Health” (MSI 25th). Of course this can be a dou-ble-edged sword: either some of these problems have not reached sustainable solutions or medical students are a real group of young visionaries! Believing that in the latter lies the answer to the first premise, we take you to the future with the “Sustainable Development for the New Era” serving as the motto of the 63rd General Assembly August Meeting 2014. In your hands are the testimonies, from the all the IFMSA Standing Committees, Projects and future Global Health leaders, that prove that in us lies the power of looking beyond today and envisioning a better tomorrow. We invite all IFMSA enthusiasts to embark on this adventure until the end and wish you an unforgettable experience! Yours truly,

Diogo Martins Editor-in-Chief

medical students worldwide | AM 2014 Taiwan


A u g u s t

2 0 1 4

6

Happy 30th MSI! Dear medical students worldwide, “Publications” is the tool that can provide a clear picture our Organization’s work to general society and even to governments. In IFMSA, we soon realized their enormous potential and so we started creating one that was made by medical students from A to Z, with their activities, plans and dreams for a better world. It is the Medical Student International (MSI) Magazine!

Ibrahim A. Kandeel

NMO: IFMSA-Egypt MSI Design Coordinator

ibrahim.kandeel@gmail.com

Each edition of our MSI is special, but this one I would dare to say is a little more: we’re celebrating the 30th issue! For the last three years I’ve been working with a lot of IFMSA publications, as a member of the Publications Team. But while coordinating this edition I felt different. I never stopped thinking “this is a challenge we have to take, we have to design something that would really give our Members and other outside readers an extraordinary impression of our Federation”. We worked very hard, trying to make it as perfect as it could be, especially for you. Finally, I want to appreciate the great work of the “Fantastic Ten”, our Publications Team! Thank you: Mohamed Yasser, Rami Abdallah, Betty Huang, Boriana Gorgieva, Christine Haddad, Eman Ismail, Mariko Kondo, Nina Nguyen, and Nowrus Emand. And, of course, our incredible Director: Diogo Martins! Yours,

Ibrahim Kandeel MSI 30th Design Coordinator

www.ifmsa.org


( M S I

7

3 0 )

President’s Message Joško Miše

IFMSA President 2013-2014

president@ifmsa.org

Dear IFMSA members and friends, It is with great excitement I write to you on the occasion of the 30th edition of Medical Student International (MSI), that over the years has become a key platform for medical students worldwide to express their ideas and showcase their activities and projects.

63 Years of IFMSA

Established in 1951, in a post-World War II setting, IFMSA founders came together in a period of history where growing disparities in the socio-economic and political arenas challenged the health and wellbeing of people around the world. IFMSA was created to foster cooperation and collaboration among medical students by breaking down societal barriers through promoting opportunities for dialogue and creating clinical exchanges. IFMSA rapidly expanded to become one of the pioneering non-political, non-governmental organizations working in the field of community health and capacity building for medical students. While we find ourselves in a world where the boundaries and tools have changed drastically, we still find ourselves in a world where there are growing disparities and a lack of equity—in education, socio-economic opportunities, environment, personal safety, and health. These disparities are further challenged by gender, sexuality, discrimination, and socio-political factors. And we are studying medicine at a time and in a world that is characterized by – inequality and insecurity. How does this affect healthcare and us, as future physicians?

Sustainable Development for the New Era

With less than 400 days until eight Millennium Development Goals (MDGs) expire, the world leaders are getting together to form the next set of development framework – in a process called ‘Post-2015 Development Agenda’. What is ‘Post-2015 Development Agenda’? It is the first major intergovernmental policy process guided by the UN Development Group that has so far involved more than 1.3 million people to get their insights as to what the people’s most critical development issues are around the world. Large numbers of people have been reached – youth, academics, experts, policymakers, entrepreneurs and interested citizens. IFMSA, as the largest student run organization in the world, and a NGO focusing on health, has put post-2015 development agenda at the center of its advocacy efforts with the goal of ensuring youth and health issues remain strongly represented in the next set of development goals. With more than one billion people unable to access the healthcare they need, while 150 million people experience a financial catastrophe every year from outof-pocket health costs, exacerbating inequality and poverty, it is clear that health deserves a high priority in the development of the post – 2015 agenda. Now is

the time to act and to reverse the negative trends that lead to poor health outcomes of people worldwide. And the big question is - how? Going back to the very core of ‘Health for All’ principle, coined in 1978 in Alma-Ata, there is an emerging global movement for Universal Health Coverage (UHC) to be the health priority in the development framework of the post - 2015. The definition of Universal Health Coverage is ‘ensuring that all people obtain the health services they need, of good quality, without suffering financial hardship when paying for them’.

The role of medical student and young people

As future physicians, we will be the ones experiencing throughout our careers and lives, successes or shortcomings of the new development framework that will be agreed in 2015. As such, we will be the ones responsible for carrying out the goals and reaching the targets agreed. As Dr Margaret Chan, Director-General of the WHO said in the interview for IFMSA, ‘You are the future of healthcare. I believe the best days for health are still ahead of us. Turning that prediction into a reality lies squarely on your shoulders’. That is why the theme of the 30h Edition of Medical Student International (MSI) and IFMSA General Assembly August Meeting 2014 is ‘Sustainable Development for the New Era’ with the clear message that it is the responsibility of every medical student to engage in creating a sustainable future and seeing the best days for health turning into a reality. Going through the articles of this MSI, and seeing the great interest and deep understanding of the global development issues that medical students have, it is with certainty that I say that IFMSA is successful in its mission of creating culturally sensitive medical students who are able to grasp global health problems, work with others to address the global burdens of disease and health to create healthier communities, and thus a healthier world. I would like to give a special thanks to all those that have taken the time to create and contribute to this edition of MSI. Yours,

Joško Miše IFMSA President 2013-2014

medical students worldwide | AM 2014 Taiwan


The IFMSA We Want! Dear IFMSA friends! IFMSA has been through a lot recently. But we learn from our mistakes, and IFMSA always strives to improve. Sometimes, we do it gradually to make the organization of tomorrow better than it was yesterday. This term we take a quantum leap, and re-think fundamental functions of the organization, to give way for creativity, new ideas and needed organizational strengthening. We have focused on four areas, and we call them the “Big 4”: Programs, Leadership, Secretariat and Strategy. With the new Programs we turn the current vague and complex projects structure into a simplified and outcome-oriented structure for activities. It will provide a flexible framework for National Member Organizations’ activities, no matter if they are oneday events, long-term projects or somewhere in the middle. IFMSA’s current framework for projects and events has so much potential to facilitate collaboration between our National Member Organizations, but a number of shortcomings hinder the realization of this potential. Especially the bureaucracy is a significant hindrance currently, whereas the new framework allows and empowers volunteer medical students to excel and innovate, to become agents of positive change in their communities. The Programs framework has simple and relevant reporting mechanisms, and a simple enrollment process. And we hope that National Member Organizations, in the future, can obtain financial support from international and regional institutions through their participation in these Programs, thus taking the Federation to a whole new level as a service provider to our members. IFMSA has grown tremendously in recent years, and the administrative requirements are ever increasing. Until now, each Team of Officials has been spending a disproportionate amount of time on technical and administrative tasks.

www.ifmsa.org

IFMSA Executive Board 2013-2014 eb@ifmsa.org

As medical students, we do not join volunteer organizations like IFMSA to carry out routine administrative tasks, filling out reports and do massive amounts of paperwork. We do it to fight for what we believe in, and have a positive impact on the world. Because we are medical students, administration is just not our strong side. This has three immediate consequences: it drains all the positive energy that should help the organization thrive, it takes longer than it needs to, and it is usually not done properly. Officials struggle to keep their heads above waters, and when Officials are overburdened with administrative tasks, there is simply no energy to develop the organization and support our National Member Organizations. Instead, administrative tasks should - and will - be taken care of by a professional secretariat with trained personnel. After years of brainstorming and consultations involving countless former, current and future IFMSA leaders, your Team of Officials 2013-14 now presents the proposal for a new leadership model that will take IFMSA to the next level. A leadership model that ensures rounded, responsive and representative decision making. And a leadership structure that is apt for supervising a well-functioning International Secretariat.

So, what will the role of the secretariat be? There is really no way to define a universal set of tasks that applies to all organizations. But for an organization like IFMSA the secretariat should handle the tasks that we should not burden our volunteers with, and that are instrumental for the survival of the organization. The exercise is to identify how staff can support the volunteers and make their work easier, less strenuous and more fun (!) - and still avoid that the secretariat gains too much power and steers the organization. Striking this balance can be very difficult, but is absolutely crucial so that the ideas and visions of the volunteers direct the practical work of the secretariat, and not the other way around. This requires a confident and competent leadership, and it requires the right leadership structure, just as the one that is proposed at this August Meeting in Taiwan. The secretariat will carry out administrative and GArelated tasks, provide organizational support, ensure that IFMSA adheres to relevant legislation in The Netherlands, and liaise with legal advisors. All financial management has been delegated to an accounting firm with the capacity to advise IFMSA on financial-legal matters.


9

Finally, to tie it all down and link the implementation of these changes to the reality of the Federation, we will have a three-year strategic plan, Strategy 2014-17. The strategic plan will help the organization implement structural changes that transcend individual leaderships. Indeed, as these structural changes cannot be implemented in the course of a single term, it is key to ensure that future leaderships follow up on and conclude the implementation. The strategic plan will also help future Executive Boards and Teams of Officials align their work with the long-term interests of IFMSA as an organization. It will help aspiring Officials write relevant candidatures when they run for positions in the leadership of the Federation. And it will help each Executive Boards document how they have expended IFMSA’s resources - and why. Three things signify IFMSA’s volunteers: independency, self-management and creativity. The strategic plan will guide the collective work of each Team of Officials to achieve IFMSA’s long-term strategic goals defined by the National Member Organizations. Yet, it must leave enough room for each volunteer to realize her or his own ideas. This way every individual who devotes time and energy to IFMSA will benefit personally and play a key role in the continuous strengthening of the Federation. So, by letting the strategic plan guide the annual work plans of future Teams of Officials, the strategic plan will ensure continuity, transparency and accountability in the work of IFMSA’s.

( M S I

3 0 )

These are the “Big 4”. And they will take us to the IFMSA We Want!

With love, Your Executive Board

Salma Abdalla

Benjamin Skov Kaas-Hansen Fredrik Johansson

Dimitris Stathis

Joško Miše

medical students worldwide | AM 2014 Taiwan


A u g u s t

2 0 1 4

www.ifmsa.org


( M S I

11

3 0 )

IFMSA AM 2014 Theme: Sustainable Development for the New Era

AM2014 Organizing Committee - Academic Division NMO: FMS-Taiwan

infantchen@gmail.com

This summer, Taiwan will hold the 63rd General Assembly August Meeting (AM 2014) of IFMSA. The theme of AM 2014 will be ‘Sustainable Development for the New Era’ with two subtopics including: ‘Sustainable Healthcare’ and ‘Sustainable Environment’ However, what will we discuss in Sustainable Development? Here is the information we want to introduce you.

The origin of ‘Sustainable Development’: In 1992, the first of its kind Earth Summit held in Rio de Janeiro released the document ‘Agenda 21’. It introduced the concept ‘Sustainable Development’ and disclosed the action plan for the 21st century in order to achieve a more sustainable society. The document also emphasized that actions for sustainable development should be executed from different aspects; meanwhile, at local, national, and global levels. This ambitious work had not only spread the new concepts of sustainable development into the international communities, but also set a significant milestone in the history of human development. Twenty years later, the third Earth Summit Rio+20 published the document ‘The future We Want’ that re-emphasized the importance of sustainable development. Now, it has become the doctrine of almost every system and organization in the world.

A. The essential role of health promotion in achieving sustainable healthcare Beginning with Alma Ata Declaration on Primary Health Care in 1978 (1) and the Ottawa Charter for Health Promotion in 1986 (2), people in the whole world strive to put more emphasis on eliminating health inequity, advocating health promotion activities, and understanding social determinants of health. Currently, people have consensus that ‘Health for All’ is a very important cornerstone to promote sustainable development. In order to reach the exalted goal ‘Health for All’, we need to adopt effective strategies such as establishing inter-sectoral collaboration to fulfill ‘Health in All Policies’ (3). By doing so, complicated challenges like health inequity, prevention and control of non-communicable diseases may be solved. As medical students, what can we do and what should we learn to achieve this goal? First, we need to learn how to communicate and cooperate with public health experts and organizations. We should no longer rely solely on medical treatment to cure diseases, but to be advocators of health promotion. Second, we need to learn how to interact and collaborate with government and public. Third, we should take advantages of our professional impact. Based on the professional field of hospitals, we should promote value-adding healthcare not only cure the disease, but also prevent, protect and elevate people’s health! B. A dream to achieve sustainable universal coverage and healthcare system

Sustainable Healthcare Sustainable Development involves lots of issues, including Sustainable Healthcare. Aging society, unequal allocation of resources, and threatened right to access healthcare decrease the quality of healthcare system nowadays. As medical students, how to promote a sustainable healthcare system is the question we all have great interest to know. There are three aspects we will discuss in AM2014 Taiwan.

Beginning in late March of 1995, the Taiwan government began to offer its national healthcare via a single payer system (National Health Insurance, NHI) (4). Today, with the NHI’s coverage among 99.5% of Taiwan’s population and a wide scope of benefits for medical services, Taiwanese government has achieved the universal coverage with expenditure much lower than the average of the OECD countries (5). However, two decades after NHI’s establishment, over-utilization and growing demands for more health benefits have made this miracle gradually lost its color. The heavy fiscal burden of NHI, deteriorating reimbursement and longer working hours for healthcare workers have put both the NHI and the health care system into crisis. In remedical students worldwide | AM 2014 Taiwan


A u g u s t

2 0 1 4

sponse to the call for reformation from the public, the second generation NHI was carried out as an initial step of reformation in 2013. Nevertheless, it’s still a long road toward a sustainable system. In this session, we would provide different view of points toward sustainable healthcare from the government, the health providers, and the scholars. C. The sustainability of long term care system (LTC) According to the report of WHO in 2002, the worldwide population of the disabled will rise to a historically high. Among the Taiwanese population, this serious situation still holds, with 400 thousand people still unable to deal with their daily chores. These statistics warn us that besides aging society, chronic diseases, mental and physically disabling, and the over-loaded caring system will become challenges for us in the near future. Under these circumstances, the plan of long term health care will be an important and equally urgent issue for most of the countries globally. Take Taiwan as an example, the act of long term health care will reform the current laws for the elderly and the mentally disabled populations. However, the system of long term care does not confine only to medical industries. Under the influence of Confucius, Chinese culture view the care of elderly as a family responsibility, and it has become a new challenge for the establishment of law. Furthermore, caring a public issue has also been a long struggle for the women’s movement in Taiwan. To sum up, there are more issues to be concerned including fairness, accessibility and broader subjects such as the distribution of manpower, social insurance, and the need for the caregivers.

12 A. Sustainable Development - from domestic to global view In AM2014, we will discuss sustainability from different perspectives including governments, NGOs and businesses. In the United Nations, the United Nations Framework Convention on Climate Change (UNFCCC) manages to help countries finding new ways of adaptation and mitigation in order to fight against climate change. Meanwhile, with the pressure that Kyoto Protocol will expire on 2020, UNFCCC make efforts to negotiate with country delegates to sign a new protocol in 2015. For businesses, Corporate Social Responsibility (CSR) has become an important value in the future sustainable society, businesses should take the responsibility of taking actions and encourage positive influence on society (6) . By civil society’s power, dedication of NGOs will also play a vital role in the promotion of sustainable development. Last but not least, we cannot achieve the goal without governmental help, policy makers should establish appropriate policies and take sustainable development into consideration in policy making. B. Disaster risk management and sustainable development Natural hazards, including earthquakes, floods, and drought, pose significant threats to human lives. According to International Displacement Monitoring Center (IDMC), the number of weather-related natural disasters has tripled since 1960s, causing over 30 million people displaced worldwide in 2012 (7). As global warming becomes more serious, it is very likely that climate-related natural extremes become more frequent and more severe in the future. In face of this, focus on disaster response and recovery is simply not enough; furthermore, reinforcement of community resilience through disaster reduction and mitigation is what we have to put into consideration. As Hyogo Framework for Action (HFA), the first international disaster action plan aiming to reduce disaster risks in 2005, is going to move on to the next stage in 2015, it is high time for us to get more insight into the field of disaster risk management now. Thus, in AM2014, we are going to learn the connection between health sectors and disasters and redefine the role doctors should play in disaster risk management. We will discuss how to mitigate the impacts of climate change by utilizing disaster risk management, see how Japanese Disaster Medical Assistance Team (DMAT) promptly and appropriately responses to serious disasters, and learn the local experience from Taiwan Red Cross.

We are looking for your participation! To achieve the goal of Sustainable Development, there are still lots of difficulties we have to overcome. Together, let us embark on a journey to shed some insight to the root of the problems, seek more solutions, and create a more sustainable environment for our future generations! References: (1) International Conference on Primary Health Care. Declaration of Alma-Ata. September 6-12, 1978. http://www.who.int/publications/almaata_declaration_en.pdf (2) First International Conference on Health Promotion. The Ottawa Charter for Health Promotion. November 21, 1986. http://www.who.int/healthpromotion/conferences/previous/ottawa/en/ (3) Report from the International Meeting on Health in All Policies. Adelaide Statement on Health in All Policies. April 2010. http://www.euro.who.int/__data/assets/pdf_file/0005/171707/Intersectoral-governance-for-health-in-all-policies.pdf

Sustainable Environment Sustainability has become an important issue nowadays. Human activities, including overpopulation, overexploitation of natural resources and excessive emission of carbon dioxide have already exceeded the carrying capacity of the earth. If we don’t mitigate and reverse this trend, it will lead to an irreversible destruction, threatening our environment and health, furthermore, our survival.

www.ifmsa.org

(4) A Review of ROC’s National Health Insurance. p57, p71, p273-281, p632. The Control Yuan, ROC. 2010. (5) Second Generation National Health Insurance Guidebook for Healthcare Facilities. National Health Insurance Administration, Ministry of Health and Welfare. 2013. (6) Corporate social responsibility,CSR: http://en.wikipedia.org/wiki/Corporate_social_responsibility (7) Hyogo Framework for Action 2005-2015: Building the Resilience of Nations and Communities to Disasters, UNISDR. 2005.


( M S I

13

3 0 )

Building the Next Generation of Medical Researchers:

Increasing Value, Reducing Waste (1) Ivana Di Salvo

LO to Research and Medical Associations 2013-2014 lorma@ifmsa.org

As medical students, we enjoy a thorough education on many aspects that prepare us for our future work in healthcare. However, some medical students aspire to become researchers. Some even move directly into work improving and contributing to research right after completing medicine. Unfortunately, many universities do not sufficiently teach how to become a good researcher and how to publish successfully. The lack of training related to Research Methodologies and Publications led IFMSA to organize a pre-General Assembly with the aim of providing insight into good research practice and successfully communicating results. The pre-General Assembly is a great opportunity to organize such a workshop, IFMSA holds two biennial General Assemblies during which around 1.000 medical students from more than 100 countries gather together. The theme of the 63rd General Assembly March Meeting 2014, hosted by the local member AssociaMed-Tunisia was ‘Health Beyond 2015: Get Involved!’ This preGA-Workshop took place from the 28th of February to the 3rd of March 2014 in Hammamet, Tunisia and was organized by Ivana Di Salvo (IFMSA Liaison Officer to Research and Medical Associations), Joško Miše (IFMSA President) and Balkiss Abdelmoula (Development Assistant (2) Academic Quality SCORE) together with Sabine Kleinert, Senior Executive Editor at The Lancet, and Elizabeth Wager, Publications Consultant at Sideview and Former Chair of COPE (the Committee on Publication Ethics). They touched on key topics of medical research, beginning with the research question and leading up to post publication responsibilities. ‘’Medical Research has a fundamental role in changing clinical practice, changing understanding of disease and stimulating further research’’ Sabine Kleinert

The Standing Committee on Research Exchange (SCORE) aims to improve the knowledge of medical students on research, specifically on its principles and methodologies. Several national member organizations aim to build medical student capacity in broad research concepts. Specifically, SCORE would like to offer an international training workshop to introduce national organizations to the potential of research methodology workshops. As many of our member organizations have medical student members who may not have the opportunity to learn about research principles and methodologies, we feel that it is central to achieving better global health that our members learn these skills. Our vision is to equip medical students with the knowledge and skills to take on health leadership roles locally and globally. We hope that moving to address the growing data gap will start by building capacity for all our members. The three day workshop started with a brainstorming of expectations from all of the participants (21 in total, from Poland, Switzerland, Austria, Italy, Finland, Norway, Spain, Ethiopia, Libya, Egypt, Iran, China, Taiwan, and Australia) who expressed their interest in the research process and their enthusiasm about gaining knowledge and skills not usually included in the medical curriculum. The first day was based on the topic of research planning covering many basic aspects from the interrogation of what research is, to defining the study question, the primary and secondary outcomes and to putting research into context. It was followed by study design in which strengths and weaknesses of designs were analysed considering interventional studies, observational studies, systematic reviews and meta-analyses, research conduct (consent, research integrity, questionable research practices), ethics approval and trial registration, protocol writing (SPIRIT guidelines - Standard Protocol Items: Recommendations for Interventional Trials) and authorship agreement (ICMJE criteria). The concept of team science, in a cross-disciplinary and complex research setting was highlighted against the pressures to publish that are experienced by many health professionals and researchers for the sake of authorship credit, advancement and personal gain. Nowadays, with more than 12 million research papers on PubMed and 4,600 biomedical journals on PubMed, who reads, let alone interprets, all this research? Other topics covered included the funding gap (disease burden vs actual funding), publication medical students worldwide | AM 2014 Taiwan


A u g u s t

2 0 1 4

14

of negative studies and conflicts of interest. Special emphasis was put on the question of authorship, a topic which all too often leads to heated debates amongst contributors and can be the source of great disappointment. Frequently young researchers feel disappointed, when they do not end up on publications, even though they feel they deserved authorship. Contrary to that, one survey showed that 62% of French investigators only learnt after publication that they were listed as authors. Even after authors are chosen, there are further problems as little or no guidance on authorship order is available to writers.

Going through all the parts of a scientific publication, practical exercises and theoretical background taught us what to pay attention to. We were given practical examples and valuable hints on how to avoid the most common pitfalls. The topic of Open Access was also introduced with its pros and cons as well as the financial aspects, in order to have a clear idea of this initiative.

Another focus on the first day was the importance of the preparation of a research project. Not only does a good research protocol help to guide you through your project, it also greatly facilitates the writing of a paper after the results have been obtained and analysed. Often negative research never gets published. Trial registration makes this clearly visible and encourages publishing. From an ethical standpoint, this is very important. The trial participants have been put at risk, however small it might have been, and they deserve to have the results published because negative results can also alter clinical guidelines and provide information for patients’ benefit.

An evaluation was realized at the end of the last day during which we expressed our enthusiasm about the sessions for the wide range of subjects covered including both theory and exercises. Giving an overview in a way no other format, such as lectures and classes can with practical and concrete contents and clear take home messages stimulated the participants to be engaged in all the topics covered. After enjoying those three days in a pleasant atmosphere and group, we have also built a future network in which to discuss our activities and projects to research, the importance of research training in medical student curricula and we went home with very constructive feedback. We also extended very positive feedback to the trainers who were consistently energetic and motivated toward teaching. Their overwhelming experience in the field allowed for interactive and dynamic sessions.

During the last day we faced other parts of article preparation such as writing the introduction and discussion, writing the cover letter and understanding what journals want including details regarding the publication, understanding the peer review process, publication ethics and guidelines. All of those topics were also followed by practical exercises such as key sentences, writing the title and writing or editing an abstract.

This workshop was not only helpful for people who want to conduct research themselves, but also for those who read publications in scientific journals, gaining an in-depth knowledge of the basics of research. Being aware of possible biases, knowing the publication process in detail and having seen some examples of tortured data, allows them to correctly interpret and question results. Nowadays, evidence-based medicine is the core of our current studies and of medical practice. We would like to encourage all medical students and faculties to reflect upon having good research methodology training in the medical curriculum and the impact it will have on the quality of research, for the benefit of students, doctors and patients. The workshop being the first of its kind in IFMSA pre-GAs with international participants, we really encourage people interested in medical research to develop similar programs in their National Member Organizations (NMOs) and Universities, providing this important knowledge to their members on a larger scale, from local to international level. Active members of IFMSA’s Standing Committee on Research Exchange (SCORE) who were participating in this workshop can play a key role in providing this knowledge. Global health is one the foundations of IFMSA, and by giving tools of research for medical students worldwide, we can complement the deficiency many medical students face in their curricula - education about how to perform research.

The second day started with an introduction to statistics with key concepts (p-values, confidence intervals, per protocol vs intent-to-treat analyses, power calculations). Progressively, we took an in-depth look into the writing and publishing process focusing on identifying key message, target audience, target journal, reporting randomized control trials, CONSORT (Consolidated Standards of Reporting Trials), reporting observational studies (STROBE - Strengthening the Reporting of Observational studies in Epidemiology), CARE guidelines (for case reports) and other types of publication (e.g. review articles), writing the methods and presenting the results. www.ifmsa.org

We thank Sabine Kleinert and Liz Wager for conducting this engaging and passionate workshop about research methodologies. They taught us about good research practice and successful publishing, skills that will be of great value to us all, as future health professionals or researchers. This is a joint article with Lahiruni de Silva, Stephan Ursprung, Niilo Liuhto, and Joško Miše. References (1) Biomedical research: increasing value, reducing waste Malcolm R Macleod, Susan Michie, Ian Roberts, Ulrich Dirnagl, Iain Chalmers, John P A Ioannidis, Rustam Al-Shahi Salman, An-Wen Chan, Paul Glasziou The Lancet, Volume 383, Issue 9912, Pages 101 - 104, 11 January 2014 (2) ORI Introduction to the Responsible Conduct of Research Nicholas, H. Steneck, illustrations by David Zinn http://www.mtu.edu/research/administration/integrity-compliance/pdf/rcrintro.pdf


( M S I

15

3 0 )

LGBT Health:

The Case for Nondiscrimination in the Sustainability Agenda

Paula Peremiquel Trillas NMO: AECS - Catalonia Universitat Autònoma de Barcelona, Spain

paulaperemiquel@gmail.com

Sustainable development was initially defined by the Bruntland Commission as “development which meets the needs of the present without compromising the ability of future generations to meet their own needs” (1). This has been further defined to include three pillars or dimensions: economic development, environmental protection and social equity (2). More than twenty-five years after the Brundtland Commission report, the concept of sustainability has evolved, although social equity has received less attention. In the context of health, equity has been defined “as the absence of systematic disparities in health (or in the major social determinants of health) between social groups who have different levels of underlying social advantage/disadvantage” (3). In this context, achieving sustainability demands action to address disparities and discrimination within the lesbian, gay, bisexual and transgender (LGBT) (4) communities. Overwhelming amounts of evidence highlight the correlation between discrimination based on sexual orientation and gender identity and poor health outcomes. Globally, discrimination and stigma prevent individuals who identify as LGBT from accessing and utilizing health services. From outright discrimination to substandard care from the inadequate understanding of status-specific conditions, LGBT persons suffer from the widespread stigma against homosexuality and ignorance about gender identity in mainstream society and within health systems (5). Unfortunately, such discrimination is rampant around the world. There are currently 78 countries where homosexuality is a crime according to UNAIDS (6) . In at least five of these countries, homosexuality is a crime that is subject to the death penalty (7), and several countries have recently strengthened discriminatory statutes. Stigma and discrimination are truly global phenomena, even in countries where there is no legal criminalization regarding sexuality or gender identity (8). There is significant evidence that LGBT persons experience greater health disparities and worse outcomes than heterosexual persons across the globe. These inequities are apparent through the high rates of depression, anxiety, substance abuse and suicidal ideation, due to chronic stress and social isolation (9, 10). It is estimated that, within LGBT populations, 40% have considered suicide, and over 50% have committed self-harm (11). LGBT persons are also at higher risk for HIV and other STIs (12) and face significant social barriers including higher rates of youth homelessness (13), unemployment, discrimination at the workplace, and physical and psychological violence in the community. LGBT persons can face exclusion from health services, but may also exclude themselves due to perceived stigma, or the likelihood of verbal abuse or inad-

equate understanding from healthcare professionals. This may translate into reduced accessing of all healthcare services, including preventative services, ultimately resulting in poor health outcomes. In addition, LGBT persons may feel uncomfortable disclosing their sexual orientation; information which can be vital to ensure provision of appropriate treatment (14) . Action must be taken at all levels. The treatment of the LGBT community is a human rights issue and needs to be seen as such. The application of human rights standards must apply to those who are lesbian, gay, bisexual, transgender or intersex. It is within the constitution of the World Health Organization (WHO) that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being -- governments have a responsibility for the health of their peoples” (15). This places the need for action on governments to address and end stigma and discrimination in the health sector. A recent African Commission Report stated that “the application of human rights standards should also apply to those who are lesbian, gay, bisexual, transgender or intersex” (16). The inequities and human rights abuses against the LGBT community are slowly being recognized around the world, but there is still a need for significant and urgent action to be taken by governments and the international community to adequately address the health and well-being of this population. LGBT Health was placed on the agenda for the 133rd session of the WHO Executive Board in 2013, however, due to political-motivated objections by several member states, it was not possible for member states to even discuss the tabled report. The agenda item has been indefinitely postponed pending ongoing consultations with member states on the topic. However, the path forwards remains unclear, and civil society has not had much of a voice on this topic. The WHO needs to address the health needs of LGBT persons as it is the duty of the organization to protect human rights and ensure equitable access to health globally (17). Member States should adopt a resolution condemning any legislation that criminalizes LGBT and any violence or hostility directed towards those persons. They must also emphasize the need to develop inclusive policies that take into medical students worldwide | AM 2014 Taiwan


A u g u s t

2 0 1 4

account the needs of the entire population with specific attention to vulnerable groups and high risk populations. To fully understand and address these issues, we require increased data collection and data disaggregation, as well as improved methods of collection and analysis of data on the health needs of LGBT persons. It is our duty as future health professionals and future health leaders to provide the best standard of care to everyone, regardless of sexual orientation and gender identity, and also to advocate to prevent this inequity. Health professionals should adopt a zero-tolerance approach to sexual or gender identity-based discriminatory practice. LGBT health should be included in all medical curricula as doctors and healthcare professionals need to be trained to fully understand the barriers facing this vulnerable group and the impact this has on both the health of the individual and broader society. On March 6 2014, the International Federation of Medical Students’ Associations (IFMSA) adopted a resolution on “Ending discrimination to better the health of LGBT individuals”, making IFMSA the first of its kind in recognizing the serious impact of discrimination against LGBT populations on their health, and the role that WHO could play in addressing the issue. As an international federation representing the next generation of physicians, IFMSA and its members are uniquely positioned to lead efforts to address LGBT stigma and discrimination and, as a result, advance the social equity and sustainability. IFMSA has the opportunity to continue to advocate for meaningful action to address LGBT discrimination and health disparities by the WHO. To learn more or get involved in IFMSA’s advocacy against LGBT discrimination and health disparities within the WHO, please contact IFMSA Think Global at thinkglobal@ifmsa.org. This article has been written in collaboration with Anya Gopfert, Elizabeth Wiley and Gail Robson.

16 References (1) World Commission on Environment and Development (“Brundtland Commission”): Our Common Future. 1987. http://www.un-documents.net/our-common-future.pdf (2) Sustainable development - concept and action. United Nations Economic Commission for Europe (UNECE). http://www.unece.org/oes/nutshell/2004-2005/focus_sustainable_development.html (3) Braveman P & Gruskin S. 2003. Defining equity in health. J Epidemiol Community Health 57:254–258. (4) The article has been used LGBT as it is the abbreviation used in the entire literature, but we should keep in mind that queer and intersex persons are included into all the considerations. (5) Ritter A, Matthew-Simmons F and Carragher N. 2012, ‘Why the alcohol and other drug community should support gay marriage: Editorial’, Drug and Alcohol Review, vol. 31, no. 1, pp. 1-3. (6) Clark, P. 2014. Discrimination against LGBT people triggers health concerns. Lancet. 383(9916): 500-502. Feb. 8. http://www.thelancet.com/journals/lancet/article/PIIS0140673614601690/ fulltext (7) Zhu J, Itaborahy LP. State-sponsored homophobia. A world survey of laws: criminalization, protection and recognition of same-sex love. http://old.ilga.org/Statehomophobia/ILGA_State_Sponsored_Homophobia_2013.pdf. (8) Ryan C and Rivers I. 2003, ‘Lesbian, gay, bisexual and transgender youth: Victimization and itscorrelates in the USA and UK’, Culture, Health and Sexuality, vol. 5, no. 2, pp. 103-119. (9) King M et al. 2008, ‘A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people’, BMC Psychiatry, vol. 8. (10) Hatzenbuehler ML et al. 2010, ‘The Impact of Institutional Discrimination on Psychiatric Disorders in Lesbian, Gay, and Bisexual Populations: A Prospective Study’, American Journal of Public Health, vol. 100, no. 3, pp. 452-459. (11) Mental health crisis looms for gay teenagers. 12 January 2014. The Independent. http://www. independent.co.uk/life-style/health-and-families/health-news/mental-health-crisis-looms-for-gay-teenagers-9053688.html (12) Prevention and treatment of HIV and other sexually transmitted infections among men who have sex with men and transgender people. WHO, Department of HIV/AIDS, June 2011. http://apps. who.int/iris/bitstream/10665/44619/1/9789241501750_eng.pdf (13) Durso, L.E., & Gates, G.J. (2012). Serving Our Youth: Findings from a National Survey of Service Providers Working with Lesbian, Gay, Bisexual, and Transgender Youth who are Homeless or At Risk of Becoming Homeless. Los Angeles: The Williams Institute with True Colors Fund and The Palette Fund. http://williamsinstitute.law.ucla.edu/wp-content/uploads/Durso-Gates-LGBT-Homeless-YouthSurvey-July-2012.pdf (14) Addressing the causes of disparities in health service access and utilization for lesbian, gay, bisexual and trans (LGBT) persons. Concept paper. Provisional Agenda Item 4.12. 52nd Directing Council. PAHO. http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=23145&Itemid=270&lang=en. (15) WHO Constitution, adopted by the International Health Conference held in New York from 19 to 22 June 1946, signed on 22 July 1946 by the representatives of 61 States. http://whqlibdoc.who. int/hist/official_records/constitution.pdf (16) Resolution on the treatment of LGBTI (LGBTQ) individuals. 55th Ordinary Session of the African Commission on Human and Peoples’ Rights (ACHPR). Angola, 28 April - 12 May 2014.http:// es.scribd.com/doc/224367417/ACHPR-Resolution-on-LGBTI-People (17) Scherdel L et al. 2014. The search for international consensus on LGBT health. The Lancet Global Health, Volume 2, Issue 6, Page e321. http://www.thelancet.com/journals/langlo/article/ PIIS2214-109X(13)70169-4/fulltext

www.ifmsa.org


( M S I

17

3 0 )

Doctor Burnout and Patient Safety Accelerated by Medical Commercializations: Is There a Solution?

Yi Lin and Po-Wei Chen NMO: FMS-Taiwan Chang Gung University and National Yang-Ming University, Taiwan

alexlin821217@gmail.com

The Labor Environment of Taiwan Doctors So far, there had not been any legislation concerning the average working hours for interns and residents. In 2013, the Ministry of Health and Welfare issued an executive order, the Teaching Hospital Accreditation Benchmarks and Assessment Project , assorting working hours, as well as ranking resident hours into levels A, B and C. Though on the other hand, the assessment did not contain any related working hours for interns. When comparing the regulation of working hours in Taiwan with other countries, we would then realize, the severity of overwork is beyond comprehension. For instance, the European Commission states that the maximum average working hours (48 hours) per week versus maximum continuous working hours are 13 hours. While in France, it is 48 hours and 10 hours. In the UK, it is 56 to 64 hours and 14 to 24 hours. As for Denmark, it is 37 hours versus 13 to 16 hours. As stated in the Labor Standards Law in Taiwan, excluding doctors, the working hours are 84 hours every two weeks. However, in Taiwan, as mentioned in the Teaching Hospital Accreditation Benchmarks and Assessment Project the maximum average working hours is 88 hours with the maximum continuous working hours of 36 hours, which implies that the situation still leaves a great adjustment potential for more reasonable working hours. However, the assessment does come into its expected efficacy. The new standard for working hours is in its trial phase without exerting any practical power. Even when the hospitals violate the Teaching Hospital Accreditation Benchmarks and Assessment Project , they are still free of punishment. Moreover, the assessment exhibits an intrinsic defect. The average working hours only mentioned the results from the average total working hours of the summation of all divisions practice. It is worth to notice that, working hours among different divisions in practice exist. Therefore, although some doctors working hours may seemed to be able to pass the assessments of not exceeding 88 hours per week, it does not necessary means it applies to the overall working conditions. Another example worth mentioning is that, a plastic surgeon from hospital numbered 15 who worked on a whopping 150 hours a week. It is hard to imagine that with the total of 168 hours a week, this plastic surgeon only have 18 hours to take a rest. It is definitely inconceivable how long the working hours are for this surgeon. According to the research on the Internal medicine, Surgery, Obstetrics and Gynaecology and Pediatrics from Medical Labor Condition Group ( ), the average working hours for interns in Taiwan is 89 hours a week while it is 104 hours for residents. The research also unveiled that there is an astonishing high percentage of interns and residents working over 34 hours continuously.

Sweat Hospitals and Patient Rights “Sweat hospitals� is a long-existing problem for medicine in Taiwan. It can be resulted from the financial groups monopolizing the medical service, inefficiency of the publicness of health insurance and the incompetence of our government. Under the highly stressful conditions, doctors must be exhausted physically and mentally because of the tiredness from overworking. Researches had been conducted all over the world had proven that continuous working and night shifts produces a non-neglectable influence on the cardiovascular diseases and other body functions. The phenomena described above diverge tremendously in terms of patients’ health. The overworking of medical personnel will definitely cause damages to the overall quality of medical services. In 2002, published in the journal, JAMA, a research finding on the, Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. In the study, 168 hospitals were surveyed, which consisted of more than 10,000 medical personnel and about 230,000 patients. This research finding concluded that there was a close relationship between the total number of medical personnel and the mortality of patients. Taking into the account that, for a standard personnel, caring for four patients at the same time, the mortality of patients within 30 days was increased by 7% if the personnel took care of one extra patient. In 2011, another journal, NEJM, also published an essay, Nurse Staffing and Inpatient Hospital Mortality, insufficient medical personnel and burnout bear relevance to the mortality to hospitalized patients. If a nursing staff continuously worked for more than 8 hours, the mortality of hospitalized patients would increase by 2%. Thus, the unexpected burnout of doctors, as well as members of medical personnel providing medical service, was likely to jeopardize the rights of patients.

medical students worldwide | AM 2014 Taiwan


A u g u s t

2 0 1 4

18

Class Oppression Accelerating Medical Collapse Since the1980s, the distribution of medical facilities scale in Taiwan had moved towards the M-shaped form. Regional hospitals vanished quickly while more and more manpower switched into big hospitals. Nowadays, over 70% of doctors work in big hospitals and lives on salaries paid by their bosses. In order to pursue profit in highly competitive market, hospital managers, usually senior doctors, tend to adopt an interest-oriented strategy such as marketing out-of-pocket service or forcing front-line doctors to boost their service amount. Meanwhile, most of the labor burden have been laid on junior doctors such as interns and residents, which leads to longterm overtoil, putting patients’ safety in danger. Due to its high entry threshold and tight class structure, hospitals are usually run by senior doctors, while junior doctors are ruled by seniors, so they are generally the ones suffering from long working hours. The Taiwan Medical Association is the biggest medical interest group in Taiwan and it plays an important role in health policy making. Nevertheless, many of its members are managers of private sectors, which means that they might prioritize profit other than publicity and lobby the government to implement a more commercializing health policy. In recent years, the Medical Labor Condition Group ( ), which formed by medical students and junior doctors who pursue medical publicity, urged that doctors should be protected by the Labor Standards Act because exhausted doctors might do more harm to patients. However, the Taiwan Medical Association opposes this reform, as because once doctors are covered by the Labor Standards Act, the hospital managers would have to recruit more manpower and the overall hospital expenditure will rise. In addition, private sectors would be facing with multiple problems, such as transactions among the related parties to lower the book surplus to rationalize its claim, making junior workers share highs and lows with the hospitals which they are bound to.

www.ifmsa.org

Commercializing Risk around the Corner This year, the government plans to establish international healthcare industry park, boasting that the park will boost the overall medical care, biotechnology, pharmaceuticals, rehabilitative care, health enhancement and other industries. Paradoxically, knowing that there had already been an existing manpower shortage in Taiwan, which means that the extra manpower needed for in the park might create further shortage and medical inequality. On the other hand, the senior, skilled doctors who will get the ticket to the park and make a big fortune. While burden on junior doctors will continue to become heavier and heavier, the healthcare system in Taiwan might lose its original publicity.

Stand By Patients’ Side, Retrieve Publicity Even though the overwhelming wave of medical commercialization seems unstoppable, with pre-existing interest-oriented hospitals still gain profits, and the international healthcare industry park lurking around the corner. However, there are many medical students and doctors who believe that medicine should not be commercialized volunteered their time and effort in forming the Medical Labor Condition Group ( ). While criticizing current system defects and uniting junior doctors and medical students, they hope to reverse the current situation. They believe that one day, publicity shall be retrieved and they can proudly state that “The health of my patients will be my first consideration”!


( M S I

19

3 0 )

Primum Non Nocere:

Addressing Patient Safety in the 21st Century

Elias Ortega Chahla

Regional Coordinator for the Americas 2013-2014 rcamericas@ifmsa.org

Mr. S. was a 42-year old patient that I got to examine during my surgery rotation in my 6th year of medical school. Little did I know the first time I saw him, that he would be a case that taught me a valuable lesson that I keep until this day and hopefully for the rest of my career as a healthcare professional. On his first consultation he showed a textbook case of a simple appendicitis, so I paged the surgeon on call and he was successfully intervened within a couple of hours. It was not until two weeks later that I saw him again, this time he presented signs of sepsis, so he was rapidly examined by the senior physician and taken immediately into surgery. The next day I found out that he had had not made it through the surgery and that he had passed away. When I asked which was the probable cause of him dying, the doctor showed me his x-ray in which you could see a piece of surgical equipment inside his abdomen, which was left during his first intervention. I was in shock; I could not believe what happened‌ Patient safety is a fundamental principle of health care. Every point in the process of care-giving contains a certain degree of inherent unsafety. Health care professionals whose focus is on patient safety are very familiar with these alarming and frequently cited statistics. Medical errors result in the death of between 44.000 and 98.000 patients every year in the United States (1). Even using the lower estimate, preventable medical errors in hospitals exceed attributable deaths to such feared threats as motor-vehicle casualties, breast cancer, and AIDS in the US (2). Beyond their cost in human lives, preventable medical errors exact other significant tolls. They have been estimated to result in total costs (including the expense of additional care necessitated by the errors, lost income and household productivity, and disability) of between $17 billion USD and $29 billion USD per year in hospitals in the US (2).

Patient safety and quality are at the heart of the delivery of healthcare. For every patient, caregiver, family member and healthcare professional, safety is pivotal to diagnosis, treatment and care. Doctors, nurses and all those who work in the health system are committed to treating, helping, comforting and caring for patients and to excellence in the provision of health services for all who need them. Unfortunately there is a universal lack of actual training when it comes to patient safety in healthcare professionals. The main reason for this is that in the vast majority of the cases, there is no structured place for it on the medical curricula. This is a direct consequence of the fact that medical education, on its current form, cultivates knowledge but takes compassion away. We should cultivate medical student’s character throughout his or her education by developing moral values and attitudes that aim to ensure patient safety and quality healthcare. However a remarkable milestone has been achieved by the World Health Organization, who released in 2011 the Patient Safety Curriculum Guide (3) in an attempt to facilitate the teaching-learning process.

The United States Association for Healthcare Quality’s four components to improve Patient Safety (5) There has been significant investment in recent years in the improvement of services, the enhancement of the capacity of the system, the recruitment of highly trained professionals and the provision of new technologies and treatments. Yet, health systems across the world are facing challenges dealing with unsafe practices, incompetent healthcare professionals, poor governance of healthcare service delivery, errors in diagnosis and treatment and noncompliance with standards (4). Work in the aviation, aerospace, nuclear power, construction, and other high-risk, high reliability industries has demonstrated that a strong safety culture is essential to recognize and mitigate sources of potential error and harm (5). Adverse events may result from acts of commission or omission (e.g., administration of the wrong medication, failure to make a timely diagnosis or institute the appropriate therapeutic intervention, adverse reactions or negative outcomes of treatment) (6). medical students worldwide | AM 2014 Taiwan


A u g u s t

2 0 1 4

Sir Liam Donaldson, WHO Envoy for Patient Safety, identifies different areas that need to be addressed within a healthcare system in order to decrease medical error and introduce a safety culture: • Open disclosure culture; • Risk awareness culture; • Human factors culture; • Blame free culture; • Systems thinking culture; • Patient centered culture; • Non-hierarchal culture; • Data culture. While a strong and just safety culture has been recognized as a key element for improvement, a critical deficit that has not yet been fully addressed is the lack of protective infrastructure to safeguard responsible, accurate reporting of quality and patient safety outcomes and concerns. In fact, as attention to creating a culture of safety in healthcare organizations has increased, so have concomitant reports of retaliation and intimidation targeting staff who voice concern about safety and quality deficiencies (5). Some healthcare providers acknowledge that they fear reporting events or conditions that could endanger quality and patient safety. Some professionals whose direct responsibilities include the monitoring and reporting of quality and patient safety outcomes have experienced pressure, outright harassment, or even experienced serious legal and licensure challenges when they recognize and report events of concern. Only with integrity in reporting can healthcare organizations identify and eliminate the root causes of systemic problems that threaten patient safety (5). If individuals fail to report near misses and significant events, underlying systemic issues will remain unseen and unaddressed. We must recognize the value of safety incident reports and acknowledge that we can and must learn from our mistakes, so we can make healthcare safer. When it comes to patient safety, we should always have in mind a moral compass constituted by these three points: • To err is human, error is inevitable. • To cover up is unforgivable. • To fail to learn is inexcusable.

20

We must safeguard the integrity of healthcare quality and safety systems by cultivating a strong and just safety culture and developing a protective infrastructure to ensure the truthful and reliable reporting of quality and safety concerns.

Without such protection, healthcare providers and professionals with direct responsibility for quality and safety reporting may fail to address all concerning events, leaving patients at risk for recurrent errors (8). The need to address these gaps will only increase as new reimbursement models raise the incentive to improve performance metrics. We call upon leaders of healthcare organizations to implement protective structures to assure accountability for integrity in quality and safety evaluation and comprehensive, transparent, accurate data collection, and reporting to internal and external oversight bodies (9). We must also call on organizational and national leaders to take immediate action to include patient safety as a main concern in developing their current healthcare systems as part of the discussions around UHC, Social Determinants of Health and the Post-2015 Health Development Agenda, so we can transform healthcare systems into those that consistently provides high-quality, safe, reliable care—the kind of care we all want for ourselves and our loved ones. References (1) Pham JC, Aswani MS, Rosen M, Lee H, Huddle M, Weeks K, Pronovost PJ. Reducing medical errors and adverse events. Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland; 2011. Annu Rev Med. 2012;63:447-63. (2) Kohn L, Corrigan J, Donaldson M. To Err Is Human: Building a Safer Health System. Committee on Quality of Health Care in America, Institute of Medicine. Washington, DC: The National Academies Press; 2000. (3) World Health Organization. Patient Safety Curriculum Guide: Multi-professional edition. Geneva, Switzerland. 2011. (4) Government of Ireland. Building a culture of patient safety. Report of the commission on patient safety and quality assurance.2008. (5) National Association of Healthcare Quality. Call to action: Safeguarding the Integrity of Healthcare Quality and Safety Systems. 2012. (6) Nance, J. J. Why Hospitals Should Fly: The Ultimate Flight Plan to Patient Safety and Quality Care. Bozeman, Montana: River Healthcare Press. 2008. (7) Department of Veteran Affairs. Veteran Health Administration. VHA National Patient Safety Improvement Handbook. 2012. (8) The Joint Commission. Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation. Oakbrook Terrace, IL: The Joint Commission, Nov 2012. http://www. jointcommission.org/. (9) Stone PW, et al. Organizational climate of staff working conditions and safety—An integrative model. In: Henriksen K, et al. editors. Advances in Patient Safety: From Research to Implementation (Volume 2: Concepts and Methodology). Rockville (MD): Agency for Healthcare Research and Quality (US); 2005 Feb. PubMed PMID: 212498253

Every patient deserves patient-centered high-quality, safe, reliable healthcare. This constitutes a main pillar when addressing Universal Health Coverage (UHC) for all, because after all it is not about guaranteeing access, but also guaranteeing the quality of it. On the other hand, every person working in healthcare deserves a professional environment that values integrity, dignity, accuracy, and a commitment to quality.

An Integrative Model of Healthcare working conditions on Organizational Climate and Safety (7)

www.ifmsa.org


( M S I

21

3 0 )

Prioritizing Youth Engagement and

Promoting Sexual and Reproductive Health Rights in the Sustainable New Era Cephas Avoka NMO: FGMSA-Ghana SCORA RA for Africa avokacephask@yahoo.com

Imagine that youth in Africa is able to effectively contribute and benefit from Africa’s renewal and lives Africa’s dream of prosperity, peace, stability and in charge of its own destiny. Imagine the impact if a young African woke up one day and has the means and freedom to fully realize his or her potential to become positive force for development. The African Youth Decade 2009-2018 Plan of Action (DPoA) is a framework for multi-sectoral and multi-dimensional engagement of all stakeholders towards the achievement of the goals and objectives of the African Youth Charter which emphasizes that Africa’s greatest resource is its youthful population and that through their active and full participation, Africans can surmount the difficulties that lie ahead. This plan intends to support the development of national and regional plans of action, while simultaneously providing a framework to allow coordinated activities at the continental level. The AU Youth Decade 2009-2018 plan of action provides a framework for youth mobilization based on two guiding principles of youth empowerment, “the principle that young people are empowered when they realize that they have or can create choices in life, are aware of the implications of those choices, make informed decisions freely, take action based on those decisions and accept responsibility for the consequences of their actions”, and youth development, “ (…) the ongoing growth processes in which youth are engaged in attempting to: (1) meet their basic personal and social needs to be safe, feel cared for, be valued, be useful, and be spiritually grounded, and (2) build skills and competencies that allow them to function and contribute in their daily lives.” (Pittman, 1993, p. 8). Youth should play a very key role in deciding what kind of future they want to live in. In the next ten or twenty years, it is the youth that will be at the forefront actively engaged in implementing the strategies that world leaders are currently working on and, therefore, it is imperative that they participate in the actual decision making process. In pursuance of this goal, the African Union brought together young people from all over the continent to deliberate on issues pertaining to family planning and Sexual and Reproductive Health Rights (SRHR) services and to come up with strategies for addressing the problems identified. Four main thematic areas were chosen for discussion with an emphasis on how the policies that have been drafted at the regional and high-level meetings can be translated to community initiatives taking into account the many barriers that we young people face. Four thematic areas were discussed:

Creating an Enabling Environment for Youth SRHR Services

An enabling environment refers to factors that promote, facilitate and strengthen the youth development, youth empowerment and the meeting of young people’s sexual and reproductive health needs and protection of related rights. This involves several cross cutting issues including policies, legislation, programs and services. An essential component of an enabling environment is the promotion of opportunities, support and resources for young people to meet their sexual and reproductive health needs. Global and regional conventions and policies such as those listed below have set the pace for young people in Africa to actively engage in placing their own SRHR needs at the forefront in national and regional deliberations on developing sustainable development initiatives. • • •

Addis Ababa Declaration on Population and Development in Africa beyond 2014. Youth Decade 2009-2018 plan of action Accelerating Youth Empowerment for Sustainable Development. The Maputo Plan of Action for the Operationalization of the Sexual and Reproductive Health and Rights Continental Policy Framework.

Some of the challenges that impair the translation of these regional and national strategies into the community level include legislative instruments such as the legal age of consent and access to family planning, cultural and ethnic backgrounds, gender related issues such as ability to negotiate for access and use of contraception, effects of HIV on the family as well as stigma and discrimination and access to youth-friendly sexual and reproductive health services and information. However, best practice over the years have proved that the engagement of young people in advocating for and the design of improved policies and programs contributes to ensuring that their needs are met, the use of popular culture and social media are important vehicles for behavior change communication, information provision and engagement in advocacy to advance youth SRHR and the recognition that youth are not a homogenous group and that their experiences and needs vary makes provision medical students worldwide | AM 2014 Taiwan


A u g u s t

2 0 1 4

for diversity in a non-discriminatory manner and that youth empowerment requires access to evidence, research and the use of data. A broad reaching principle underpinning an enabling environment is the genuine commitment and investment in young people.

Social Change and Youth Sexual and Reproductive Health Adolescent health, especially sexual and reproductive health and rights is key to allowing young people to participate in their own, their communities’ and countries’ development. Policies and programs exist that have the potential to change the poor outcomes for adolescent sexual and reproductive health, but are often poorly implemented. Promising practices such as peer-led interactive information communication technologies can engage youth in taking their own SRH challenges into their hands and devising innovative strategies to overcome these challenges. Participants at the conference deliberated on how socio-cultural issues affect access to SRHR services and what can be done to drive national governments to put in place favorable policies on SRHR. Access to family planning among other SRH information and services is critical to young people’s ability to exercise their reproductive rights. This principle has been agreed upon by governments in Africa and supported by the Maputo Plan of Action for Sexual and Reproductive health of 2006.

Improving Access to Quality, Youth Friendly Reproductive Health Services Young people in their reproductive years are increasingly facing reproductive health risks such as STIs including HIV, unintended pregnancies and complications of pregnancy and childbirth. Discussions at the conference focused on measures and strategies to remove barriers to young people’s access to health services and the training or personnel to deliver youth friendly services. Youth friendly services relate to the provision of SRH services to young people based on a sound understanding of their peculiar needs. The adoption of regional policy frameworks which promote the delivery of youth friendly services such as the Maputo plan of action and the African Youth Charter have increased advocacy for the implementation of youth friendly service initiatives. Youth friendly service provision is grounded in evidence that suggest that providing young people with age appropriate and non-judgmental services increases their uptake of these services and subsequently empowers them to make informed choices, thereby preventing negative health outcomes.

www.ifmsa.org

22 Reaching Young People with Comprehensive Sexuality Education Access to comprehensive sexual education, including family planning, is an essential element of youth sexual reproductive health and rights programming and such initiatives are supported by already existing regional policies within the continent. However, more work needs to be done to scale-up successful practices within Africa including building on innovative technology based approaches which young people are identifying towards navigating some of the barriers they encounter. Youth at the conference deliberated on efficient ways of providing young people with comprehensive sexuality education and how the current prejudices and barriers can be surmounted. It is imperative to invest in age, gender and culturally appropriate, rights-based comprehensive sexuality education that empowers young people to make informed choices, build healthy relationships and acquire necessary life skills. The African Union, in collaboration with other stakeholders and youth groups working in SRHR issues within the continent, has committed to ensure the implementation of the outcome document of the youth deliberations at the Youth Pre-Conference of the International Conference on Family Planning--the largest gathering of young people working in SRHR on the continent. I commend very much the African Union and other stakeholders in Africa for engaging youth groups in these discussions and giving us the chance to participate in shaping our own future. I believe strongly that with continues engagement with youth organizations and civil society organizations at national and community levels, we will play an active role in solving the problems in our community and brace ourselves for another decade or more of implementing sustainable development strategies that we have contributed in developing. References (1) African Union, African Youth Charter, Addis Ababa, Ethiopia 2006 (2) Addis Ababa Declaration on Population and Development in Africa beyond 2014 (3) African Union African Youth Decade 2009-2018 Plan of Action Accelerating Youth Empowerment for Sustainable Development Road Map towards the Implementation of the African Youth Charter. May 2011 (4) Maputo Plan of Action for The Operationalization of the continental policy framework for sexual and reproductive health and rights 2007-2010 (5). UNESCO 2013: Young People Today: Time to Act Now. Why adolescents and young people need comprehensive sexuality education and sexual and reproductive health services in Eastern and Southern Africa (6). www.youthfpc.org (7). UNFPA and Population Reference Bureau, Status Report on Adolescents and Young People in Sub-Saharan Africa: Opportunities and Challenges, 2012. www.prb.org/Reports/2012/status-report-youth.aspx (8). UNFPA, 2012. By Choice not by chance: Family Planning, Human Rights and Development. State of the World Population Report. New York: UN Population Fund.


( M S I

23

3 0 )

Safe and Sustainable Roads: The Case for a Sustainable Development Goal Naren Nallapeta NMO: MSAI-India J J M Medical College, India naren.nallapeta@gmail.com

“I lost my daughter, Zenani when she was only 13. In a matter of seconds, her world and her future was destroyed. And with her, a huge part of my world was gone too. For the sake of all our children, for our world and the future we want, we must make sure we include road safety this time round” - Zoleka Mandela Safe mobility should be a right to all. Like access to education, drinking water and provision for health care, safe road transportation must be a key foundation of modern society. Yet many of the roads that are used by pedestrians in middleand low-income countries have no adequate footpath. Also, car companies do not comply with the United Nations’ basic crash test standards designs, while governments fail to enforce speed limits, to rule out driving under influence, to recommend seat belt use or to suggest motorcycle helmet wearing. Road traffic injuries are a global, man-made (and preventable) epidemic with a health burden similar to the scale of HIV/AIDS and malaria. There is a significant and serious impact of road traffic injury on global mortality and disability which has been confirmed by two new studies – the 2013 WHO Global Status Report on Road Safety and the 2010 Global Burden of diseases (GBD). The reports suggest a staggering overall number of annual deaths on the world’s roads at almost 1.3 million deaths. Road traffic accidents are the leading cause of death worldwide for young people aged 15 to 29. According to the GBD study, road injury is the world’s leading cause of death for boys and men aged 10 to 29. Between the ages of 30-40 it is the second biggest killer of men overall, after, HIV/AIDS (1).

The vast majority of casualties occur in middle and low income countries which are experiencing rapid motorisation. Around half of those killed are pedestrians, cyclists or motorcyclists, who are often among the poorest members of society. The 2011-2020 UN Decade of Action for Road Safety is promoting cost effective solutions proven to reduce road casualties. Improving road design and vehicle safety, implementing motorcycle helmet and seat belt laws, and effective police enforcement have all succeeded in reducing death and injury in low, middle and high income countries alike. But many governments and international agencies must do more to prioritise road safety and integrate it into wider sustainable development agendas. Furthermore, there is very limited international funding or policy support to catalyse national action plans and to help build capacity. Such catalytic international support is urgently needed. In his recent report on the post-2015 development agenda “A life of dignity for all: accelerating progress towards the Millennium Development Goals and advancing the United Nations’ development agenda beyond 2015”, UN general secretary Ban Ki-moon recommended that reducing the burden of road traffic injuries should be one of the targets in a new health goal. A few initiatives taken as a part of the UN Decade of Action for Road Safety by the world associations to reduce the burden of road traffic accidents: • The UN Decade of Action for Road Safety has raised awareness of road injury to an unprecedented level. With leadership from the Russian Federation, more than 100 Governments committed at the UN to support the goal of the Decade of Action: to stabilize and reduce global road fatalities by 20201. Eighty-eight countries, with a total population of almost 1.4 billion, reduced the number of deaths of their roads in the four years to 2010. •

IFMSA also declared at the AM2012 to recognize the period 2011-2020 as the Decade of Action for Global Road Safety and also released a policy regarding the same.

medical students worldwide | AM 2014 Taiwan


A u g u s t

2 0 1 4

24

Fédération Internationale de l’Automobile (FIA) and the Clinton Global Initiative: The Clinton Global Initiative (CGI) established by the former US President Bill Clinton, brings together philanthropies, Governments, companies and development and public health experts to collaborate on major social and health issues through, ‘Commitments’. The FIA Foundation, a UK-based philanthropy, has made three 10 year CGI Commitments totaling 30 million. The FIA Foundation’s commitments pledge support for key initiatives in support of the Decade of Action Global Plan.

A PLAGUE on the YOUNG: The global burden of road traffic accidents New studies confirm that young people face their greatest risk of death or disability when travelling on roads and streets.

Boys and young men are most at risk on the world’s roads Young men are most at risk. According to the GBD study, road injury is the world’s leading cause of death for boys and men aged 10-29. Between the ages of 30-40 it is the second biggest killer of men overall, after HIV/AIDS. For women, road injury is between third (during teenage years) and fifth leading cause of death consistently from the age of 5 to 40. This is a young person’s plague.

The five pillars of the global plan are: 1. Road Safety Management strengthening institutional and operational capacity to achieve national road safety objectives; supporting stronger governance and policing. 2. Safe roads and mobility: improving the planning, design, construction and operation of road networks to ensure safety for all users; encouraging investment in sustainable modes of transport. 3. Safer vehicles: promoting crashworthiness and empowering consumers with safety information; accelerating introduction and use of proven safety technologies. 4. Safe road users: putting vulnerable road users, like pedestrians and cyclists, first in policy; promoting use of seat belts and crash helmets; tackling drink driving; setting and enforcing effective speed limits; improving driver training. 5. Post-crash response: improving emergency response and trauma care; supporting rehabilitation and care of road injury victims; providing advice, support and legal redress for victims and their families; encouraging third party insurance schemes to finance rehabilitation. •

The Bloomberg Global Road Safety Program: In 2009 Bloomberg Philanthropies announced a $125 million, five year programme to support road safety in 10 focus countries: Brazil, Cambodia, China, Egypt, India, Kenya, Mexico, Russia, Turkey and Vietnam. Working with the Governments of these countries, and with partners including the Association for Safe International Road Safety (ASIRT), EMBARO, the Global Road Safety Partnership, Johns Hopkins Bloomberg School of Public Health, the World Bank Global Road Safety Facility and the World Health Organization, the Bloomberg Philanthropies, the family Foundation of New York Michael Bloomberg has succeeded in demonstrating the potential of road safety investment.

www.ifmsa.org

Road injury is also the leading cause of DALYS or young people aged 15-24, second leading cause (behind HIV/AIDS) for those aged 25-35, and the leading cause for men until age 29. A Post-2015 Agenda for Mobility: Safe and sustainable road transport, the ‘Safe System’ speed management at its heart, must be a post-2015 priority. The current debate on a future framework for sustainable development provides an opportunity to integrate safe and sustainable transport within the next set of development goals, and to establish new partnerships for safe, healthy and clean transport and urban development strategies, with road safety and effective speed management at their heart, which put people first. At the Rio+20 UN Conference on Sustainable Development in June 2012, world leaders agreed to begin a process of designing new “Sustainable Development Goals” to replace or renew the Millennium Development Goals which expire in 2015. For the first time at a UN ‘Earth Summit’, road safety and sustainable transportation were recognised in the communique as being an important part of the overall agenda to deliver social equity, health and urban development. Road safety must be recognized and included in the post-2015 Sustainable Development Goals framework. This should include reducing road traffic deaths globally by 50% from 2010 levels by 2030. This would be consistent with the current UN Decade of Action for Road Safety objective, endorsed by more than a hundred governments in UN General Assembly Resolution 64/255, to ‘stabilise and reduce’ road deaths by 2020.

Fatalities target: •

By 2030, reducing the number of people killed on the world’s roads to less than 620,000 per year from the 2010 baseline of 1.24 million per year.

Fatality targets by country income cluster (the Results Framework also includes injury and economic targets by income level). Reduce road traffic fatality rates by 2030 to: • • •

< 4 per 100,000 population in high-income countries (baseline of 8.7 in 2010) < 7 per 100,000 population in middle-income countries (baseline of 20.1 in 2010) < 12 per 100,000 population in low-income countries (baseline of 18.3 in 2010)

Serious Injuries target: •

By 2030, reduce the number of people seriously injured on the world’s roads to less than 6,200,000 per year from the 2010 baseline of 12.4 million per year.


( M S I

25

3 0 )

Economic Impact target: •

By 2030, reduce the global economic impact of road crashes to less than 1.5% of GDP per year from the current 3% of GDP per year.

In conclusion, I encourage the youth of IFMSA and all the member nations to support safe roads for all as a part of the journey towards “Sustainable Development for the New Era”. Like education and healthcare, safe roads should be a right to all. References (1)Institute for Health Metrics & Evaluation, published in The Lancet. 2012 Dec 13; 380: 2095–2128 (see www.healthmetricsandevaluation.org for full report and data visualisations)

The End of AIDS Kelly Thompson LO to Reproductive Health incl. AIDS lra@ifmsa.org

I have grown up in a generation that has never known a world without AIDS. Six months before I was born, Gallo and his collaborators published in Science about the retrovirus that they believed caused AIDS. In six months, I will be welcoming a new niece into the world. It is audacious and brash, and perhaps a bit naïve, but I believe we can end AIDS before her sixteenth birthday. I am not alone: in March 2014, 1.000 medical students gathered in Hammamet, Tunisia, to discuss health in the post-2015 agenda. The result of this was a document enshrined as “The Hammamet Declaration”, which called for governments to commit to finish the unfinished MDGs, including setting new ambitious targets to get to the end of the AIDS epidemic. Again, medical students are not alone. As part of the PACT, a collaboration of 25 youth organizations working on HIV, over 180 community dialogues were organized worldwide. These dialogues allowed young people everywhere, including those in marginalized and vulnerable groups, to express their wants for post-2015. Two key messages were apparent throughout all of those dialogues: 1. 2.

Secure a commitment for universal access to sexual and reproductive health & rights and harm reduction services. Secure a commitment to ending the AIDS epidemic by 2030.

Now, as a pessimistic optimist, I believe this can only be done if we accelerate our current work, and more specifically if we accelerate our work around young people and adolescents and the numbers agree with me.

AIDS-related deaths have been on the decline globally, but HIV-related deaths among adolescents have increased between 2000 and 2012, with most of the cases in sub-Saharan Africa. In 2012, nearly 100.000 adolescents died from HIV-related causes. Globally, the second leading cause of death of adolescents is HIV/AIDS. The African region has by far the highest adolescent mortality rates. HIV accounts for 16% of this, and 90% of the world’s HIV-related deaths in adolescents occur in this region. Globally, HIV is the leading cause of death for adolescent girls – compared to 2000 when it wasn’t even in the top 5 causes of death. In Sub-Saharan Africa, young women aged 15 to 24 are eight times more likely than young men to be HIV-positive. To me these aren’t just numbers on a piece of paper, they are telling me something is seriously wrong: that young people in this moment are experiencing a public health emergency and something needs to be done about it. All of these statistics however come with a strong caveat, that there are large data inconsistencies for young people. So for me the first step in ending AIDS – with a focus on young people – is getting age disaggregated data that allows us to have a full picture of what is happening to young people. Having this information will allow us to develop more targeted programming and to monitor and evaluate progress here. A key idea that is demonstrated by the successes of the HIV response is that health does not live in isolation. When creating the Hammamet declaration we realized that the end of AIDS could not be achieved without addressing larger issues like inclusion of medical students worldwide | AM 2014 Taiwan


A u g u s t

2 0 1 4

vulnerable and marginalized populations, gender equality, sexual and reproductive health and rights, the social determinants of health and intellectual property rights. All of these, when not addressed, serve as barriers to accessing health services, and for me and every other young aspiring physician it disables us from providing the best care possible to our patients. I mentioned earlier, the PACT, our collaboration of 25 youth organizations. We like to think of ourselves not only as a think tank, but also as an action tank. The group is exciting for me because it allows me to step outside the walls of my clinic and to truly engage with the community. It brings together young people living with HIV, young medical students, young advocates and activists, young peer educators, young treatment experts and young members of key populations – giving all of them a voice. And like I said we don’t only like to think about the HIV response, but following the mantra of not for us without us, we have identified key areas of action that we believe are essential in ending AIDS. Firstly, we believe that HIV services need to be integrated into sexual and reproductive health services and policies. A key area where this is evident is in comprehensive sexuality education, or CSE. CSE has a strong evidence base that it delays sexual debut, reduces the frequency of sexual activity, and reduces number of sexual partners and increase condom and contraceptive use. The PACT also believes strongly in harm-reduction for young people and that it should be included in HIV National Strategic Plans in countries where drug use constitutes a significant percent of new infections among young people. I know this is effective. As mentioned earlier, I study in Sydney, Australia. Sydney was an early adopter of needle exchange programs and the decriminalization of people who inject drugs. Research has shown it is the reason for

www.ifmsa.org

26 low HIV and Hepatitis C rates amongst people who inject drugs. Personal experience has told me this is true. My hospital is located in an area of Sydney where there are high rates of injecting drug use, but our population of people living with HIV is low. PACT members are also working to ensure knowledge is increased among policymakers and program developers about treatment gaps for young people living with HIV. One of our PACT members, Carlo from Puerto Rico, has lost several young friends in AIDS-related deaths in the past year. Why? They were suffering from treatment fatigue. Musah, our member from Uganda, works with other young people living with HIV in Busia, and they all want and need innovative technology and ideas for treatment aimed specifically at adolescents and young people. UNAIDS has done amazing work in ensuring a scale up of access to treatment, but we need to push even further – not only are adolescents not accessing treatment, but those who are accessing treatment need to have treatment that meets their unique needs as adolescents and young people. The PACT also recognizes the impact of legal barriers on the ability of young people to access services. We want to see age-related laws and policies to enable access to services and not to serve as a barrier. We are taking actions to decriminalize sex work, drug use and sexual activity. My friend Penny is a young GP in Thailand. Penny spoke to me about an adolescent girl that came to her because she wanted to know her HIV status, but because of the girl’s age she was unable to consent to an HIV test without the approval of her parents. Penny knew this girl’s evolving capacity indicated she was capable of consenting, but the laws tied Penny’s hands and prevented her from providing a needed service to her patient. The action takers of the PACT know that we cannot do this work alone and that we need resources to achieve our aims. We believe that resources for young people and HIV should be allocated based on need and evidence, and that resources for young people must be allocated appropriately and existing decision-making mechanisms need to include the participation of young advocates. Finally, the PACT feels strongly that HIV should be articulated as a priority within the post-2015 framework – as I noted above that over 188 community dialogues worldwide came to the same conclusion ending AIDS should be a priority in the post-2015 agenda, and we have committed ourselves to advocate at every level to see this happen. I will leave you with a question, Young people have committed to take action and to hold themselves accountable for that action: how will member states hold themselves accountable?


( M S I

27

3 0 )

IFMSA represents the Youth’s Voice in UNISDR Consultations

Creating a World Free from Disasters IFMSA Disaster Risk Management Permanent Small Working Group ifmsa.drm@gmail.com

“One of the easiest disaster risk reduction measures we can take is to empower children and youth and ensure they are actively involved in disaster risk reduction and contribute to making their cities and communities resilient to disasters. The earth needs youth’s support to survive the threats of climate change and the growing intensity and frequency of disasters.” - Margareta Wahlström, special representative of the Secretary-General for Disaster Risk Reduction Disasters are not natural, but are the result of human interaction with both natural and man-made hazardous events. Preventing disasters is the mission of the global society, including IFMSA. No country is immune to these hazards, but with improved prevention and preparedness we can assure that hazards do not turn into disasters. Together we aim to build a society, both locally as well as globally, fully equipped to handle hazards as they occur. By improved prevention and preparedness, and by reducing the risks of hazards resulting in disasters, we will fulfill the mission of creating a sustainable and resilient world with no disasters.

ness, response, and rehabilitation [2]. We especially stress the need of maintaining the right to health within societies stricken by hazards and that the post2015 Framework for Disaster Risk Reduction assure that the health care system is fully prepared for handling disasters (2). Establishing a solid human right to health is fundamental and cannot be abridged, but should be protected and upheld (3).

In 1999, the United Nations General Assembly assigned the United National Office for Disaster Risk Reduction (UNISDR) to implement an International Strategy of Disaster Risk Reduction. Six years later the ”Hyogo Declaration” was adopted by all UN member states, aiming to build the resilience of nations and communities to disasters. This declaration expires in 2015 (1). The UNISDR currently coordinates activity through consultation with governments, agencies, civil society and the private sector, reviewing each actor’s priorities, challenges and strengths in disaster risk reduction. These consultation outcomes will compose the post-2015 Framework for Disaster Risk Reduction, voted upon by UN member states attending the Third UN World Congress for Disaster Risk Reduction, in Sendai, Japan, in March 2015. After endorsement by the UN General Assembly in October 2015, this framework will guide the international and national obligations in disaster risk reduction for the coming era. The ongoing consultations provide a platform for each region and profession to contribute to improved societal resilience. Now is time to act. We have the opportunity to create the world we want: a world free from disasters.

The IFMSA also advocates for the need to pay special attention to vulnerable groups in the post-2015 Framework for Disaster Risk Reduction, amongst others children and youth (2). Children and youth are at the forefront of disasters and it is of importance to build their capacity to handle the after effects of disasters. As the decision-makers and leaders of tomorrow, children and youth need to acquire appropriate knowledge, critical thinking and life-saving skills in order to make well-informed decisions and take action to protect themselves and their community against future risk. With this knowledge and these skills, children and youth will represent well-prepared citizens capable of engaging in decision-making processes to develop risk-sensitive policies that will shape their communities and the world’s future. Until recently, the role of children and youth in developing agile, resilient communication network within the framework of Disaster Risk Reduction has been significantly underestimated (4). Thus, we believe this is the time to take action and assure best possible outcome of the consolations for post-2015 Framework for Disaster Risk Reduction.

The IFMSA is taking a lead in presenting the voice of youth and children within UNISDR consultations of the post-2015 Framework for Disaster Risk Reduction. The IFMSA calls upon governments to implement comprehensive disaster preparedness and response plans and programs that are inclusive and sustainable, covering the different stages of disaster management – risk reduction, preparedness, response, and rehabilitation [2]. We especially stress the need of maintain-

IFMSA, together with other youth, student and children organizations, is now taking an active role in the UNISDR consultations. By this active participation in regional and international advocacy of UNISDR, we will make a contribution to a sustainable and resilient future for us all. medical students worldwide | AM 2014 Taiwan


A u g u s t

2 0 1 4

28

The IFMSA Disaster Risk Management Permanent Small Working Group: Monika Bednarek, David Eisenbrey, Bassel Abu Warda, Ana Pamela Gomez Sotomayor and Moa M Herrgård. References (1) www.unisdr.org. 2014-05-14 (2) IFMSA Policy Statement “Disasters and Emergency”, August 12th 2012 - August 12th 2015, Mumbai India (3) Grad, Frank P. (Jan 2002). “The Preamble of the Constitution of the World Health Organization”. Bulletin of the World Health Organization 80 (12): 981. (4) Mitchell T, Haynes K. (2008), “The Roles of Children and Youth in Communicating Disaster Risk.” Children, Youth and Environments, Vol 18, No. 1

Trade Agreements:

A Serious Threat to the Sustainability of Our Environment

Sustainable development is a term of increasing familiarity in global health. Concern for the environment is seeping into policies internationally, and the future of global development is currently being debated in the form of Sustainable Development Goals. It is on the basis of this shift that the 2014 August Meeting of the IFMSA will focus on “Sustainable development for the new era.” In a world under ever developing threats from climate change and an expanding population, innovation and sustainable interventions are essential to tackle food production issues and to protect the environment. Sustainability is the endurance of systems and processes; this can refer to anything from biological processes, to financial services or health care. All innovation in the field of sustainability can have impacts on health and, in a globally interconnected world, it is not possible to focus solely on one aim such as increasing sustainability without simultaneously considering how progress in this area may be affected by parallel decisions. In this context, we must consider the emerging next generation of multilateral trade agreements, namely the Trans Pacific Partnership and the Transatlantic Trade and Investment Partnership. “If these agreements open trade yet close access to affordable medicines, we have to ask: Is this really progress at all?” Director General of the World Health Organisation, Margaret Chan, at the 67th World Health Assembly specifically highlighted the potential impacts of trade on access to medicines, but trade reaches into all corners of every sector. At this moment in time, two international trade agreements www.ifmsa.org

Anya Gopfert

NMO: Medsin-UK Newcastle University, UK

thinkglobal@ifmsa.org

are being negotiated which are looming threats to sustainability and global health. Although globally some progress is being made in areas of sustainable development with consequent health benefits, these trade agreements hold the potential to compromise and undermine this progress.


( M S I

29 The trade treaties under consideration are the TPP (Trans Pacific Partnership between the United States, Australia, Brunei, Chile, Canada, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, and Vietnam) and the TTIP (Transatlantic Trade and Investment Partnership between the United States and the European Union). These negotiations are taking place in secret, so all of the concerns about the impacts on health and sustainability are drawn from leaked draft texts or from comparison with previous trade agreements. This lack of transparency is a significant concern in itself. Numerous NGOs and Civil Society groups have been campaigning for transparent negotiations with little success thus far. The discussions are therefore lacking in participation and accountability; principles which allow for meaningful input from stakeholders and subsequent rationale to justify the final decision. Industry have however been allowed preferential access to negotiations, and allegedly even been able to collaborate with negotiators and view draft texts. This lack of transparency and bias in consultation allows streamlined communication by certain interested parties and effective silencing of concerns raised by civil society (1). Secondly, among the most worrying and potentially catastrophic elements of both the TPP and the TTIP negotiations is the Investor State Dispute Settlements (ISDS) provisions. By seeking to privilege corporate interests, ISDS would have widespread negative implications across sectors including public health and climate change. Introduction of ISDS will allow corporations to sue governments if policies are introduced which may threaten their interests or profits. With regards to sustainability and climate change, let us consider the TTIP and the European Union (EU). Climate change policy in the EU is sparse, and implementation of relevant policies is already weak. With the added degree of fear related to ISDS is it highly unlikely that climate change and environmental policies will develop significantly in the EU, and could even regress. Furthermore, it seems that the situation is worse for sustainability than could be imagined. Whilst simultaneously preventing the implementation of sustainable policies, the TTIP and TPP could directly oppose such policies, hurling our world towards disaster at an accelerated pace by increasing energy and resource consumption. One report from Friends of the Earth highlights a particular concern regarding local initiatives promoting sustainable food supplies utilising local suppliers. Given that a main aim of the TTIP is to challenge ‘localisation methods as barriers to trade’ such schemes could be severely affected (2, 3).

Erosion of the ‘precautionary principle’

One example demonstrates the potential impact of these trade agreements upon food safety and food policy in the EU, which could have unintended consequences for sustainable food protection and consequently public health. The precautionary principle in the EU has been identified as a potential barrier to a successful TTIP (4). The EU adopted the precautionary principle to allow removal of a product from the market if it threatens public health or the environment, and facilitates the development of public health and environmental policies which may protect health even if there is a lack of scientific data or unclear data on the product. One example here is fracking, for which there

3 0 )

facilitates the development of public health and environmental policies which may protect health even if there is a lack of scientific data or unclear data on the product. One example here is fracking, for which there is currently very little scientific data. The precautionary principle is essential for protection of population health allowing the EU to adopt a cautious approach with regards to new products. In contrast to the EU, the US has adopted a scientific approach, necessitating scientific data for policy production or removal; however, this can often be data heavily funded by and produced by industry. This will be one area for which the US and EU will have to find common ground; Knoll et al. theorise that for the TTIP negotiations to be successful the EU will have to adopt the scientific method, and the US will have to adopt product packaging (currently food labelling is only mandatory in the EU) (1). Such compromise could have colossal impacts on public health as well as other areas. For example it could be easier for the chemical industry to bring new products into use within the EU with only industry backed data for evidence of safety. Here we have only painted an outline, the details are complex and unclear but speculation is rife. There is consensus that the public health community should be wary of the TPP and TTIP for protection of the environment and sustainability, public health policies and other direct impacts on access to essential medicines and healthcare systems. This is a global problem, with no clear solution. But civil society needs to be heard, and the voice of youth can resonate higher and louder than many. So far, IFMSA NMOs and individual members have been speaking up across the globe. Following the introduction of the Trade and Health Policy Statement at March Meeting 2014, we have reaffirmed multiple times our belief that trade agreements should promote public health and should not prioritize multinational corporate profits over patients and consumers around the world. With members of NMOs writing to national governments, attending stakeholder events and webinars, we have strengthened our voice and advocated for international trade agreements which promote environmental protection and seek to curb climate change. If you want to help promote the message “Don’t trade health for wealth”, get in touch on thinkglobal@ifmsa.org. This article was written in conjunction with Claudel P-Desrosiers and Elizabeth Wiley. References

(1) Cardoso, D et al. The Transatlantic Colossal, Global Contribution to Broaden the Debate on the EU-US Free Trade Agreement, December 2013, Berlin Forum on Global Health, Internet and Society Collaboratory, Futurechallenges.org. (2) Friends of the Earth Europe, Institute for Agriculture and Trade Policy. EU-US trade deal: A Bumper Crop for ‘big food’. October 2013. (3) Transcript: Briefing by USTR Ambassador Ron Kirk and Deputy National Security Advisor Michael Froman on US-EU Trade Negotiations, 13 February 2013, http:// www.ustr.gov/about-us/press-office/press-releases/2013/february/transcript-briefingus-eu (4) Maine Government, “TTIP FAQ – Negotiation Phase (Transatlantic Trade and Investment Partnership (12 July 2013, at p. 4.)

medical students worldwide | AM 2014 Taiwan


Projects Bulletin


( M S I

31

3 0 )

Introduction from the Projects

International team

Karim Abu Zied

IFMSA Projects Support Division Director 2013-2014 projects@ifmsa.org

Dear IFMSA Project Addicts, Over the years there has been a trend growing all over the globe. Such is more fatal in the history of civilizations than any disease we study about in our medical schools. Developing and growing all over the globe, adaptation has presented itself as one misused ability of human beings through generations. And by this, I mean adaptation to how our lives have turned out to be, to all the misfortunes happening around us, to the structures and procedures that are not functioning, to governments and communities in need of development, yet lacking initiative. Being members of an international community as the International Federation of Medical Students’ Associations (IFMSA) only means that we, as medical students and future doctors, have decided to break this tradition. Observing the world in a massive need of change, we have taken upon our shoulders the responsibility of reshaping it for the future generations, deciding that this is not the way our world should look like. We identified the problems we need to face and started taking actions to end the injustice and the inequality that move us away from a better world, aided by our motivation and enthusiasm. In our crusade, we have chosen projects to be our weapon through the process of reshaping the world one step at a time. It’s undeniable the vitality and importance of our projects since they are the foundation of the future we want. Therefore, I would like to welcome our readers to the Projects section of IFMSA’s well-known publication MSI (Medical Students International), previously known as “Projects Bulletin”, to get a glimpse on how your fellow medical students over the world are contributing to change our globe like small puzzle pieces that create the bigger picture of our Federation. We, Projects Support Division Team, hope that you would enjoy reading the finely chosen articles for the Projects section. With our best wishes, Karim M. Abu Zied

On behalf of Projects International Team, Ljiljana Lukic (Assistant Director), Fabiola Rivera (Americas), Moumini Niaone (Africa), Ervandy Rangganata (Asia-Pacific), Karim El-Sayed (EMR), Zavira Heinze and Onur Küçükerdogan (Europe), Zeyad El-Samadony (Rex Crossley Awards Coordinator), Nissa Khan (Rex Crossley Awards Coordinator Assistant). Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

32

Feed with Love Our project was founded in 2010 with the firm vision of celebrating breastfeeding by correcting misused techniques and enhancing the benefits for both mothers and babies in our communities. First of all it is worth mentioning that this project englobes several IFMSA committees. How? SCOME generates trainings for our members, so they can transmit updated and scientifically supported information on breastfeeding. We count on keynote presentations by renowned medical specialists (mainly Gynecologists), aimed at medical students, doctors and interns.

Mabel Ortíz De Leo

NMO: IFMSA-Mexico Universidad Veracruzana, Mexico nora.ifmsa.mexico@gmail.com

SCOPH addresses the basics of breastfeeding for mothers, such as the minimum time recommended and benefits for their babies. SCORA explains the correct techniques of breastfeeding using anatomical models and other multimedia materials. Evaluation forms prior to and after the explanations intend to reinforce the information transmitted. SCORP promotes maternal bonds through breastfeeding and prepares a symbolic gift for all mothers involved. Our main targets are the Gynecology and Obstetrics departments as well as the maternal and child hospitals. We believe in ‘Feed With Love’ because our teamwork has led into four years of successful editions so far. Our dream is that our national project can be reproduced worldwide, and this way help women practicing breastfeeding correctly.

www.ifmsa.org


( M S I

33

3 0 )

Universities Allied for Essential Medicines The Need for a New Research and Development Model Ida Marie Nyhagen Vikan NMO: NMSA-Norway The Arctic University of Norway ida.n.vikan@gmail.com

The present model for Research and Development (R&D) is not sufficiently developing drugs towards the global health needs and the disease burden as it should; rather it is driven by profit. This is particularly clear when it comes to the need for new antibiotics. As students of universities we have the opportunity to influence the accessibility of drugs originating at our institution, and call for a more just R&D model, especially since universities often are the first step in this process.

As described above, the current model for R&D is not going to provide us with the medicines we are dependent on to treat our patients in the future. With this, it is clear that we need a new R&D model to make it possible for the pharmaceutical industry to earn money through other means than selling large quantities of antibiotics. Furthermore the access to these newly developed antibiotics in the future is an important issue.

In all parts of the world today we can find bacteria that are resistant towards all known antibiotics. This concern was presented in the first surveillance report on antibiotic resistance by WHO in May 2014 (1). As a result, treatment of infections now, and in the future is more and more dependent on the development of new antibiotics, as the present ones are loosing their effect. Not only is this important in treating infections, but also in many aspects of modern medicine, where preventive treatment with antibiotics before surgery and other treatments such as chemotherapy, are crucial. This is thus not only a concern within low and middle-income countries, but also highly relevant in the developed world. Despite these facts, there is little research and development being conducted on the field of developing new antibiotics, nor has there been for some time. There are plenty of reasons for this. Firstly the pharmaceutical industry is manly driven by profit, and as current antibiotics are sold at low prices, developing these is not as desirable for the pharmaceutical industry as developing for example cancer drugs, which sells at much higher prices. In addition the prospects of selling the newly developed antibiotics is limited by the governments need to store them away, not to be used until the present ones no longer are effective. This to prevent that resistance is developed towards these as well. Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

If the prices in low and middle-income countries reflect the total costs of R&D, we might face the same problem we encountered with antiretrovirals and HIV treatments, where steep prices makes them inaccessible for those who need them the most. A possible solution to the problems we are facing, may be as illustrated in a report by Chatham House (2) suggesting a model based on “de-linkage”. The main thought is to break the link between research and development costs and the need of selling large quantities of antibiotics. Rewarding the scientists in each successful step of the process could create a market for innovation. With a financial reward granted by a public fund, the industry would no longer be as dependent on sales. At the same time the degree of public ownership could contribute to make those medicines available and accessible for all, and the R&D can be regulated based upon public health needs. The WHO’s Consultative Expert Working Group on Research and Development report (3) suggested that all member states contribute with 0,01% of their GDP to create such a R&D fund. In conclusion, the problem we are facing with the current R&D model and the development of antibiotics is not unique. There are many diseases that do not yet have a treatment because they

34 affected people mainly living in low and middle-income countries. Producing treatment for these diseases is not perceived as profitable enough. With a new R&D model we need to both fill the need for essential medicines, but also makes sure that the research being conducted is a reflection of the global disease burden on all levels, to make a more just world. This is why we as students need to work together with our universities and with our governments to influence the way R&D is being conducted today. We need to start developing drugs now, to have new antibiotics accessible to treat our future patients with. Universities Allied for Essential medicines (UAEM) is an international student organization working for access to medicines and research. Our main goals are: 1)To promote access to medicines and medical technology in low and middle-income countries, by working for a just patent and licensing system at academic institutions. 2)To ensure that medical research and development reflect the global burden of diseases. 3)To spread knowledge about the limitations that exists in today’s research and development system. References: (1) WHO. Antimicrobial Resistance. Global Report on Surveillance. [Online] 25.06.15. Available from: http://apps.who.int/iris/bitstre am/10665/112642/1/9789241564748_eng.pdf (2) Outterson, Kevin. New Business Models for Sustainable Antibiotics. [Online] 25.06.14. Available from: http://www.chathamhouse.org/sites/files/chathamhouse/public/Research/Global%20Health/0214SustainableAntibiotics. pdf. (3) The Consultative Expert Working Group on Research and Development. Research and Development to Meet Health Needs in Developing Countries: Strengthening Global Financing and Coordination. [Online] 25.06.14. Available from: http://www.who.int/phi/CEWG_Report_5_April_2012.pdf

www.ifmsa.org


( M S I

35

3 0 )

Water the World Mohammed Ali NMO: MedSIN-Sudan University of Khartoum, Sudan mhusseinawad@yahoo.com

What is the most basic resource for life on any planet? What is the most important necessity that if compromised or polluted can lead to the death of all life on Earth? “Have those who disbelieved not considered that the heavens and the earth were a joined entity, and We separated them and made from water every living thing? Then will they not believe? (The Holy Quran, 21:30)”

below the Poverty line. ‘Water the World’ was established in August 2010 to bring forward the active role of medical students in the Sudanese community, as leaders and role models, to help solving the water crisis in rural Sudan. Since then, water pipelines have been installed in four schools within Mayo IDP camp, 800 primary students in Mayo camp were educated, and a well has been dug to provide clean and safe drinking water to over 5.000 citizens.

“Protoplasm is the basis of all living matter, and ‘the vital power of protoplasm seems to depend on the constant presence of water” (Lowsons’ Textbook of Botany, Indian Edition. London 1922, p. 23) These references all point to the fact that ‘a life without water is no life at all’ and this is the motto that drives us at the ‘Water the World’ project. Having the vision of creating an ideal environment, where water is readily available to all humans and animals in an amount that meets their daily needs is not an easy feat to accomplish, not at all. Therefore, we made our mission to utilize the energy of Sudanese and international medical students to help our communities. We strive to improve people’s quality of life by educating them on general issues connected to water. Aiming for a sustainable development in Sudan and elsewhere in developing countries, we involved the youth, especially medical students, with their communities. Being a human rights-based project falling under the umbrella of the IFMSA Standing Committee on Human Rights and Peace (SCORP), our main focus has been in Mayo, an internally displaced people’s (IDPs) camp in the outskirts of Khartoum. Much like any refugee camp, it remains without electricity, running water and proper sanitation systems. Thousands of Sudanese people, coming from war-ridden areas of western Darfur and southern Sudan are struggling to survive there, Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

36 The plan is to dig the first water well outside of Khartoum by the end of 2014. This project meets the seventh Millennium Development Goal (MDG) – ‘to halve the proportion of people without sustainable access to safe drinking water and basic sanitation’ (1). The Article 29 of the UN Universal Declaration on Human Rights states that ‘Everyone has duties to the community’ (2). In other words, it is our right and our responsibility to work together peacefully and with great dedication to create an environment fit to live in, free from poverty, without fear of injustice, where basic rights are granted and no one is left behind. And no one shall be forgotten!

References: (1) United Nations. Millennium Development Goals and Beyond 2015. GOAL 7: ENSURE ENVIRONMENTAL SUSTAINABILITY. [Online] 2014. Available from: http://www.un.org/millenniumgoals/environ.shtml (2) United Nations. The Universal Declaration of Human Rights. [Online] 2014. Available from: http://www.un.org/en/documents/udhr/

www.ifmsa.org


( M S I

37

3 0 )

My Planet, My Health Wenzhen Zuo NMO: IFMSA-Quebec Université de Montréal, Canada maplanetemasante@ifmsa.qc.ca

According to the journal The Lancet, “climate change is the biggest global health threat of 21st century” (1). Currently, world environment is facing tremendous threats originating from poor use of water, air and land pollution, depletion of resources, industrial errors, and overall apathy. The World Health Organization (WHO) records several examples of poor environment’s detrimental effects on health (2). For instance, 1.3 million deaths are attributable to air pollution annually; 60.000 people die each year due to largescale natural disasters, and climate change directly is estimated to be responsible for 154 000 deaths, with an attributable burden of 5,5 million DALYs in 2000 (3).Consequently, it is urgent to take action and to contribute to the elimination of the negative factors that have led to these issues.

For example, in the aim of educating students on the process that leads pollution to contaminate groundwater, we recreate an edible aquifer in a cup with sparkling water as groundwater, frozen yogurt and cereals as the earth, and grapes as rocks. We then add a drop of food colorant to represent the pollutant so the students can see its infiltration into the groundwater. We also have other games for each session (such as Air Bingo).

Upon admission to medical school, some students realized how little was being done to protect and promote the health of communities with regards to climate change, despite its widespread recognition as a major threat. IFMSA-Quebec had many projects on public health issues, but nothing was being done in a sustainable way to educate children and future decision makers about the importance of preserving the environment in the name of health. This is why ‘My Planet, My Health’ was implemented. This project aims to raise awareness among elementary school students about the different impacts that the environment has on human health and about the importance of preserving the environment. This entire educational project involves four 45-minute sessions, during which medical students successively discuss the importance of air, water and food on health and how these three key determinants of our health will be severely affected by climate change all around the world. To make the activities interactive, we developed planned discussions revolving around potential solutions to the issues behind climate change as well as games to illustrate these very issues. Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

The final and fourth session is comprised of an effective review of the important material covered over the weeks and allows us to remind participants of the importance of a good environment for our health. In conclusion, we hope to address the above issues by amplifying the level of environmental health education for elementary school students with the hope that it will enlighten them with a new perspective of climate change, and that they will be inspired to preserve and care for their environment, and consequently for their health. We believe that participants of the program will be inspired by the experience, sparking action in the future at an age and time when caring for the environment is at the crux of caring about health.

www.ifmsa.org

38 References: (1) Costello A, Abbas M, Allen A, Ball S, Bell S, Bellamy R, et al. Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission. Lancet. 2009 May 16;373(9676):1693-733. (2) World Health Organization and World Meteorological Organization. Atlas of Health and Climate. Geneva: World Health Organization; 2012. 68 p. (3) World Health Organization. The World health report : 2002 : Reducing the risks, promoting healthy life. Geneva: World Health Organization; 2002. 248 p.


( M S I

39

3 0 )

Human Being in the Streets Mirella Gomes NMO: IFMSA-Brazil Federal University of Rio Grande do Norte, Brazil mirellacristinasg@gmail.com

Homeless people are often seen as a neglected population, whom is frequently marginalized and hard to be reached through public health efforts. They live in constantly vulnerable environments, surviving on the streets with interrupted or weakened family ties, most of the times having no residency. Several obstacles have to be overpassed, day after day, such as extreme weather conditions, loneliness, illnesses, unsatisfactory hygiene habits, physiological needs and invisibility to governmental institutions. In consequence, violence, hunger and fear are generated. This particular group also faces the prejudice and contempt from our society, beyond the barriers imposed by their life stories, which not only decrease their self-esteem but also preclude certain social interactions. Given our concern, as medical students, with the inhumane conditions that homeless people have to live with in Brazil, the central idea of the ‘Human Being in the Streets’ is,

through a multidisciplinary approach, to confront and mitigate some of the adverse situations they face. It also intends to generate hope, improve self-esteem, and encourage social inclusion, by improving related social parameters and offering new opportunities and life prospects. It also aims to raise awareness of how societies often discriminate these populations instead of promoting equal rights. The key message of this project is that there is always someone who needs help and there is always a way to provide it. ‘Human Being in the Streets’ has a duration of 8 weeks, and participants can assist with meals, psychological assistance (recreational activities, community therapies, painting, conversation, music and dance) and legal assistance. Moreover, homeless people can take a bath, cut their hair and beard. They receive clothes, shoes and personal hygiene kits, and medical and dental care is also provided. Hence, we have some workshops to promote new opportunities.

Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

Step by step, they start feeling better about themselves and end up with an enhanced self-respect, become protected against some infectious diseases with vaccination, and aware of how to prevent certain health conditions and treat others found throughout the timeline of the project. This article was written in conjunction with Fabiane Mendes de Souza.

www.ifmsa.org

40


( M S I

41

3 0 )

HAMPINA Medical Brigades Maria Jose Cisneros NMO: IFMSA-Ecuador Universidad Internacional del Ecuador majocc93@gmail.com

IFMSA-Ecuador is proud to share ‘Hampina: Medical Brigades’, a project that speaks directly from our hearts. Hampina means ‘healing’ in Quichua (a native language in Ecuador), and intends to show that medical students are capable of generate real changes in our health care systems, starting now! Our beloved region, the Americas, shares a common background marked by poverty and social inequity. Our main goal with ‘Hampina’ is to create medical brigades in local communities across the country where medical students can improve their knowledge, skills and empathy in the doctor-patient relationship. Most importantly, we urge to address the reality of primary health care sector in Ecuador. The project also creates the opportunity to carry out research projects on epidemiology, and undertake workshops on basic medical and social skills.

‘Hampina’ was not only designed to treat disadvantaged populations but also to create better medical students, with a holistic perspective, for the sake of the future of our country. The amount of effort and love involved in this project cannot be explained but has to be lived. ‘Hampina: Medical Brigades’ – a once in a lifetime experience!

“Alone we can do so little; together we can do so much.” - Helen Keller

Medical Students Worldwide | Taiwan AM 2014


A u g u s t

www.ifmsa.org

2 0 1 4

42


( M S I

43

3 0 )

WHO Simulations

The Future of Advocacy Training for Medical Students

David Benrimoh NMO: IFMSA-Quebec McGill University, Canada benrimoh@gmail.com

Political advocacy - this is perhaps one of the most crucial activities for physicians and medical students, and yet it is not a skill that is emphasized by medical school curricula or by many medical practitioners. It is critical, then, to create some kind of framework for health policy and health diplomacy training, so that today’s medical students can become tomorrow’s local and global health advocates. Why is this? Because it can be argued that the majority of the health issues faced by people around the world are not rooted in technological or methodological failings, but in failures of policy and in the realities of politics. For example, while we certainly cannot cure all cancers, we do have effective screening programs for diseases like cervical cancer, which can drastically drop mortality rates. And yet there exists a huge discrepancy between the availability of cervical cancer screening between the developed and developing world. The reason for this is not simply one of lack of resources - it goes far deeper than that, stemming from the political makeup and agendas of nations, aid organizations, corporations, and powerful individuals. It is often when political changes happen that populations benefit the most from advances in healthcare - a government decision to fund a comprehensive network of primary care facilities will go much further to actually improve the overall health of a population than all of the innovations in treatment and diagnosis that make individual doctors more capable of healing. Doctors have a special role here: we know the science, the epidemiology, and the realities in our communities. Therefore, if we truly want to care for our patients, we must join other health professionals in calling for needed change. The only problem is that no one teaches us how to do it!

Simply reading about health policy issues, while essential (and an essential part of being in a WHO Simulation), is not enough to turn someone into an advocate. That takes practice, and that practice comes in the form of WHO Simulations. These Simulations are conferences that simulate real meetings of the largest health policy body in the world - the World Health Organization and its subsidiary agencies and committees. Delegates take on the roles of nations, corporations, reporters, and important figures, learn the issues from their perspectives, and try

That is where WHO Simulations come in. Just like surgery, health diplomacy is an art that must be experienced to be truly learned.

Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

to act their role, pursuing the interests and goals of their assigned actor. This teaches them first the importance of understanding the motivations of others, and secondly the ability to understand issues from multiple sides. They are forced to eschew their idealism, for a little while, and engage in the realpolitik that defines global health policy creation. Quickly they learn how to make allies, how to compromise, what to say to convince a crowd of their ideas. I have seen students completely new to the political sphere learn how to use diplomatic pressure on other nations - and learn how to cooperate in order to create meaningful new policy. Their objective during the simulation is to create one or more resolutions - new pieces of health policy that actually get sent to the real WHO. Throughout the process they learn about leadership, critical thinking, organizational, and real diplomatic skills. And most importantly, they get to learn a bit about how the governments and corporations they will be lobbying for change work - what makes them tick, and how to make them work in their favor. They learn the importance of research, of speaking to the right people, and of truly understanding the interests of all involved parties,

www.ifmsa.org

44 and gain practical experience with both the kind of language used when writing health policy, and the rules of debate and bureaucracy. Armed with these skills and experiences, delegates emerge from these fun-filled and truly educational weekends as proto-advocates, students who have in many cases become committed to the idea of seeking change, and who now feel a little bit more confident in their skills as advocates and diplomats. WHO Simulations, if they become a focus for the IFMSA and its NMOs, have a chance to transform medical education, adding the needed advocacy and health diplomacy components and making future physicians into future health advocates as well.


( M S I

45

3 0 )

Tutorat NMO: ANEMF-France University of Versailles, France audrey.larnaudie@anemf.org quentin.degez@anemf.org

Quentin Degez

Audrey Larnaudie

In each medical faculty of France, only about 13% of the 1st year medical students are able to continue to the 2nd year. Also, a student is not allowed to repeat the 1st year more than twice. For a lot of them, the dream of practicing as medical doctors will never come true and demotivation levels start rising. This measure was made to control demography impact of the number of medical doctors in the country. The 13% that are lucky enough to go on to the 2nd year are selected from the results of two exams and, as a result, a huge competition among medical students occurs. Therefore, some private companies have proposed supplementary classes in parallel to the university. Obviously, these courses are incredibly expensive, around ten times more in a semester than students have to pay in a whole academic year. Years ago, the common thought was that students wouldn’t be able to succeed their first year of medical studies without these classes. Slowly, our public system was being forced into a private one in front of our eyes. Created in 1976 by the faculty of Saint Etienne, ‘Tutorat’ project helps medical students of the 1st year by providing them with academic preparation for free or at a very low price. A local committee team made by students, with a coordinator and some tutors, all in 2nd and 3rd years of medical studies, was in charge of this project. Now, it runs in each of the 37 local committees and has become even more relevant. At least one mock exam is done every week and all disciplines are covered by the ‘Tutorat’. Every year, more than 4.000 tutors guide about 55.000 medical pupils. ANEMF-France coordinates the project at a national level and provides trainings in its national General Assemblies for local committees. We’re very satisfied to see that the team of tutors is getting bigger and bigger:

in University of Versailles, there are more than 100 tutors in the 2nd year. The ‘Tutorat’ project is obtaining even more recognition, with some departments of the Medical Council and universities requiring their professors to be involved and giving us materials for free. By creating a free preparation, accessible to every student of the 1st year, the chances to continue with the dream are equal to everyone. Selection for the 2nd year of medical studies will not be based on economic power but rather on individual performances. This project started as a little one but has now changed the stereotype of the future medical doctors the French system is able to select. Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

46

LSD The only addiction allowed! There are several kinds of addictions. Drug addiction is one of them. A reality that most countries face, and Greece is not an exception. Considering that a person with an addiction is often seen as a sociopath - and therefore neglected sometimes -, these people clearly face discrimination in various aspects of their lives, including health care. Medical students, and even medical doctors, are not always aware of an addicted person’s psychological profile. As a result, the treatment may be biased because of a non-efficient stereotypical approach. And this is why the ‘LSD’ project was born. Medical students are educated about addictions, different people’s profiles and techniques for the right approach to this problematic in a two-day workshop conducted by experienced healthcare professionals. During this time, best practices and experiences are shared and the first step towards building up a sound knowledge for medical students is taken. In the following two weeks, a hands-on experience is provided by the participation in the therapeutic process. It takes place in KETHEA - Therapy Center for Dependent Individuals - the famous center for people with addictions in Greece and main partner in the project. Medical students not only observe procedures, but they also do interact with former addicted persons, and eliminate any kind of existing prejudice.

www.ifmsa.org

Learning Strategies about Drugs

Alexandra Kyrou NMO: HelMSIC-Greece University of Athens, Greece projects@helmsic.gr

As mind-blowing as it may seem to talk with an addicted person, one can learn about their stories and obstacles along the way and create our own opinions, regardless of the perspective of our society. Since May 2012, ‘LSD’ project has been organized in seven different cities and more than 350 medical students have participated. Keeping in mind the still existing social stigma, street actions took place with the goal of raising public awareness during June 26th 2014 - the International Day against Drug Abuse. Addiction is not a social curse. People with addictions do not require our pity or our sympathy, but they do need our respect and help when accessing health care services. The ‘LSD’ project is a first step for us, medical students, to learn how we can be part of a solution.


( M S I

47

3 0 )

CEMEF’s Diogo Silva NMO: PorMSIC-Portugal University of Porto, Portugal projetos@anem.pt

In the last year, around 3.000 vacancies were available and we had a total of 1.018 participants. This year, with the same number of vacancies, we had an increase of participants of 25%, to a total of 1.245 electives. The general evaluation has always been positive and the final result in the last edition was 4,33 (out of 5). Hence, each specific topic was classified at least in 4 (out of 5). Some of the topics evaluated were the relationship with the tutor, the quality of health centers and hospitals, the organizing committee, the application process and ranking methods.

‘CEMEF’s’, which stands for ‘short clinical clerkships on vacations’, is one of the oldest projects organized by PorMSIC-Portugal, and works as the middleman between medical students and medical centers spread along the country, being the responsible for assuring, in its 19th edition, a professional experience to approximately 1.000 Portuguese medical students during their summer vacation. The main goal of this project is to enrich medical curricula and students’ knowledge through a two-week practical internship on vacations, especially relevant after the recent changes in the Portuguese medical education panorama, where a great increase in number of medical students without a similar increase in medical faculties or facilities has taken place.

Given the long term reach of this project, we have developed a strong database of the Medical Centers and facilities in Portugal. We have also evolved to a reality in which we can offer this opportunity to more than 25% of our medical students in our country, being a very inclusive and popular activity. Sustainability will always be a goal for PorMSIC’s projects. Since the current tutors were once participants of ‘CEMEF’s’, we couldn’t be more proud of its great impact in our eight medical schools and associated hospitals. In fact, some of these institutions have already recognized and endorsed our project, allowing this elective to be included in the medical students’ final degree.

Every student from the third to the sixth year is eligible for this program and can choose among more than 60 different specialties. Besides, this year we have created another branch, ‘CEMEF’s Insight’, which intends to introduce the clinical practice to medical students of the first and second years, by offering them an an observational elective after a short semiology workshop. Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

Copyright Š MSSA-Menofia, Egypt, All rights reserved.

www.ifmsa.org


( M S I

49

3 0 )

Introduction from the

SCORA International Team

Joe Cherabie SCORA Director 2013-2014 scorad@ifmsa.org

Dear IFMSAians and SCORAngels, The past six or so months have been packed full of SCORA success stories. In our March Meeting in Tunisia, we held the first ever Advanced IPET on Sexuality and voted in our Vision and Mission. Our partnerships with UNAIDS and Ipas have been flourishing with new trainings and agreements being formed. We have held successful campaigns on International Women’s Day, the International Day against Homophobia and Transphobia, as well as the International AIDS Candlelight Memorial. Not to mention all of the amazing campaigns you have all been holding in your respective NMOs on Peer Education and Sexual and Reproductive Health Rights. All of this is great, but the theme of this GA is Sustainable Development for the New Era. So how are we, as SCORA, going to sustain the developments we’ve made into the near future? I believe the answer lies in you! As we all know, the Post-2015 agenda is being drafted and it is our job as the youth to voice our concerns and beliefs as to what this agenda should be focusing on. And this is exactly what our main focus over the last 6 months has been. We have 5 main focus areas in SCORA: Maternal Health, Access to Safe Abortion, Comprehensive Sexuality Education, Prevention of Stigma and Discrimination, and Gender Based Violence. We as SCORA have been working hard on these issues, such as having created policies on Access to Safe Abortion and LGBT Health, the first of its kind accepted by an international body. From this, we have drafted a plan and roadmap for advocating on the issue of LGBT Health in the WHO. We have also worked on providing trainings on access to safe abortion, and are working to advocate for this issue along with our partners Ipas, through webinars, trainings, and policy discussions.

Also, we have worked avidly on the PACT, where we as the youth are raising our voices to make sure all youth have access to reproductive health services. Last but not least, I must mention our amazing International Peer Education Trainings, which have been aimed at creating Peer Education programs and advocating for Comprehensive Sexuality Education for all youth. We are moving forward, but once again, it starts with you! It is up to you to advocate for sexual and reproductive health rights in your community, your schools, your country, and your region! It is up to you to speak to policy makers and advocate for sexual and reproductive health rights! It is up to you to open discussion on access to reproductive health services, women’s rights, and LGBT health! And if you can do this, even if you just start a small discussion, I guarantee you can make a difference, one that is sustainable for the future. Joe Cherabie

On behalf of SCORA International Team, Kelly Thompson (Liaison Officer to Reproductive Health incl. AIDS), Emily Steward and Jeazul Ponce (Americas), Cephas Avoka (Africa), Tsukasa Watanabe (Asia-Pacific), Sanam Seyedian (EMR), Michalina Drejza and Maria Cunha (Eu­rope), Anna Szczegielniak and Ming Yong (Publications).

Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

50

Era of Sustainable Development: Family Planning is Key!

The collective efforts of the global community towards ending extreme poverty and hunger as well as to promote gender equality were successfully directed by the Millennium Declaration and the Millennium Development Goals (MDGs). The importance of health as a key feature of human development was recognized, with three MDGs explicitly linked to health indicators and the others structured around major determinants of health. While considerable health gains have been achieved through the MDGs, there needs to be a continued commitment for accelerating progress related to those goals, many of which will not be achieved by 2015. Sustainable development is development that meets the needs of the present without compromising the ability of future generations to meet their own needs. Sustainable development is both a way of understanding the world and a way to help save it. Sustainable development encourages a holistic approach to human well-being; one that includes economic progress, strong social bonds, and environmental sustainability. Health is crucial for sustainable human development, both as an inalienable human right and an essential contributor to the economic growth of society. Health is also a good summative measure of the progress of nations in achieving sustainable development. It contributes to national development through productive employment, reduced expenditure on illness care and greater social cohesion. Family planning and reproductive health services support both objectives of sustainable development which are providing for www.ifmsa.org

Cephas Avoka NMO: FGMSA-Ghana SCORA RA for Africa avokacephask@yahoo.com

human needs today, while protecting the environment for future generations Ensuring access to reproductive health services empowers women, improves public health and helps break the cycle of poverty. Moreover, where women are able to choose the number and spacing of their children, population growth slows - which reduces pressure on natural resources. Family planning and reproductive health services have numerous benefits for women, families and societies. The health benefits of meeting unmet need for family planning and reproductive health services would be dramatic: unintended pregnancies would drop by more than two thirds; seventy per-cent of maternal deaths and forty-four per-cent of newborn deaths would be averted; and unsafe abortions would decline by seventy-three per-cent. Also, women who are empowered to make choices about childbearing are more likely to seize economic opportunity and invest in their children’s education; they and their children are less likely to be poor. A growing and increasingly affluent world population is increasing its demand for and pressure on vital natural resources and services. Advancing sexual and reproductive health and rights, including increasing access to voluntary family planning services, can initiate a demographic dividend and positively influence population dynamics and advance a number of sustainable development priorities, including those related to health, gender equality, food, water and energy security and environmental sustainability.


( M S I

51

3 0 )

SCORAlicious EMR Sanam Seyedian NMO: IMSA-Iran SCORA RA for EMR ladiseyedian.sanam@gmail.com

In 2005, the first Eastern Mediterranean Regional Meeting was held in IFMSA-Egypt. At that time, Ahmed Khamis from Egypt was SCORA Director. The event was not only a start for SCORA in EMR, but it was an important step to share the same concerns and find out regional solutions.

Although we are arguing with taboos, cultural issues and unstable political situations, we are proud of working in a region with fully dedicated and motivated members and hardworking NMOs. We are constantly growing and pushing forward and each year is more successful than the last. We are trying hard to have a region free of HIV/ AIDS and other STIs, with respect to every person’s reproductive health and rights.

Three years ago, there were only around 5 active SCORA teams among EMR NMOs but now we have 11 NMOs that have active SCORA. Also KuMSA-Kuwait and IFMSA-Iraq have recently joined SCORA in EMR. Regarding SCORA projects, the EMR has been participating in several transnational projects such as SHAPE (sexual health and peer education), Female Genital Mutilation, Mr & Mrs BreasTestis, illuminAIDS and SCORA X-change. EMR NMOs also have held awesome World AIDS Day Campaigns and performed amazing projects on Breast Cancer Awareness, Men’s health, Violence against women and prevention of stigma and discrimination. Also EMR SCORA projects have gained multiple major successes including the projects from IMSA (IFMSA-Iran), AssociaMed Tunisia, IFMSA-Egypt and LeMSIC Lebanon, all of which are enlisted as previous award winning NMOs in SCORA as well as in IFMSA. During recent years, the EMR have implemented Peer Education Trainings in different NMOs and the first EMR-PET (EMR Peer Education Training) was held in pre-EMR9. In the field of external partnerships, SCORA in EMR is working with UNAIDS, and during the 10th Regional Meeting (EMR10) we held a workshop focusing on Maternal Health, especially access to safe abortion, with the help of IPAS (a global non-governmental organization dedicated to ending preventable deaths and disabilities from unsafe abortion). Medical Students Worldwide | Taiwan AM 2014


A u g u s t

www.ifmsa.org

2 0 1 4

52


( M S I

53

3 0 )

The Cervical Cancer

Awareness Campaign

Ivan Lumu NMO: FUMSA-Uganda Mbarara University of Science and Technology, Uganda ivanlumu@gmail.com

Cancer of the cervix is the second most common cancer in women worldwide, with about 500.000 new cases and 270.000 deaths per year (1, 2, 3). Worldwide, every two minutes, a woman dies of cervical cancer (2, 3). Nearly 90% of these deaths occur in low income countries (2), where more than 95% of women have never had a pap test (1). Sub Saharan Africa and South America have the highest incidence of cervical cancer (3). In Uganda, about 7.19 million women aged >15 years are at risk of the disease (4). The age standardized incidence is 45.6/100.000 while the age standardized mortality is at 25/100.000 (4). Annually, 2.429 cases are diagnosed and 1.932 (80%) die annually. Furthermore, 80% of the women diagnosed with cervical cancer have advanced disease, usually stage III/IV, and the 5 year survival rate stands at approximately 20% (5). Up to 65% of Gynecology beds at the national referral hospital are occupied by cervical cancer patients where cervical cancer causes 70% of gynaecological deaths (4). Cancer of the cervix is largely preventable, but why is it the most common cause of cancer death among women in the developing world? The explanations include lack of organized screening programs (1, 2), the low level of education of women and limited access to health information (2), competing health care priorities (e.g. maternal and perinatal mortality, AIDS or Tuberculosis) (2), and lack of widely available vaccination programs (2). In an effort to reduce the burden of cervical cancer, medical students in Uganda created a SCORA project “Cervical Cancer Awareness Campaign�. The major objective of the project is to sensitize the community about the cancer and provide free screening as well as appropriate interventions.

The project is run as a two phase campaign; phase I has both fundraising and cervical cancer awareness (a fundraising Marathon, radio talk shows, vaccination advocacy campaigns and training workshops for volunteering students), and phase II consists of village outreaches to selected underserved communities in the nearby districts. The outreaches involve health education, free cervical cancer screening programs, and referral of patients with precancerous lesions and invasive cancer to the university hospitals for treatment. Since the establishment of the project, we have been able to reach over 10.000 people through radio and social media, and we have offered free cervical cancer screening services to about 1500 women nationally. A significant increase in the number of women that turn up for screening at university hospitals during the weeks of the campaign has also been noted. This campaign is scheduled to run for three years Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

54

and the project is now a signature event for FUMSA-Uganda. In the future, we hope to offer cervical cancer screening services to 3.000 women per year for five years at a fixed facility. Our dream is to raise money to equip one of the five cryotherapy centres in the country such that it is capable of handling those referred with precancerous lesions. References: (1) Preventing Cervical Cancer—Jhpiego Innovates to Save Lives (internet). Available at; http://www.jhpiego.org/files/%20ERCO-new-infosheets/2-What-We-Do/2 Cervical%20Cancer/Preventing%20CECAP/PreventingCECAP_0409_final.pdf. Last accessed on 27th May 2014 (2) Mozambique: cervical cancer and Human papillomavirus infection, 2013, (internet). Available at http://www.isglobal.org/documents/10179/25254/Mozambique-Human+Papillomavirus+Infection+and+Cervical+Cancer.pdf/d3cb8884-a8fc-4989-b143-88242b593cda last accessed May 27th 2014 (3) Kerr DJ and Fiander AN: To word prevention of cervical cancer in Africa, Report from Meeting at St. Catherine’s College, Oxford 26‐27 ,March 2009, (internet). Available at http://www.afrox.org/uploads/asset_file/Towards%20the%20Prevention%20of%20 Cervical%20Cancer%20in%20Africa%20-%20Conference%20Report.pdf . Last accessed May 28th 2014 (4) Association of Obstetrician and Gynaecologists in Uganda AOGU (internet). Available at; http://sogc.org/aogu/index3b39.html?contentID=54 last accessed on the 27th of May 2014

www.ifmsa.org


( M S I

55

3 0 )

Safe Abortion in Mexico Health Problem? A Right which is Finally Getting Access? Jeazul Ponce NMO: IFMSA-Mexico Benem茅rita Universidad Aut贸noma de Puebla, Mexico gblue.1990@gmail.com

Medical education in Mexico has significant shortcomings in the field of sexual and reproductive health, and provides students little information needed for recognition of abortion as a relevant problem in the practice of medicine. Medical education lacks options for clinical training of future physicians in models for comprehensive abortion care, including the use of safe and effective technologies, and a range of services to meet the needs of women. Between 1990 and 2005, abortion was the third leading cause of maternal mortality in Mexico City, while at the national level it was the fifth. In 2005, the average annual rate of hospitalization for abortion per thousand women aged 15 to 49 years in Mexico City was 9.1%, significantly up compared to the national flag, which was 5.8%. Mexico City is the only one of the 32 districts in the country that has a law which allows legal abortion before 12 weeks of gestation. The law was adopted in April 2007 and has allowed 31,033 proceedings until September 11 last year in hospitals of the Mexican mayor, according to official figures. Ipas Mexico and SCORA Mexico, began work in February 2012, with Ipas Mexico trainers attending the XVIIIl National Assembly in Puebla in 2012. The main objective of this work together was to sensitize medical students to a topic, which in Latin America is still a taboo, by explaining medical procedures and sexual rights, including reproductive health issues. Another objective was to encourage and train new coaches to spread the message and goals on issues of law and access to health services. With two years of collaboration, trainings, four national assemblies, and through distributing educational materials, we are still looking for real change. Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

56 Now, trainings are not only given to SCORA but also to SCORP and SCOPH members. We are looking to expand and access more horizons, and remove more barriers. In turn, Ipas Mexico has awarded scholarships and invitations for ToTs to members SCORA Mexico, in order to update us on reproductive health issues and problems specifically in Mexico, and to establish the medical student tools to promote access for all women to prevent maternal deaths. This April 24 marks seven years since the decriminalization of abortion has been allowed until 12 weeks gestation in Mexico City. Since then, 5.925 women have interrupted her pregnancy in public health services in the capital, and 150.000 did so in a private clinic, which equates to an average of 71 interruptions per day from April 2007. It is worth mentioning that still most Mexican states are penalizing the right to health as a crime. However, with the hard work of different NGOs, the Mexican Society is becoming more accepting and less judgmental against abortion. There is still much work to be done. This article was a joint article with Alexis Hernandez, Ipas Mexico member and trainer.

www.ifmsa.org


( M S I

57

3 0 )

NECSE? SECSE? ACSE? Maria Cunha NMO: PorMSIC-Portugal SCORA Co-RA for Europe mariaescunha@gmail.com

NECSE, SECSE... ACSE? What are these people talking about? From the beginning: in 2003, some Northern European (NE) NMOs showed their will to meet every year, during 4-5 days each time, to share teaching methods, ideas and networks that each one of them uses for their peer-education projects. Sharing geographical and cultural similarities, the NECSE NMOs were AMSA-Austria, IMCC-Denmark, EstMSA-Estonia, FiMSIC-Finland, bvmd-Germany, IMSIC-Iceland, NMSA-Norway, IFMSA-Poland, IFMSA-Sweden, SWIMSA-Switzerland, IFMSA-The Netherlands, Medsin-UK - all of them experts on peer-education but willing to learn from each other and improve their own programs. For 11 years, 4 to 5 delegates from these NMOs have been facing a tight agenda full of methods exchange sessions, time for discussions (about the present and about the future), creation of new methods (first time this year, but something to keep on the agenda), theme events focusing on “sex, gender and culture” (2011, Finland), “sexual morality” (2012, UK) or “sexual satisfaction” (2014, Switzerland), sports programs (to keep the energy level always high) and (of course) social programs (like Sex-lympics, theme nights, and NFDP). After 4 days, participants return home full of new resources, counting the days for the next Northern European for Sex Education Projects (NECSE). However, while Switzerland was elected to host the NECSE 2014 in the UK 2012, the Southern European (SE) countries started buzzing around about also having a Cooperation on Sexual Education (CSE). So, thanks to their motivation, the hard work of Evelina Dimitrakopoulou (SCORA RA for Europe 2013), Désirée Lichtenstein (SCORA Director 2013) and the amazing MMSA-Malta OC, the first Southern European Cooperation on Sexual Education (SECSE) finally happened, from 14th to 18th September 2013 in the

beautiful Malta. And of course, the first SECSE was a success! The participants came from Greece, Italy, Croatia, Malta, Spain, Catalonia, Portugal, Slovenia, and in addition, representatives from NECSE countries were also there to contribute. SECSE, while having a similar structure and agenda to NECSE, as some SE countries are not as experienced on sexual-education as the NE, works not only as a methods exchange event, but also as the diving board that some of the member NMOs need to go home with the energy and materials to start their peer-education projects! Looking to the present: EstMSA-Estonia is preparing the 12th edition of NECSE while AECS-Catalonia is working hard towards the 2nd SECSE. Meanwhile, both families underwent some changes, with Belgium becoming a NECSE country since NECSE 2014, and this year’s SECSE will also count with France, Turkey, Bulgaria and Serbia. And this leads us to the future! The plan is that from now on, more NMOs from all IFMSA regions, with a similar mentality and cultural background, create their space (aka their Cooperation on Sexual Education) to share their methods on sexual education for sessions in schools, training new SCORAngels, and also to have a deeper knowledge on a certain subject, suitable and pertinent for their region, that should be chosen as theme event.

Medical Students Worldwide | Taiwan AM 2014


A u g u s t

www.ifmsa.org

2 0 1 4

58


( M S I

59

3 0 )

Candlelight Memorial Day Video Campaign with Y+ Michalina Drejza NMO: IFMSA-Poland SCORA Co-RA for Europe

We have come a long way since the discovery of HIV. However, we should never forget the past but rather shine a light on it as well as our present situation in order to push the HIV/AIDS Agenda forward.

michalina.drejza@gmail.com

This year on 18th of May, we were celebrated International AIDS Candlelight Memorial Day, coordinated by the Global Network of People living with HIV. This year’s theme is “Let’s keep the light on HIV”, which aims to be positive and forward-looking whilst also recognizing that this remains a memorial event for many. In addition, with the post-2015 agenda looming, it speak the urgent need to ensure that HIV/AIDS does not drop off the agenda for international policy makers. As medical students, we wanted to ensure our commitment to provide comprehensive integrated HIV and Sexual and Reproductive Health (SRH) non-stigmatizing services, and make sure to deliver high quality treatment concerning this very important issue. This year’s video campaign was a result of collaboration between IFMSA and Y+ programme that represents young people living with HIV (PLWHA). Y+ members held up placards describing what their needs from health services are, and IFMSA members made pledges and contributions for future better HIV treatment. The International AIDS Candlelight Memorial Day is a campaign meant to commemorate the past struggles of people living with HIV/AIDS, while also looking forward to make positive strides in the future. Keeping the light on HIV is meant to express collaboration between people living with HIV/AIDS and future healthcare providers. This campaign is meant to make sure each of us pledges to push the agenda of providing comprehensive sexuality education on HIV/AIDS issues, providing all people with non-discriminatory sexual and reproductive health services, and delivering quality health care services to all people living with HIV/AIDS.

The outcomes of the campaign were far beyond our expectations. Having input from SCORAngels from every region and Young People Living with HIV, we created the video that expresses our pledge for the better care of PLWHA and keeping the light on HIV in our future physicians’ lives. We are hoping for further fruitful collaborations with Y+ as an open dialogue and step forward in HIV/AIDS issues advocacy.

Link to the video: http://youtu.be/w_YqBglWYMM

Kelly Thompson - Liaison Officer to Reproductive Health and AIDS Tsukasa Watanabe - SCORA Regional Assistant for Asia-Pacific Michalina Drejza - SCORA Co-Regional Assistant for Europe Joe Cherabie - SCORA Director

Medical Students Worldwide | Taiwan AM 2014


A u g u s t

www.ifmsa.org

2 0 1 4

60


( M S I

61

3 0 )

IDAHO in the Asia-Pacific Tsukasa Watanabe NMO: IFMSA-Japan SCORA RA for Asia-Pacific ifmsa.j.tsukasa@gmail.com

May 17th is IDAHO, the International Day Against Homophobia and Transphobia. It celebrates quite a health related anniversary: on May 17th 1990, homosexuality was removed from WHO’s International Classification of Diseases. Since then, IDAHO has become a major date when it comes to fighting discrimination and stigma from which LGBTIQ persons still suffer all around the globe. On the symbolic level, IDAHO provides a great opportunity to take action. As the Asia-Pacific region displays a wide spectrum of socio-cultural environments and languages, the situation of LGBT advocating in each country can vary greatly. However, we can say that these societies are, in general, relatively conservative, and regard sexual diversity as a taboo. For example, in Japan, although studies demonstrate that there are almost 5% of LGBT persons among the population (1), the Japanese government has never shown any interest in offering possibilities of partnership of any kind to samesex couples (civil union, marriage). Furthermore, LGBT rights and health related issues are never debated at the national level. Trans* people are still labelled with “DISORDER” when they ask for the medical support they need. At school, during sexual health classes, teachers never mention LGBT identities and practices. This is quite an old-fashioned situation for such a developed country, but this is what we have been facing, and what we have to get through.

for the IDAHO campaigning movie: https://vimeo.com/95548301 We hope you enjoy them! I am dreaming that, someday, governments of Asia-Pacific countries will approve samesex marriage, provide equal access to information and healthcare, regardless of gender and identity and sexual orientation, and encourage a social climate that allows anyone to follow their life-path with equal acceptance and support. Until then we should never give up!

References: (1) Dentsu Diversity LAB. Dentsu LGBT Survey 2012. [Online] 2012. Available from: http://dii.dentsu.jp/project/other/pdf/120701. pdf [Accessed June 6th 2014]

In 2014, we, SCORA Asia-Pacific, got together and produced campaigning material (a video and a poster) to advocate for LGBT rights and health. Surprisingly, we had never set up any cross-border campaigns on this issue within this region. Since each NMO is facing specific difficulties in initiating change and nurturing LGBT people communities, it was a great opportunity for us to share experience and knowledge, and push our situation forward. The following picture is the poster we made, and here is the URL Medical Students Worldwide | Taiwan AM 2014


A u g u s t

www.ifmsa.org

2 0 1 4

62


( M S I

63

3 0 )

Discussion on Marriage Equality Draft in Taiwain

NMO: FMS-Taiwan Chung Shan Medical University, Taiwan nora@fmstw.org Sheng-Ting Huang

Lin-Chia Yu

On October 25th 2013, Legislator Yuan has passed the first reading of the Marriage Equality Draft Bill proposed by Taiwan Alliance to Promote Civil Partnership Rights (TAPCPR). Including the legal recognition of non-monogamous, same-sex and even transgender marriage, the draft bill is now under consideration by the committee. However, although Taiwan is such a democratic country, the draft bill still causes some confrontations and fierce debates due to the involvement of same-sex marriage. Based on the disputes between both sides, members of FMSTW-SCORA have carried out a deep discussion at the national meeting. Our conclusion is to support the draft bill.

conclusion. Perhaps many people in Taiwan still insist values such as monogamous or heterosexual marriage. Nevertheless, in the view of FMSTW-SCORA, marriage shouldn’t be just the privilege of heterosexuality. With comprehensive measures, homosexual and even transgender families should have access to this right. We wish for the coming of the new era of equal marriage in Taiwan.

There are still many suspicions toward same-sex marriage within Taiwan. For example, same-sex families are unable to conceive, leading to insufficiency of manpower thus changing social structure. At the same time, discrimination might cause unstable family relationships among same-sex families. Besides, children who are adopted by same-sex couples may be bullied, and struggle with gender confusion. However, most of our members believe that the purpose of the bill is to protect the fundamental human rights and to ensure the freedom of marriage. In our opinion, those problems will be inevitably present, but the central cause is the society being still under traditional atmosphere. We shouldn’t ignore the human rights of those who are non-heterosexual because of existing conventional values. Both the law and societal values have to keep progressing over time. Since the reform of the law can bring up the change of public values, drawing up complete complementary measures is what we should work for in the future, rather than sacrificing the right of non-heterosexuality. We have also discussed about this issue at the annual meeting with 150 medical students this February, and reached almost the same Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

64

Violence against Women & Girls

Violence against women and girls [SD1] continues to be the most fundamental and globally widespread violation of women’s human rights worldwide. The United Nations Declaration on the Elimination of Violence Against Women defines “violence against women” as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life.” “Domestic violence is a global public health concern with one in three women throughout the world experiencing physical and/ or sexual violence by a partner or sexual violence by a non partner,” Professor Sir

www.ifmsa.org

Stijntje Dijk SCOME Director 2013-2014 scomed@ifmsa.org

Michael Marmot, Director of University College London Institute of Health Equity, spoke at a luncheon seminar during the 67th World Health Assembly, organised by the World Medical Association and the International Federation of Medical Students’ Associations. Sir Michael outlined the extent of domestic violence around the world. In many countries, married women believe a husband is justified in beating a wife if she refused to have sex. Education, however, is key. The more educated women are, the less likely they are to think that violence from a husband is justified.


( M S I

65 Domestic violence is only one of the many forms of violence that women experience worldwide. In conflict situations, sexual violence is common and is often often associated with physical violence and abductions. Unwanted pregnancies, HIV/AIDS, mental disorders and traumatic fistula are common complications. Gender Based Violence should be included in continuing education curricula of health workers, being also integrated into mental health and primary care services and these should be made available universally. Sir Michael explained how physicians and health professionals have to be more active in this field. Staff training in equality issues should be improved so that physicians detect cases of abuse among their patients and ask the relevant questions. For instance, much domestic abuse starts during a woman’s pregnancy. Physicians should be aware that asking questions regarding violence is particularly effective during this time. Previously silent women may come forward because of fear of harm to their baby. Women and girls should be empowered through education and social support.

3 0 )

WMA and IFMSA represent millions of doctors and medical students worldwide. Deploring the costs of violence, its health consequences to the women, children and to society as a whole, health professionals have a key role to play in combating one of the most severe human rights violations.

References: 1. 67th WHA resolution on addressing violence: http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_ACONF1Rev1-en.pdf 2. IFMSA Policy Statement on Violence against women: http://www.ifmsa.org/Media-center/Policy-Statements/Violence-Against-Women 3. WMA Resolution on Violence against Women and Girls: http://www.wma.net/en/30publications/10policies/v3/ 4. World report on violence and health: https://mail.google.com/mail/u/0/#inbox/14641d53b1097bed 5. WHO prevention of violence: http://www.who.int/violence_injury_prevention/violence/en/ 6. WHO violence publications and resources: http://www.who.int/violence_injury_prevention/publications/violence/en/ 7. IFMSA Activities Transnational Activities within the field of Reproductive Health including HIV and AIDS: http://www.ifmsa.org/Activities/Standing-Committees/Reproductive-Health-including-HIV-AIDS/ Transnational-Projects#.U4WhNJR_tJc 8. Working for Health Equity: The Role of Health Professionals: http://www.instituteofhealthequity.org/projects/working-for-health-equity-the-role-of-health-professionals 9. Closing the gap in a generation: health equity through action on the social determinants of health: http://www.who.int/social_determinants/thecommission/finalreport/en/

On May 24th, the 67th WHA adopted the resolution “Strengthening the role of the health system in addressing violence, in particular against women and girls, and against children.” It notes interpersonal violence as a major challenge for public health, and raises concerns related to the consequences, including death, disability, physical injuries, mental health, sexual and reproductive health and social consequences. The resolution affirms the health system’s role in prevention, response and advocacy to combat tolerance of interpersonal violence, and calls the World Health Organization to develop a global plan of action and scientific data collection.

Medical Students Worldwide | Taiwan AM 2014


A u g u s t

www.ifmsa.org

2 0 1 4


( M S I

67

3 0 )

Introduction from the

SCOPH International Team

Dr. Marwa Daly SCOPH Development Assistant on Publications and Marketing da.scoph.pub@gmail.com

Dear readers, On behalf of the SCOPH Dream Team, it’s our pleasure to introduce you to the 30th issue of MSI, the biannual publication that showcases projects, actions and causes of the members of our federation. These students who represent 117 NMOs contribute tremendously to the education and values of their countries. No work such as this magazine can be done without the help of many individuals. We would like to express our gratitude to beloved authors who contributed their writing. In addition to the SCOPHeroes who worked energetically in coordinating several campaigns. We also would like to thank the IFMSA Publications Team who worked to submit the essays, edit them and come up with this beautiful design. They have done a great job in putting this magazine together. Finally, we would like to express our appreciation to the SCOPH Dream Team, the reference and amazing staff. We hope you will enjoy reading these essays and keep in mind that “Alone we can do so little; together we can do so much”. So consider submitting your own paper to be published in the upcoming issues.

On behalf of the SCOPH International Team

Petar Velikov (Director), Altagracia Johansson (Liaison Officer to Public Health), Arthur Mello (Americas), Mohamed Taber (Africa), Wonyun Lee (Asia-Pa­cific), Skander Essafi (EMR), Ivana Mrázková (Europe), Manon Pigeolet (General Assistant).

Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

68

Put It Out! Before It Puts You Out Smoking is an enormous threat to public health. It harms almost every organ in the human body. According to the WHO, Jordan leads the region in the prevalence of male smokers followed by Palestine and Turkey, and comes third in the prevalence of female smokers. In a study done in Jordan University of Science and Technology, the highest prevalence of smokers was surprisingly among medical students. All of this research and discovery led to an eager launching of the National Smoking Awareness Campaign: Put It Out! Before It Puts You Out. The campaign’s principal objective was to spread awareness among all the strata of our community about the dangers of smoking. Hence, it aims at striving to decrease the percentage of smokers by targeting non-smokers hoping that they won’t approach it in the future. The campaign consisted of several steps, all of which target a different age group hoping to reach as many members of the community as possible: 1.

2.

3.

4.

Kindergarten Awareness Campaign: The main goal was to educate kindergarteners about the harms of tobacco, the power to say ‘no’ to anyone who smokes next to them, and to conclude with a promise that they won’t smoke in the future. Schools Awareness Campaign: Implementing videos, PowerPoint presentations, and other methods, we have educated teenagers about the systemic effects of Tobacco and smoking, critically compared effects of cigarettes and argileh, and positively suggested alternatives for better ways to spend their time in order to protect themselves from smoking and becoming addicts. Universities Awareness Campaign: We focused on the medical subject matter related to smoking and teaching that knowledge to students. We used multiple methods to argue in favor of quitting smoking and hopefully empowered all audience with the critical awareness and knowledge to educate other community members as well. The campaign consisted of many booths and lectures. Behind the Smokescreen Talk: Under the patronage of HRH Princess Dina Mired, and with the participation of ministers, senators, professors, doctors, companies and hospitals, a huge event was organized and covered by Ro’ya TV. The event aimed at creating a strong

www.ifmsa.org

Ahmad Abbadi NMO: IFMSA-Jordan Jordan University of Science and Technology ahmad.o.abbadi93@gmail. com

foundation to fight tobacco following the recent changes in the public health law. It also provided and presented solutions to the issues at hand, and how we can prevent more addict victims. 5. Tobacco Workshop: In association with King Hussein Cancer Center and Dr. Firas Hawwari, a workshop to discuss tobacco dependence and treatment was conducted. Participants received a certificate signed from KHCC and Global Bridges. 6. Malls Awareness Campaign: Trying to reach a broader spectrum from the community, we aimed for the most vital areas in cities, the malls. We made multiple booths targeting many medical aspects of smoking and tobacco. We also were equipped with walking units carrying smart devices with pictures to reach more people. 7. Spot Checks: This project was proposed by HRH Princess Dina to give certificates to companies, restaurants and cafes that are smoke free, under the name of smoke free areas. We helped KHCC/KHCF in their project by conducting the spot checks and sending reports to them about the participants in the award who really are smoke free areas. We received a certificate from KHCC/KHCF for helping them in their project. 8. A Media Project: We created a video comparing those who choose to be addicts and those who choose to quit smoking. This video was in our Schools’ campaign, and was shared on Facebook in order to reach even more people. 9. Fighting tobacco through the Bylaws: We added a motion to JUST/LC consti tution and bylaws, preventing smoking in all meetings whether it is for a project, EBs meeting, or any other kind of meeting.


( M S I

69

3 0 )

10. Publications: We published an article about smoking in IFMSA-Jo Magazine. We are very proud of our accomplishments and the results we obtained. We are also grateful for the support and participation of many governorates (a total of 5), leaders and professionals of the community. However, we realize that more steps are to be taken in order to accomplish our future goals and best results including the scheduled events below: 1- Karak Castle Awareness Campaign: Tentatively scheduled in August. 2- Smoke Free Activity Day: Tentatively scheduled in July. 3- Adding Tobacco Dependence and Treatment to the Public Health syllabus in JUST. As Gandhi said: “You may never know what results come from your action. But if you do nothing, there will be no result�. Hence, we can make a difference; we only need to make an effort and try.

Keep your Kidneys Healthy Naren Nallapeta NMO: MSAI-India J J M Medical College, India naren.nallapeta@gmail. com

In an effort to raise awareness of the importance of our kidneys to our overall health and reduce the frequency and impact of kidney disease and its associated problems, we at MSAI-India organized a wide range of activities throughout the country. As the Asia-Pacific region declared to work on noncommunicable diseases this year, and highlighting on chronic kidney diseases (World Kidney Day 14 theme) MSAI-India declared May 11th-21st 2014 as the World Kidney Week celebrations, and successfully conducted 10 different events targeting different age groups and cities in India. The event was organized under the guidance of Naren Nallapeta, Treasurer and Sunil Kumar, NPO. The first event was on May 11th, named Quizomania, a quiz for the undergraduate students of Father Muller College, Mangalore. The quiz had two rounds: a preliminary round with 32 teams of 2, followed by finals with 6 best teams. The topic of the quiz was chronic kidney diseases (CKD). On the 13th, the next event took place in Dr. Jeyase karan Hospital, Nagercoil, Tamil Nadu. Dr. Devaprasath and Dr. Arputharaj spoke about CKD and renal calculi respectively for the doctors, patients and nurses. Then Jeff Walter, SD Tamil Nadu spoke a few words about MSAI and the role of youth in society. There was also a poster competition for the nursing students. On the 14th, Dr. Kunal held a talk in his dental clinic in Ara; regarding kidney diseases and gave information regarding keeping kidneys healthy.

On the 15th, we had several events. An old age home (Aadhar), Mumbai was visited by senior nephrologist and MSAI member Manasi Shah who gave a talk on CKD to the old folks followed by distribution of booklets about keeping kidneys healthy. Kidney function tests were performed on the 70+ members of the Aadhar and results were provided on the following day with personal counseling. Another event was conducted in a Government high school, Hyderabad by our LPO Samreen Fathima who gave a presentation regarding kidneys and their functions to the high school students. Emphasis was laid on prevention of noncommunicable diseases. A similar event was conducted in Government high school, Ahmedabad by our LPO Prakruthi. On the 16th was a rally in Mangalore where more than 350 students took part in the 1.5 km march shouting slogans and holding placards. On the 20th, we had our LOPH Vasuki Tikkiwal in SMS Medical College, Jaipur conducted a poster competition aiming to spread awareness about kidney donation where numerous medical students took part which was followed by a talk by Dr. Pankaj regarding renal transplant. Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

70

On the 21st, our officers Bianca, Ashwini and Nishtha conducted a talk in every ward of J Hospital, Mumbai regarding kidney diseases. The event came to an end on the 26th, when a talk regarding CKD was given by a senior nephrologist in FMMC, Mangalore. We were able to reach out to over 5.000 people across the country. Hearty congratulations to MSAI who made this program a success!

Get Records, Do Studies and Save

Public Health! Omenya Mahmoud NMO: IFMSA-Egypt Alexandria University, Egypt omneya.m.mahmoud@ gmail.com

We all know the fundamental role of Public Health in taking the pulse of our communities. In fact, there are common issues that Public Health tackles in all countries, yet some are addressed according to the needs of certain communities. Additionally, a global issue may exist due to different causes in a community. Without having enough information about the state of communities, namely by epidemiology, we might say that ‘Public Health’ is in danger! On one side, providing vital and health records acts as a source of incidence and prevalence rates that aids in providing specific public health programs in an efficient way. They also help Public Health providers in a long term wise to evaluate the effectiveness of their programs and, in return, make changes if necessary. The lack of such records leads to a threatening print into the whole community as the issue/disease crisis will not be solved. It also consumes useless time and expenses that may be already a limiting factor in the program. Over and above that, reporting a case to the local health departments provides the basis that epidemiologists need to set upon disease surveillance systems. www.ifmsa.org

As once said by the observational epidemiologist Yogi Bera: “You can observe a lot just by watching”. Basically those simple reports, as a case of Cholera, help in establishing disease geographical patterns and time clusters that will, in return, help Public Health providers to disseminate this ‘information for action’ in a manner that will effectively and efficiently reach out to the public and have an impact. Actually the lack of such reporting, specially in developing countries, is a threatening remark. Moreover, establishing disease control measures can be simply done through case-control studies. Providing the agent, host and environmental factors associated with the disease can remarkably aid in such measures even without initiating deeper studies in that certain disease. Neglecting of such quick actions can severely affect the processes by which public health providers improve their community. Because it will not only increase the burden of the disease upon that community, but will also affect the community’s economy and productivity. Adding to that, disease outbreak investigations can be considered one of the most beneficial methods of learning about diseases in a certain population. It will, in return, have major effects to the Public Health, as it highlights the main risk factors and groups of a certain disease. However, this is not a common case; especially in developing countries, where money investments in such studies are absent. In conclusion, such a ‘dramatic’ issue bounds to be addressed. If truth is to be told, without establishing vital and health records and constructing epidemiological studies, Public Health would be extremely unsubstantiated.


( M S I

71

3 0 )

Healthy Generation Skander Essafi NMO: AssociaMed-Tunisia Medical University of Sousse, Tunisia skander.es@gmail.com

Let’s start from the roots! Nowadays, noncommunicable diseases (NCDs) are a real Public Health issue to be considered as one of the top-priorities in the low and middle-income countries. Indeed, they induce premature death, causing pressure on our health care system and an economic burden. These diseases are the consequence of the ‘lifestyle of the modern man’. However, boards and diets seem to be ineffective after the emergence of the disease especially that it is very difficult or impossible to change the habits of patients. Thus, simple hygiene measures can prevent their occurrence, then what’s better than educating the new generations? To have healthy future generations, we must establish the mentality of a healthy lifestyle in childhood. To make this happen, we have established this project through which we aim to raise awareness and sensitize children in elementary and middle schools. Thus, we can ensure that generations will enjoy better health. The timeline of the ‘Healthy Generation’ project concerns the whole year. By the end of this term, a total of 400 children from different schools will have attended interactive educational sessions about one or more of the following themes: Drugs and Tobacco, Food Hygiene, Hand hygiene and Oral hygiene.

We are aiming at dealing with these same children for the whole project in order to check what kind of impact did we have on them throughout our activities and evaluations, such as competitions, informative videos, debates, lectures, drawings, brainstorming, physical games. We believe that such methods are very useful to strengthen children’s conceptions about the healthiest lifestyle in the most reasonable way. Last but not least, we hope that they could keep these exemplary behaviors on the long run! As we already mentioned, NCDs need to be dressed in a strategic plan from the Tunisian Health Ministry. However, such things are not being implemented. This is why we are counting on our collaboration with NGOs and professionals to spread healthy messages around the society, starting from the youngest and vulnerable generation!

Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

72

The Promise of Healthcare for All Since 2004, Mexico became one of the pioneers in health systems working towards the achievement of Universal Health Coverage by presenting ‘Seguro Popular’, an insurance scheme that aims to provide healthcare to all people not affiliated to a social security in the country. Today, it represents the best and most efficient effort made by the government in order to reduce health expenditures in general population. By 2011, over 41 million people were receiving the benefits of this program. However, there are still millions of people that suffer from lack of any insurance or health care. Even more worrying is the fact that most of them are represented by indigenous groups, young and unemployed people. IFMSA-Mexico, through the Standing Committee on Public Health, in order to take part in the fight for an access to a better health, developed ’PROMESA: Proyecto México Saludable’ (translated as Healthy Mexico Project), a big national brigade taking medical students, specialists and other healthcare students with a simple objective: bring first and second level prevention to outcast communities as well as offer them health care services for free (medical, dentistry, psychological and nutritional).

Sergio Menchaca NMO: IFMSA-Mexico Universidad Autónoma de Nuevo León, Mexico sergiomen93@gmail.com

As once said by the observational epidemiologist Yogi Bera: “You can observe a lot just by watching”. Basically those simple reports, as a case of Cholera, help in establishing disease geographical patterns and time clusters that will, in return, help Public Health providers to disseminate this ‘information for action’ in a manner that will effectively and efficiently reach out to the public and have an impact. Actually the lack of such reporting, specially in developing countries, is a threatening remark. Moreover, establishing disease control measures can be simply done through case-control studies. Providing the agent, host and environmental factors associated with the disease can remarkably aid in such measures even without initiating deeper studies in that certain disease. Neglecting of such quick actions can severely affect the processes by which public health providers improve their community. Because it will not only increase the burden of the disease upon that community, but will also affect the community’s economy and productivity. Adding to that, disease outbreak investigations can be considered one of the most beneficial methods of learning about diseases in a certain population. It will, in return, have major effects to the Public Health, as it highlights the main risk factors and groups of a certain disease. However, this is not a common case; especially in developing countries, where money investments in such studies are absent. In conclusion, such a ‘dramatic’ issue bounds to be addressed. If truth is to be told, without establishing vital and health records and constructing epidemiological studies, Public Health would be extremely unsubstantiated.

Beginning in 2011 in Ocotlan, Chiapas (a little community in the south of the country); dozens of medical students came nationwide to offer their knowledge and ability to people living there. Most of the inhabitants were part of an indigenous group and declared to have never visited a hospital or doctor before. Not because they didn’t need it, but because of the big challenge it represented for them: both economically and tiring since in most cases, the closest clinical center to their communities was two to three hours away. By the attendance

www.ifmsa.org


( M S I

73

3 0 )

A Constant Fight with Having a Drink or Two Lukas Galkus NMO: LiMSA-Lithuania Lithuanian University of Health Sciences npo@limsa.lt

12 May 2014 – The date when The Global status report on alcohol and health 2014 was launched in Geneva, during the second meeting of the global network of the WHO national counterparts for implementation of the global strategy to reduce the harmful use of alcohol. It is also the date when the WHO published a shame list – a list of countries that aren’t working enough and therefore consumes the largest amount of alcohol per capita. Unfortunately this year it was my homeland that “won” third place with 15.4 liters of pure alcohol per person (aged 15+) [1] – which is twice higher than the WHO harmful consumption limit. What is worse, is that this doesn’t only mean that we consume a lot, it also means that our citizens are affected by all the consequences of harmful alcohol use: suicides, murders, road accidents, domestic violence, neglected and abused children, disability benefits, crime and corruption burden, etc. Lithuania thrives in a wide range of theories about why Lithuanians drink. However, we must recognize that we aren’t the only ones, in alcohol consumption rates. Along with other countries, it is mainly related to industries created and maintained conditions that guarantee the country easily available, cheap and widely advertised alcohol. So what can we do as medical students? First we must understand that alcohol in general is a problem and it affects us personally, nationally and globally. Almost everyone knows about alcohol harms to the body but what is beyond often is

forgotten. The social cost of alcohol in the EU alone is estimated to be 125 billion euro per year [2]. As the range of the issue is immense we have to realize that only scientifically proven measures can help us fight against the well-prepared, profit-orientated alcohol industry. Lithuanian medical students are exactly such fighters; knowing that only law changes and stricter regulations can reduce alcohol consumption. As the target group, we have chosen Members of Lithuanian Parliament who, by making a decision, can make a significant change. In order to inform them about the best scientifically proven methods also called best buys (affordability, availability and advertisement). We have created and handed them a fact sheet with all the relevant information, suggestions and what they should do. In addition to the fact sheet, a website was launched, where people can support stricter measures for alcohol by sending a support letter directly to the Member of Parliament. This website helped us get around 800 letters directly to mail boxes of the politicians. This campaign gave insights we’ve never seen before, people really crave for change! It is really important to understand that we as the future healthcare professionals can make a difference. We are the voice of youth, and if we work hard - we can make the changes we all dream about. References [1] World Health Organization. “Global status report on alcohol and health 2014.” (2014). Available from: http://www.who. int/substance_abuse/publications/global_alcohol_report/ msb_gsr_2014_1.pdf?ua=1 [Accessed 7th May 2014] [2] Anderson, Peter, and Ben Baumberg. “Alcohol in Europe.” London: Institute of Alcohol Studies 2 (2006): 73-75. Available from: http://leonardo3.dse.univr.it/addiction/documents/External/alcoholineu.pdf [Accessed 7th May 2014]

Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

74

The Treasure in your Fridge «A country starch is another country treasure»; a deep statement that makes us think about the real treasure of the world. Is it oil? Is it coal? , water?, or is it soil? You may be wondering what is the world’s most valuable treasure, but to limit your thoughts you should know that, in 2013, in every 15 minutes 8 people die of obesity, and 225 children die starving. Let’s admit that food is one of the world’s most precious yet abused treasures. The problem of food is divided into different scales first of which is food wastes. In Egypt, 20% of the daily garbage are food remnants and as a developing country, it acts as a source of many diseases like: brucellosis, salmonellosis, tuberculosis, food poisoning, hepatitis, typhoid fever and other acute diseases. Unfortunately, this type of diseases is not limited to Egypt but can be found in almost all the Arab world in addition to South Africa and South America. On the other hand, flies that accumulate on this kind of food cause incurable diseases. However, if the developing countries suffer from extra food, actually the developed countries share in the suffering by another way. All over the world there are more than 530 million obese people compared to 19.230 dead people from hunger just by the end of the current May 30th, 2014. Surprisingly, the US takes the biggest ratio occupying 31% of the obese.

Sohaila Elmehiy NMO: IFMSA-Egypt Tanta University, Egypt sohaila.exc@gmail.com

In addition, the size fast food – the national meal in the U S- has increased 4 times from nineties till now. Thus, it is expected to increase 10 times in 10 years. So if you always enjoy a dedicated meal in a restaurant or at home you should be asking yourselves about your food remnants; where do they go? Launching a campaign about misused food became necessary all over the world. Starting with the developing countries, IFMSA family has the opportunity to launch an awareness campaign about how food can be reutilized for fertilizing soils and feeding the cattle. Fortunately some organizations are already working in this field. Not just this, Egypt EFB (Egyptian Food Bank) in cooperation with Egyptian Hotels association collect the remaining untouched food on trays in big events and restaurants and donate to the nearest needy people. In 2012, the average rate of meals saved and distributed was 15.5 million per month. For the high-income countries, it’s possible to put an end to world’s starvation as 42% of their food uses is lost in garbage annually. Briefly, it’s all about the balance between what we eat, what we throw away and, of course, to whom we give this food. If we realize that our fridges are full of an internationally needed treasure, perhaps we can start consuming it more wisely.

Academy of Health ‘Academy of Health’ is a project created to promote a healthy lifestyle, to improve knowledge in the sphere of health and a healthy lifestyle among youth. Since 2012, medical students from Kazan State Medical University in Tatarstan have been independently delivering lectures on various aspects of health at schools and universities of Kazan. Subsequently, the project was presented at the VII Students’ Congress of the Republic of Tatarstan, the project entered the resolution of the congress and it was signed by the president of Tatarstan. www.ifmsa.org

Ekaterina Ratner NMO: TaMSA-Tatarstan Kazan State Medical University, Russia ekaterina.ratner@kazansmu.com


75

( M S I

3 0 )

The project is implemented with the active collaboration of the concerned departments of the Kazan State Medical University, the Republic Centre of Medical Prevention and some other relevant institutions both at the stage of beginning of the project and the realization. As for now the working group includes not only medical students, but also students from other universities of the Republic. Currently, weekly meetings of the working group of the project are held on the basis of our medical university and we have already organized events at 8 universities of Kazan dedicated to the World Day of Immunity, the World Health Day and so on.

Guidelines of the project: 1. School of lecturers: A course of lectures on the basic aspects of a healthy lifestyle and public speaking skills is given for students, including non-medical ones. These lectures are delivered by professors of the Medical University and founders of the Academy of Health. 2. Organizing interactive lectures on healthy lifestyle, smoking cessation, alcohol and drug abuse, hygiene, nutrition, emergency care in urgent situations and so on. 3. Conducting public debates. 4. Consultations on different aspects of Healthy Life Style. 5. Organizing flash mobs, including events dated for special dates (such as the World Health Day, etc.) 6. Development and distribution of posters at universities and schools of Kazan, spreading leaflets with information about the importance, the rules of healthy lifestyle and about the prevention of the most common non-communicable and infectious diseases. 7. Raising awareness among the youth about conforming a healthy lifestyle. As a separate part of the Health Academy project we are actively developing the idea of the male and female reproductive health, in the context of which we are giving lectures at various universities and dormitories of the city. In 2013, the project won a grant from the Ministry of Youth, Sports and Tourism of the Republic of Tatarstan. The funds were spent on developing the material support of the organization, as well as on delivering training lectures and printing promotional materials.

Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

76

The Rebirth of JAMSA-SCOPH Martin Baxer Jamaica Medical Students Association - Standing Committee on Public Health (JAMSA-SCOPH) started in 2014 by delivering health orientated workshops and outreach programs to the public of Kingston. We worked along with Dr. Havanlee Henry, an orthopedic resident from Yale University funded by The Clinton Foundation, to provide medical examination and screening tests on March 29th 2014, at a mobile clinic in Downtown Kingston. SCOPH’s participation in the ‘Food For The Poor Health Fair’ at St. Joseph’s Hospital in Kingston on April 12th 2014, saw the team conducting free depression screening and advising atrisk persons to seek further medical assistance. Volunteering at the health fair brought to mind the gargantuan task the health sector has in treating each individual equally; explained final year medical student and volunteer Jamila James: ”The lack of resources tremendously impacts the level of care afforded to citizens. However, efforts like those made by SCOPH, is what gives a ray of hope”.

www.ifmsa.org

NMO: JAMSA-Jamaica University of the West Indies, Jamaica mbaxt3r@gmail.com

2014 has seen our membership grow, with a new president and support staff leading a rebirth of SCOPH, positioning our volunteer-lead organization to make even greater strides in the next academic year. “Our general mission is to provide health information and services to the public, particularly those from lower socio-economic backgrounds” said SCOPH President, Kizanne James. From our ‘Marijuana Induced Psychosis’ mental health campaign to our ‘Mind Matters Program’ promoting good mental health for healthcare professionals, our work has been well received. Our main goal for this upcoming academic year is to start a SCOPH Scholarship for students in need of financial assistance. We see health holistically and whole people make a happier and healthier society.


( M S I

3 0 )

Copyright Š Mohammed Yasser - Egypt, All rights reserved.

Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

Copyright Š MSSA-Menofia, Egypt, All rights reserved.

www.ifmsa.org


( M S I

79

3 0 )

Introduction from the SCORP International Team

Monika Szamosová SCORP Director 20132014 scorpd@ifmsa.org

“All human beings are born free and equal in dignity and rights.” This is the powerful beginning of the Universal Declaration of Human Rights proclaimed in 1948 by the then newly-established United Nations. The full realization of human rights requires all human beings to be aware of their and other people´s rights and of the means to ensure their protection. This is the task of the human rights education, which builds knowledge, skills and attitudes prompting behavior that upholds human rights. In the past few months, the Standing Committee on Human Rights and Peace was putting maximum energy into focusing on the broad area of human rights education. It will also be this General Assembly´s SCORP main pillar. At the moment there are many topic areas that we are giving our maximum attention to, for example health as a human right, migrant´s health, mental health, domestic violence, peace culture, responsibility or any other fundamental human right. No matter what we are doing in SCORP, we carry out these actions because we believe that human rights education can make a real difference in people’s lives. We are starting by ourselves. By knowing our rights - simply because – human rights are all we need to wear. Human rights are like armor, they protect you. They are like rules, they tell you how you can behave, and they are like judges, you can appeal to them. They are abstract, like emotions; and like emotions, they belong to everyone and they exist no matter what happens. They are like nature because they can be violated, and like the spirit because they cannot be destroyed. Like time, they treat us all in the same way - rich or poor, old or young, white or black, tall or short. They offer us respect, and they charge us to treat others with respect. Like goodness, truth and justice, we disagree about their definition, but we recognize them on seeing. Human rights claim that they depend on no promises or guarantees by another party. Someone’s right to life is not dependent on someone else’s promise not to kill him or her; their life may be, but their right to life is not. Their right to life is dependent on only one thing: that they are human.

Over the last months, I have been blessed to hear and see all the work that SCORPions all over the globe are carrying out, and I must say that every day I feel all the beauty left in this world thanks to the wonderful work these individuals are doing and the impact they are making in their societies. They are leading by example. When I am with SCORPions, there is no better place to be. I hope that you find the same in the following articles as I have the chance to see it every day. I hope that they will be like the “Qi“ to you – enlightenment, revelation, motion and inspiration; quite like the SCORP spirit of this August Meeting.

Eternally yours,

Monika Szamosová On behalf of the SCORP International Team Moa Herrgard (Liaison Officer to Human Rights and Peace), Matthew Valentino (Europe), Mariem Bouanani (EMR), Ayaka Ishihata (Asia-Pacific), Maxime Leroux-La Pierre (Americas), Meaad El-Sharif (Africa), Fiona Robertson (Development Assistant).

Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

80

Why SCORP?

Why Work in Human Rights and Peace as Future Doctors?

This is a question a lot of medical students ask themselves. Initially, the link between human rights and health can be difficult to understand, but reflecting on it, we realize the relationship is direct. The respect of human rights is essential for good health. For me it’s the basis of why I became a physician and why I got involved with the IFMSA. A fundamental question we have to ask ourselves: Why are we, as medical students, working with human rights? What is the link between human rights and health? The proof of the importance of Social Determinants of Health (SDH) is well established. Education, socio-economic level, housing, working conditions, social inclusion are all factors that influence health and ultimately refer to dignity, respect of integrity and the equality of all people. Article 25 of the Universal Declaration of Human Rights guarantees the right to health and points out the relation between SDH and Human Rights [1]: – “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.” All of these elements, food, clothing, housing, etc. are social determinants of health. Hence, acting on SDH is acting for the respect of Human Rights and consequently, every violation of Human Rights is related to a SDH. Moreover, acting for the respect of Human Rights is ensuring people do not become our patients, because, they would not get sick in the first place. All of these elements, food, clothing, housing, etc. are social determinants of health. Hence, acting on SDH is acting for the respect of Human Rights and consequently, every violation of Human Rights is related to a SDH. Moreover, acting for the respect of Human Rights is ensuring people do not become our patients, because, they would not get sick in the first place.

www.ifmsa.org

Maxime Leroux-La Pierre

SCORP RA for the Americas ra.scorp.pamsa@gmail.com

A great deal of bad health originates from social injustice and the structure of our societies. As pointed out in the report of the Commission on Social Determinants of Health [2]: “Disparities in the world’s health result of a toxic combination of poor social policies and programs, unfair economic arrangements, and bad politics.” But it does not have to be that way. As future doctors and as simple citizens, we can work together to change this toxic combination. Starting from the Regional Meeting in Panama, various trainings have been held on the link between Human Rights and health in the region of the Americas in partnership between the NMOs and the SCORP Team. During IFMSA-Bolivia’s, IFMSA-Brazil’s, IFMSA-Chile’s and IFMSA-Argentina’s National Assemblies, during trainings with IFMSA-Paraguay and IFMSA-Ecuador LORPs’ training, this question has been well explored followed by trainings on Tools in Human Rights Advocacy to move on to concrete work and projects development. As future doctors, we need to take conscience of this direct relation between Human Rights and health that will touch our patients. And we do not have to wait to be physicians to get informed, reflect and act! References [1] The Universal Declaration of Human Rights [Internet]. Geneva: United Nations; cited 2014 June 7]. Available from: http://www.un.org/en/documents/udhr/index.shtml#a25 [2] WHO, Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. [Internet]. Geneva: World Health Organization; 2008 [cited 2014 June 7]. Available from: http://whqlibdoc.who.int/publications/2008/9789241563703_eng. pdf?ua=1


( M S I

81

3 0 )

We Are So Much More Than Color!

Mirella Gomes NMO: IFMSA-Brazil Federal University of Rio Grande do Norte, Brazil norp@ifmsabrazil.org

Discrimination, as the name implies, refers to the act of making a distinction, that is, an unjust and arbitrary differentiation. Racism is a particular case of discrimination in which the individual, because of the color of their skin, are subjected to different treatments that lead to blocked social and economic opportunities, or are the target of segregation [1]. In Brazil, this fact has historical roots that refers to slavery. The abolition of slavery initiated a process of double discrimination in the face of non-existent inclusive policies and the persistence of a belief of an inferior race - which was the ideology that supported slavery [1]. Thus, slavery has bequeathed the nation a population group with very low educational levels, and a racist ideology. Blacks are thus discriminated in Brazil, for their socioeconomic status and the color of their skin. The perpetuation of stereotypes about the role of black people in society often associated with dangerous individuals or criminals, which may increase the likelihood of victimization of these individuals, in addition to perpetuation of certain stigmas. However, racism can be fought within certain limits, by unmasking and delegitimation of the idea of race [2]. It’s necessary to fight for the democratic ideal that regardless of individual performance, all individuals are bearers of inalienable rights of life in society, based on the existence of a society that ensures equal opportunity to all individuals.

Concerned about this scenario and willing to make a difference in fighting against this reality, an online meeting with IFMSA-Brazil’s SCORPions was held in April 2014. During this meeting, we held a debate on the subject and planned a national mobilization on May 13th - National Day of Action against Racism. We decided to conduct an online mobilization in which we’d share pictures and messages concerning the date and racism. For greater impact of the campaign, we decided to use the hashtag #SomosMuitoMaisDoQueCor (in english #WeAreMuchMoreThanColor) in all publications. In addition, some Local Committees held campaigns on the subject. Then SCORPions got together and embraced the cause by publicizing the goals of the campaign, with video recording (see in https:// vimeo.com/95217159), photos and leaflets expressing our dissatisfaction with the unfair reality that African descendants are inserted in Brazil and worldwide. The campaign achieved excellent results. We have achieved a large number of Internet users (about 200.000) in addition to students from over 20 Local Committees participants. By the pictures we shared we realized how miscegenation is present in our country and therefore must increasingly fight against prejudice and discrimination. Our struggle cannot stop. We must defend the #WeAreMuchMoreThanColor daily! Thus, we hope to encourage the dissemination of this issue in all NMOs in order to carry out events, campaigns, projects and even internal discussions on the topic. References [1] Cerqueira DRC, Moura RL. Vidas Perdidase Racismo no Brasil. [Online] Brasília: Instituto de Pesquisa Econômica Aplicada; 2013. Available from: http://www. ipea.gov.br/portal/images/stories/PDFs/nota_tecnica/131119_notatecnicadiest10.pdf [2] Guimarães, ASA. Combating racism: Brazil, South Africa and The United States. Revista Brasileira de Ciências Sociais [Online] 1999; 14(39): 103-115. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-69091999000100006&lng=en&nrm=iso

Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

82

Elderly and Mental Health Moein Karimian NMO: IMSA-Iran Isfahan University of Medical Sciences, Iran moein.karimian@gmail.com The “Elderly and Mental Health� project of the Standing Committee of Human Rights and Peace (SCORP) was held from May 10 - 16th in Esfahan, Iran. This two-phased project was a first in the country centered on the participation of children, elderly people and medical students. Based on statistics, the ratio of elderly people to the general population in the last 50 years in Iran has grown 27.2 times and before 2050, senile citizens will comprise about 23 percent of the population. Right now, around 380.000 elderly citizens are living in Esfahan; this brings along certain problems that have to be addressed by the authorities. As research shows, mental health plays a major role in the health of the elderly since it impacts many aspects of their lives. A healthy mind prevents depression and mental disease and increased quality of life. Maintaining contact with family and friends is the most important factor in preserving mental health in the elderly. We planned to run the project in 2 phases; first phase was to indirectly educate elementary school children about treatment of their grandparents. SCORP members showed up with white coats in four classes (each class had 30 students) and told them about some approaches to caring more about their grandparents. Next, the team designed a game of writing a diary about their grandparent’s childhood and asked them to bring the diaries into the second phase. The reason of selecting children as our target group for indirect education was that they learn easily and transfer what they have learned. Second phase was direct education of grandparents. We provided a face-to-face conversation opportunity regarding mental health, we performed a game between children and their grandparents to increase their interaction. All the children were given a present for the diaries and finally their grandparents were asked to fill an evaluation questionnaire. www.ifmsa.org


( M S I

83

3 0 )

Refugees’ Health Mohamed Shouman Sara Shouman NMO: IFMSA-Egypt AinShams University, Egypt alraees92@yahoo.com

For us, as medical students, we can take a role in improving the health care and help them to regain part of their rights. The first step to take is a massive online campaign by using facts and info on how bad the refugee situation is and how their health rights are neglected. We can take further steps in countries that have camps within their borders by contacting the authorities to provide more care and support to the refugees.

Refugee rights have been neglected over the years. Most of the organizations focus on providing food and shelter for survival and deny any other rights, such as health, education and other human rights. Escaping from wars or natural disaster does not mean abandoning your rights but it does mean that you are looking for a better place which respect these rights. One of the most important rights that have been neglected all over the years is health rights. Most of the refugees are living in camps in which the simple forms of sanitation have been neglected. Here is an example for how bad sanitation situations are in the refugee camps: 30% of refugee camps do not have adequate waste disposal services or latrines. A study conducted in refugee camps in Bangladesh found that camps that provided sanitation facilities had cholera rates of 1.6 cases per 1.000 people, while camps that had no such facilities had cholera rates that were four times greater (4.0 - 4.3 cases per 1.000 people). In addition to providing latrines and sanitation services, it is also important to provide the population with sufficient resources to curb diseases and epidemics. A study in a Kenyan refugee camp found that sharing a latrine with 3 or more households was found to be a significant risk factor for cholera due to an increase in the faecal-oral transmission of the disease. As sanitation is neglected, all other forms of health care is compromised, thus making refugees highly exposed to infections therefore declining their health. Health care declines also stems from a lack of awareness of hygiene. Most of these problems can be easily controlled by helping people to call for part of their rights in good health.

One of the most important and effective steps that can be taken to improve refugee health massively, would be awareness campaigns for the refugees. Aiming to increase refugee awareness about the importance of hygiene and sanitation while protecting them from many communicable diseases that can increase their morbidity and illness. This will help support the refugees psychologically as well as increasing their awareness about hygiene and how to avoid bad habits that can negatively affect their health. These awareness campaigns have proven to be successful when it was held by all the organisations caring for the refugees as the United Nations High Commissioner for Refugees (UNHCR); however, their efforts are never enough due to their limited resources and the progressive increase in the number of the refugees. This increases the responsibility on us towards the refugees to protect their rights and improve their health status. Hoping every refugee takes his full rights and lives in good health.

Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

84

Students Within Borders’ Initiative

“The best way to find yourself is to lose yourself in the service of others.” – Mahatma Gandhi We at MSAI-India believe in the above slogan and every member works for the betterment of the society. Each one of us here are unique in our ways and we try to provide what we can to the future of the nation and the future of India. Minister of State for Planning and Parliamentary Affairs Rajeev Shukla mentioned in 2013 that 27 crore people live below the poverty line in India. Even with the poverty line at a meager Rs. 368/ month (6.2 USD) for rural India and Rs. 560/month (9.4 USD) for urban India; the poor and unprivileged are at such high numbers. With such poor facilities, the majority of the families including children suffer from disease and inadequate availability of basic commodities to live a healthy life. Food, clean drinking water and sanitation is at its poorest. The Students Within Borders (SWB) initiative of MSAI-India aims at reaching out to people who do not have the basic necessities of life. Giving them something that would bring a smile on their faces is what members at MSAI-India aim to do. SWB aims at providing food and basic necessities with free health checkups for these children. We have activities such as orphanage visits, city slum visits, Government school visits, senior homes, etc. As one of the initiatives, Jeff Walter, a medical student in Tamil Nadu runs an organization called ‘You can’t be a celebrity overnight’ where he teaches the underprivileged youth how to stand on their own feet and the importance of education. He also has been doing a lot to inspire young minds to strive to reach out to as many people as possible in the society through service.

www.ifmsa.org

Naren Nallapeta NMO: MSAI-India J J M Medical College, India naren.nallapeta@gmail.com

Priyanka Manghani with her team was able to conduct three events in Mumbai in the past six months which included an orphanage visit, a senior home and a Government school where the team not only did free health checkups but also provided a meal for them. Shrujana and myself along with our team in Davangere have been successful in visiting a blind school, an orphanage in Davangere, and providing a one day meal with a health checkup. We have visited numerous villages as a part of the Diabetic camps “Arivu” (Health at Your Doorstep). In Tamil Nadu we have John who reaches out to slum areas and provides information regarding sanitation measures, healthy food habits, hygiene maintenance and various other health issues. Manish does his bit in Hyderabad by holding various dental camps for the underprivileged. Dr. Sunil Arora and his team in Delhi worked for world population day and also reached out to various government schools in Delhi in the past year. The entire MSAI-India team and its members always try to do what they can to provide to the poor and to try to serve as many people of India as possible.


( M S I

85

3 0 )

How Peaceful is the Blue Planet?

Navid Manouchehri NMO: IMSA-Iran Isfahan University of Medical Sciences, Iran dr.navid.manouchehri@ gmail.com

“That’s one small step for a man, one giant leap for mankind” – Neil Armstrong These words were recorded in history as the skies were first conquered by men. For millennia people looked into the night sky and wondered about this dark silk covering over their heads with shards of glowing diamonds spread across it. The quest to explain this marvel has long eluded the creative mind of mankind. Yet even today, despite all advancements in our knowledge about space, we watch the starry skies with a joyous awe. 400 million people watched the live broadcast as Apolo 11 landed on the moon. At its moment of arrival all the people on earth, perhaps for the first time in the history, were truly one. The experience was such a magnificent one, that the notion of uniting people under one idea kept on living. “Star Peace” project is among these ideas. The “Star Peace” project was a plan to use the unlimited skies above the manmade borders between neighboring countries, showing people that real earth, science and love of mankind is not restricted by these boundaries.

The project mainly used astronomical science and equipment to initiate events and gatherings of people who are not usually involved with astronomy, as well as professional and amateur astronomers to take a step forward in preserving the activity of astronomy groups, increasing the scientific awareness and ultimately encouraging peace and harmony in the participating regions. In the evening of world peace day, on the roof of the UN office in Iran, in support of this movement, we, members of IMSA-Iran, were invited to join a group of space enthusiast friends to share the experiment of exploring the night sky through telescope lenses. We gathered around telescopes and spent the night watching some of the most famous objects in the sky. But From the moon to WEGA, from Supernovas to nebulae, from friendly chats on what we knew from space, to pointing out the familiar constellations across the sky, one thing was for sure: keeping our mind busy that this little green and blue dot in this ocean of wonders is our planet home.

It belongs to all of us. Can’t we just keep it together?

Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

86

Helthcare in Danger The protection of health services (comprising health care personnel, medical vehicles and medical facilities) is vital for universal healthcare. If the delivery of health care is disrupted through direct or threatened violence, access to health care is restricted. Violence against patients and health-care workers is one of the most overloaded humanitarian issues today. WHO Director General Dr. Margaret Chan addressed this topic as something dear to her heart during the 67th World Health Assembly. “Healthcare is under attack now more than ever. We should be clear these are attacks on patients, hospitals, ambulances, violating international human rights law. These attacks have become widespread, which must not be tolerated as the new norm. We need to re-educate the world about the situation that is totally unacceptable. We must remind all parties concerned on their responsibility on what can and needs to be done by the international community. Healthcare personnel must be protected and not let vulnerable to attack”. The solution lies in prioritizing health over political differences. No one, organization or government, can address these issues alone. We need partnership between UN, humanitarian agencies, NGOs and local health authorities. Governments can systematically record violations and work for regain respect to the medical ethics and international humanitarian law in their society, as data collection helps to create a stronger case. We need dialogue, discussion, and clear adherence to the commitments to humanitarian law. Peter Maurer, President of the International Committee of the Red Cross summed up the impact: “Entire populations suffer when

healthcare workers flee and systems disintegrate”.

How does the above relate to IFMSA? For one, we’ll be the future physicians dealing with these issues. But the situation is already affecting medical students around the world, as there are reported attacks on students as well. International society needs to be mobilized in order to jointly address this topic through accountability systems and reporting mechanisms. To create momentum in fighting attacks on health care we need to spread awareness, starting with, yes, and medical students.

www.ifmsa.org

Stijntje Dijk SCOME Director 20132014 scomed@ifmsa.org

Moa Herrgård LO to Human Rights and Peace 2013-2014 lrp@ifmsa.org

Medical students and future health care workers should understand the current situation and actions needed to be taken in order to find a solution. IFMSA will work together with the World Medical Association, International Committee of the Red Cross and the International Council of Nurses to discuss a joint strategy on limiting danger in healthcare. We hope to be able to involve you all into tackling these very severe and pressing issues. We need your voices to be heard for the right to health and the sanctity of health, to be respected by all and at all times. We as medical students can take actions and contribute to a solution to this problem. References [1] ICRC Healthcare in Danger Project: http://www.icrc.org/eng/what-we-do/safeguarding-health-care/solution/2013-04-26-hcid-health-care-in-danger-project.htm [2] Protection of Health Services - IFMSA policy Statement: http://www.ifmsa.org/Media-center/ Policy-Statements/Protection-of-Health-Services [3] IFMSA Blogpost Healthcare under Attack: http://ifmsa.wordpress.com/2014/05/25/wha-67healthcare-under-attack/


( M S I

87

3 0 )

Addressing Mental Health Stigma in the Middle East

Yamen Jabr NMO: IFMSA-Egypt October 6 University, Egypt yamen.jabr@yahoo.com

The stigmatization of mental illness in Middle Eastern cultures is an ongoing presentation of a major barrier, facing individuals with psychiatric disorders. This phenomenon has been frequently associated with a lack of: • Proper awareness campaigns and initiatives; • Education of primary health care providers; • Trained mental health care specialists; • Lack of resources in certain countries. All these factors connect to the stark contrast between the people requiring and receiving treatment in the region. And eventually, ends up with cases that either don’t know where to turn to for help and guidance, or are unaware of their condition in the first place. These factors precipitate into sheer numbers of undiagnosed cases in addition to exacerbated conditions of anxiety, absenteeism and shame. Although several Arab countries (including Kuwait, Egypt, Jordan, Lebanon and the UAE) have integrated mental health care in their national health care plans over the past decade [1] - albeit still minimal in impact to raise the public’s understanding of the situation through prevention and awareness campaigns-, proper guidelines have yet to be established and followed, which would effectively translate into a long-term and sustainable approach for treating affected people. In an interview with Dr. Ziad Kronfol, a psychiatrist at Weill Cornell Medical College in Qatar, he states: “The issue in the Arab world is more to do with stigma and ignorance than it is lack of mental health problems” [2]. Additionally, he points out how data essential in the well characterization, recognition, and treatment of mental illnesses are lacking in developing countries. “Even physicians may not be aware of the magnitude of the problem since these issues are often neglected in their medical school curriculum (...). The undergraduate psychiatry curriculum needs to be updated using modern teaching methods. The curriculum should emphasize both knowledge and skills” [2].

This indicates the importance of how and why curricular changes are to be made at an undergraduate level to prepare primary health care professionals who will be trained to deal with the patients’ mental conditions. The association of social barriers alongside the aforementioned practical ones have also been noted. In a meta-analysis review of mental health services in the middle east, a reported 42 out of 78 (54%) of barriers to treatment and service implementation were due a lack of acceptability within the cultural context [3]. These social barriers include beliefs, values, etiological perceptions and stigma, including its comprising constructs (e.g., attitudes, stereotypes, prejudice, and discrimination). Public stigma occurs when members of the general public endorse stereotypes about mental illness and act on the basis of these stereotypes, resulting in their segregation from the community [4]. Disparities in mental health within any community impact society as a whole. An evidence-based approach is needed to understand what should be changed, how this change can be made, and how to best measure it. Stigma experts emphasize the need for interventions to be local, culturally specific, and carefully targeted [4]. And finally, overcoming ignorance and misguided beliefs about mental health through preventive measures and raising public awareness. References [1] Okasha A. Mental Health services in the Arab world. Eastern Mediterranean Health Journal. 1999 April; 5(2). [2] Nature Publishing Group. Nature Middle East. [Online].; 2012 [cited 2014 June 5. Available from: http://www.natureasia. com/en/nmiddleeast/article/10.1038/nmiddleeast.2012.103 [3] Gearing RE SCMMBKIROHea. Adaptation and translation of mental health interventions in Middle Eastern Arab countries: A systematic review of barriers to and strategies for effective treatment implementation. International Journal of Social Psychiatry. 2012 July; (59: 671). [4] Ayse Ciftci NJPWC. Mental Health Stigma in the Muslim Community. Journal of Muslim Mental Health. 2012; 7(1).

Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

88

Small Actions Matter! Student Action For Refugees Cardiff is the largest student-led refugee charity working to reintegrate refugees and asylum seekers within our community in Cardiff. From the outlook, our vision seems unachievable. But through the efforts of passionate students, every Wednesday, we lead a student-run drop-in for refugees and asylum seekers to come and socialize with people from all over the world who are in the same situation as them as well as university students. In an old church that we fundraise to pay the rent for, we hold English teaching and a conversation club to help refugees and asylum seekers improve their communication, giving them a greater confidence in the community, to apply for job interviews, study, and work and approach their doctors with medical problems. As a group, one of the things locally that we felt incredibly passionate about was that refugees and asylum seekers were classed as international students and therefore expected to pay fees of up to £29.000 a year whereas fees for home students were £3.500. So if an asylum seeker wished to study Medicine, a five-year degree, they would on average have to pay £145.000 in total – money that no asylum seeker, who has fled prosecution in their own country, has.

www.ifmsa.org

Zartash Javaid NMO: Medsin-UK Cardiff University, UK zartashj@gmail.com

Through continued lobbying to the university students’ union, we have managed to successfully pass that asylum seekers and refugees will now be charged home fees and be entitled to a student loan to cover academic and maintenance costs. On a slightly higher level, the second issue that we felt very frustrated about was the UK government’s lack of commitment to give refuge to vulnerable people fleeing the conflict in Syria. We wrote individual letters to our members of parliament, a giant joint letter to the Prime Minister and raised awareness of the issue at our national conference. After months of hard work, in March 2014, the UK government agreed to a refugee resettlement scheme for Syrian refugees following sustained campaigning by many charities in the UK including STAR, and the UK has now welcomed many Syrian refugees. So small actions matter! Small actions, when done by lots of individuals who are passionate to make change happen, can make the impossible possible.


( M S I

3 0 )

Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

www.ifmsa.org


( M S I

91

3 0 )

Introduction from the SCORE International Team

Dr. Sara Cerdas SCORE Director 20132014 scored@ifmsa.org

Dear SCOREans worldwide, It is with great pleasure that I present to you a new edition of the SCOREview. With 66 active NMOs, more than 3.000 research projects to offer, SCORE enables more than 2.500 students worldwide to spend one month abroad enrolling in Research Project. Since the March Meeting 2014 in Tunisia, after the amazing SCORE sessions, our Standing Committee has seen many improvements. Without a doubt one of our main achievements was the endorsement by the World Federation on Medical Education (WFME) of the IFMSA Exchange programs. This is a milestone achieved towards our goal to improve the Academic Quality of our program. And we have new NMOs that successfully started up their Research Exchange program, such as Medsin-UK, IFMSA-Iraq, BeMSA-Belgium and IFMSA-China. Please welcome them into this wide loving dark blue family! In this edition you’ll learn more the charms of Brazil, and how is it like to be on Exchange in Taipei, Turkey, Prague, Berlin and Thailand. And the tutor perspective of being part of our great program. Finally, find out more about the amazing SCOPE/SCORE sessions held in Kuwait, at the EMR Regional Meeting and Poland, at the EuRegMe 2014. We wish you a wonderful time reading the following pages, have a nice travel in the world of Research Exchange. Blue love,

Sara Cerdas

On behalf of the SCORE International Team Ivana di Salvo (Liaison Officer to Research and Medical Associations), Valter Saltorato (Americas), Osman Aldirdiri (Africa), Adelia Rachman (Asia-Pa­ cific), Maysah Almulla (EMR), Luiza Alonzo and Jorge Meneses (Europe), Jouhayna Bentaleb (Ac­ ademic Quality), Hichem Abid (Media, Publications and Marketing), Roland Strasser (Database); Bar­ bara Schaller, Marta Borys, Elyse Peron, Christine Gebhardt, Kwan Park and Nikki Francis (Supervising Board).

Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

92

The IFMSA Exchange Programs Endorsed by WFME

Dr. Sara Cerdas SCORE Director 20132014 The World Federation on Medical Education (WFME) Executive Council last week decided to endorse the IFMSA exchange programs, as made visible as a headline on the WFME website (www.wfme.org). Following the IFMSA concept paper and sessions dedicated to presenting the programs to WFME at the last IFMSA General Assembly in Tunisia, the Executive Council of WFME agreed that the IFMSA exchange programs SCOPE and SCORE are very professionally organized and absolutely worthy of endorsement and of being commended to medical schools and medical faculties worldwide. The Standing Committee on Professional Exchange (SCOPE) has a mission to promote cultural understanding and co-operation amongst medical students and all health professionals, through the facilitation of international student exchanges. SCOPE also aims to have its exchanges accredited by medical faculties across the world and to give all students the opportunity to learn about global health.

www.ifmsa.org

scored@ifmsa.org

The Standing Committee on Research Exchange (SCORE) seeks to offer future physicians an opportunity to experience research work and diversity of countries all over the world. This is achieved by providing a network of locally and internationally active students that globally facilitate access to research exchange projects. Through our programming and opportunities, we aim to develop both culturally sensitive students and skilled researchers intent on shaping the world of science in the upcoming future. The exchange programs for professional and research exchange involve national member organizations of IFMSA in 93 countries worldwide and 990 local student organizations. Every year more than 12.000 students participate making the exchange program one of the largest student-run exchange programs in the world. IFMSA is deeply thankful for this endorsement and we commit to continue improving the quality of our exchange programs.

This is a joint post with Farhan Mari Isa, SCOPE Director.


( M S I

93

3 0 )

The Heat of Brazil Douglas Valdonado NMO: DENEM-Brazil Federal University of Mato Grosso do Sul, Brazil valdonado_715@hotmail. com

Country Profile - Brazil

The largest country in Latin America, Brazil is located between the Equator and the tropic of capricorn. Therefore our culture, weather and biodiversity are vast and change drastically as we go down from north to south. Although Portuguese is the official language, an immense variety of accents can be found and reflect the different colonization each region received and the different indigenous tribes that first populated the country. The tropical weather makes ecotourism and our beautiful beaches the most visited attractions. However, samba music and regional dishes are other things that make our visitors fall in love with the country.

Social Program

Due to our continental dimensions we can offer a huge variety of activities. In the northeast, in cities like São Luis, Recife, Maceió and João Pessoa, students will be able to visit the amazing beaches and dunes. In Brasilia, our capital, planned and designed by the brilliant mind of Oscar Niemyer, the modern architecture will impress you. Cities like Campo Grande and Dourados will offer you the chance to visit the world-famous ecotourism of Pantanal and Bonito city. Rio de Janeiro doesn’t even need a presentation; the home of the Redeeming Christ and the Sugar Loaf speaks for itself. Besides the beautiful sightseeing, we can also offer a lot more cultural experiences, such as watching a soccer games, drinking our very own caipirinha and getting to know our local music, like samba, pagode and sertanejo and our tasteful dishes.

Research Project

Infectious diseases are still one of our biggest challenges concerning public health. So as you will see in our section of the Database, we have many projects involving tuberculosis, Chagas disease and Leishmaniasis, from the development of new treatments to the evaluation of the psychological impact those diseases can cause. We also have projects in basic sciences. One very interesting involves isolating pancreatic islets from animal models (rats) to study the pathophysiology of diabetes. To those more advanced in the medical course, we have clinical projects, such as one that involves studying new treatments for cerebral tumor in children.

Boarding and Lodging

We believe that staying with a local family will give the opportunity to our exchange students to fully experience the Brazilian way of life. So, every student that comes to Brazil will be placed with either a host-family or with a medical student, if he or she happens to live alone. Boarding will be provided by the local committee, sometimes in the Hospital restaurant, sometimes in the university restaurant and sometimes the students will have their meals with their host family.
Come visit Brazil, we will be waiting for you with arms wide open!

Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

94

My Taiwan Experience Emilia Danel

I participated in a Research Exchange in Department of Pediatrics in Chang Gung Memorial Hospital, Taoyuan, Taiwan. The project was titled “Characterization of a lectin from Acinetobacter baumannii in bacterial adhesion” and was supervised by Professor Cheng-Hsun Chiu. I was allowed to do: bacteria cultures, ELISA, Western Blot and PCR. Unfortunately, 2 weeks into my exchange, my tutor informed me that this project would not work out and I should help them with another project related to Salmonella. Experiments were conducted on animal models (mice). I really enjoyed working on this project. I developed skills in animal work and various laboratories techniques. I also attended morning meetings and medical rounds in the Department of Pediatrics.
 My coworkers were really nice and friendly. Most of them spoke English. The atmosphere in the lab was very good. During lunch break we went out together. I discussed with them my plans for weekend and they advised me where I should go. They also taught me useful words in Chinese.

City and Country

Taiwan is a very beautiful, green island located in the east-south of China. The official name of the state is “Republic of China”. The culture is mostly a combination of traditional Chinese and Japanese. I visited many different temples and museums, as well as other cities: Kaohsiung - beautiful city on the south, Taichung - for Chinese Medicine Camp. The weather in Taiwan was very good for me, it was hot and humid. I experienced two typhoons - heavy rains and strong wind. People were very friendly and hospitable.

www.ifmsa.org

NMO: IFMSA-Poland Medical University of Warsaw, Poland emcia08@gmail.com

Preparations, Travel and Arrival

I was in contact with my CPs before arriving in Taiwan. I got all the information I needed. Before I came, they asked me what kind of food I ate or if I could swim, cycling, because they were preparing some surprise for me. After they picked me up from the airport, we went to the restaurant and it was the first time I tried typical Taiwanese cuisine - kidneys, testicles.
 I did not need any visa for the trip, but that depends on where you are coming from.

Stay

I stayed in a hospital dorm on the floor for foreign students/doctors. I shared a room with one girl from Canada. The room was prepared for four people. We shared bathroom with two other girls. The location of the dorm was perfect - you did not need to go outside to get to the hospital. It was also very convenient to get to Taipei, as there was direct shuttle bus from the hospital.
I got pocket money from my CPs . I ate outside of the hospital or in the hospital canteen which had many restaurants. It was a great opportunity to try Taiwanese food, which you could eat only using chopsticks or spoon. Night Markets are also a very popular way to taste national food.
I spent most of the time with other incomings and my CP. We also went out with people from Taipei Medical University. 
Now I am trying to keep in touch with friends I met.


( M S I

95

3 0 )

“Ich bin ein Berliner - I am a Berliner”

Nerea Lopetegui Lia NMO: IFMSA-Spain Complutense University of Madrid, Spain

I visited the open-air museums: the Wall Memorial and the East Side Gallery.
 Berlin is a difficult city to describe in a single word: it is interesting, fun, young, tolerant, poor but sexy, old and new at the same time... You really have to visit it in order to understand what I am talking about.

nlopetegui@gmail.com

OK, I admit: I became co-NORE of IFMSA-Spain even though I had never gone on a SCORE Exchange. After reviewing thousands of documents of others going on a Research Exchange, I always wondered when my turn would arrive. Luckily, I was offered the opportunity to spend the month of March in Berlin, Germany, at the Institute of Biochemistry at Charité CrossOver. There are only a few words that could describe my experience: an outstanding research project, high-tech facilities, and awesome people.

Research Project

The title of the project is “Inositol-C2-PAF: A possible psoriasis inhibiting agent” which was developed in the laboratory. The project aims to prove whether inositol-C2-PAF has a potential benefit in local anti-psoriasis treatment. The first days I felt a bit like a fish out of water, but thanks to my tutor and her team’s dedication, I soon felt comfortable working in the lab. I must admit I have been inspired and realized the importance of basic scientific research and the impact it has on advancing clinical practice

.

Country and City

I am sure you are all thinking: “Who would want to go to Berlin in March? Isn’t it freezing and rainy?” Interestingly, I wore my rain boots once during my stay, although it was quite cold. As a matter of fact, the cold forced me to discover the thousands of vintage, cool-looking, quaint cafés scattered around Berlin. I also found shelter in several interesting museums of the capital, and on sunny days,

Stay

My stay could not have been more pleasant. I had always thought that Germans were very serious and hard-working people, which is true, but once you get to know them, they are also very easy-going and open-minded. 
I stayed in a flat that is located about 20 minutes by train/subway from the Biochemistry Institute. My flatmate was very helpful right from the beginning, as well as my contact person, who picked me up from the airport and showed me around the city. They made a real effort so that I felt at home. Now I understand John F. Kennedy´s quote: “Ich bin ein Berliner”, because I, as well, felt like a real Berliner from day one, riding the bike to the lab, learning lots of facts about German history, and even though I am a vegetarian, I could not resist the bratwurst!

 Thank you bvmd-Germany

Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

96

Meeting of the Elephant? My exchange was at the Biochemistry Department in Faculty of Medicine Siriraj Hospital at Mahidol University in Bangkok, Thailand. My project was entitled: “Study of Iron Metabolism in Thalassemia” and my tutor was Professor Patarabutr Masaratana, MD, PhD. 
 Beta-thalassemia is a disease manifesting by a hemolytic anemia. Thus, patients need frequent transfusions which lead to iron overload. Accumulation of iron results in oxidative stress induction. In the project, we were measuring the activity of glutathione system and superoxide dismutase enzymes - antioxidant in human. 
I was working with two student from SCORE – Anna Maria from Mexico and Arman from Russia. All people in the Department were extremely friendly and sociable. 
At the University, I had to be in full dress uniform.

 I had the chance to participate in many activities, such as visiting the Wat Rakung – Buddhist temple or lunching typical thai food.
 Unfortunately, we had some communication problems with Thais due to very different English accents.

Weather

Thailand is an extremely warm country, but the raining season starts in July.

Culture

Thai people don’t like to be touched. There’s no kissing on the cheek, no shaking hands. To say “hello”, one has to fold hands together, raise them to chest and say “Kap-kun-kaaa”. People also have to take their shoes off in the common rooms in the dorms, in temples or in people’s houses. Sightseeing was absolutely fantastic: temples, ruins of the old city, beautiful islands and elephants!

www.ifmsa.org

Beata Malachowska NMO: IFMSA-Poland Medical University of Lodz, Poland b.e.malachowska@gmail.com

Visa

If you travel by plane and the stay is longer than 30 days, you will need a visa.

My 

contact person, 

Okia, was really helpful and more than kind. She picked me up from the airport with a group of friends. She organized a welcoming dinner for me and we had my last thai meal together.

Stay

My dorm was located in the University complex. I was sharing a well-equipped room with a friend from Poland. In the common rooms was a fridge and electric a kettle. Laundry could be done after paying extra fee or you could go to a public one. 

From IFMSA we got pocket money (3.000 bahts). We had to eat outside the dorm, because there was no kitchen, but a couple of canteens with very good and cheap food exist in the University. 

 There was no planned social program, but my Department, contact person and other exchanges were usually organizing some events. We kept online contact with other IFMSA students in Bangkok so we could meet, travel, shopping or sightseeing together.


( M S I

97

3 0 )

Clinical Characteristics

and Evaluation of Diagnostic Tests for Human Toxoplasmosis

Prof. Jorge Marin University of Quindio, Colombia jegomezmarin@hotmail. com

Hi SCOREans around the world, I’m Jorge Enrique Gomez Marin, MD, MSc, PhD, professor at the University of Quindío and Director of GEPAMOL, a multidisciplinary research group dedicated to the study of: Toxoplasmosis (biological, medical and epidemiological aspects) and Intestinal parasites (Giardiasis and other intestinal protozoa).

 We are currently developing many projects about the clinical characteristics, the evaluation of diagnostic tests and of vaccines candidates for human toxoplasmosis. This project was reviewed and approved by IFMSA SCORE in 2013 and in this year we received our first incomings from Poland and Cataluña.

 The students will work in three places: 1. A primary health center at the University. This health center is an outpatient clinic and you will participate in clinical consultations. The most important

etiologies are ocular, ganglionar, and congenital toxoplasmosis and you will have the opportunity to see many different uncomplicated and complicated clinical forms (4-6 patients) and to work in the differential diagnosis flowchart. 

 2. The second most important place for your practice will be the lab where you will be familiarized with ELISA, immunoagglutination, PCR and western blot assays. 3. Hospital visits will be made only if interesting cases are reported. 

At our lab, you will also interact with biologists and Master students for bioinformatic and gene search of protozoan parasites as pharmacological targets as well in cell culture methodologies. You will also prepare a seminar at the end of your visit when you will resume your experience. You will also participate at our internal seminars (Monday 10 am -12 am) where you will be familiarized with the group and their work. My special invitation is for all the lovers of medical research to come to Colombia and to the University of Quindío to enrich its academic and research training in this family.

Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

98

A Spontaneous Trip My name is Katarzyna and I am a 4th year student at the Medical University of Warsaw, in Poland. I would like to write a short recollection of my great experience in South America.

 I went for my exchange as a substitute for another student who was not able to go. Three weeks prior to the exchange start date, I fortuitously found out that it is still possible to visit a foreign university and take part in a research project. I did not hesitate to make a decision. With the help of the Polish NORE, I was able to leave Poland in two weeks heading for Concepción, Chile.

 Previously, I had never seriously thought of doing laboratory work. My SCORE exchange changed my mind and expanded my knowledge and enriched my ideas for the future. My exchange took place at the Universidad de Concepción at the Facultad de Ciencias Biológicas. My mentor was Professor Luis Aguayo. The project I worked on was on B-amyloide and its influence on Human Embryonic Kidney (HEK) and neuronal cells. This four-week experience helped me gain a better understanding of the pathogenesis and therapeutic targets in Alzheimer’s disease.

 I was warmly welcomed by the Professor and his team. I was the first Polish person they ever met. On the first day, they visited me in my room and asked about my country, its language and whether we have snow during winter.

 A Spanish girl named Lara - another exchange student, and I became part of two different teams and each of us worked on her project. Nevertheless, every person working at the lab helped us and willingly showed us their work.

www.ifmsa.org

Kasia Samelska NMO: IFMSA-Poland Medical University of Warsaw, Poland Kasia.samelska@gmail.com

Every day they invited us to eat lunch together. Lara and I felt as a part of the whole team. 

I lived with Humberto, a Chilean medical student, and his family. It was so great to meet the Chileans, learn their dialect and eat breakfasts and dinners with them. Humberto’s family and Lara’s host family were really helpful and showed us around. 

I went to some parties with the students from Concepción and with the European students. Each one of them was either Spanish or spoke Spanish perfectly – this made me realize that the language barrier exists but I did my best to overcome it!

 In August, Chile is in the dead of winter… but I would rather call it a Polish autumn! I went twice to Santiago, I went skiing once and made a trip to the mountains in the south. The Andes, Pucón city, the national parks are so picturesque! Chile is the longest country in the world: it has deserts, lakes and the mountains. I fell in love with Santiago de Chile. Four weeks was not enough to see all I wanted to see there. My dream is to go back there and see what I did not get to see on my first trip.


( M S I

99

3 0 )

Thank You very much Turkey!

Maciej Szmygin NMO: IFMSA-Poland Medical University of Lublin, Poland mszmygin@gmail.com

In July of 2013, I had the chance to go to the beautiful city of Izmir in Western Turkey. I was advised to do so by my brother, also a medical student, who had done an exchange there.

On the whole, my stay in Izmir was an inspiration. I enjoyed the international flair, the great weather and my work on a fascinating problem in a very kind environment. The place and the people will stay in my memory and heart.

I was hosted by the oldest of Izmir’s eight universities – Ege University. My research exchange project was a part of a study entitled “Quercetin-induced Apoptosis Involves Increased hTERT Enzyme Activity in Leukemic Cells” carried out by Assistant Prof. Dr. Cigir Biray Avci and his colleagues at the Medical Biology Department. The aim of the project was to examine the suppressive effect of quercetin (a plant pigment found in many fruits and vegetables) on leukemic cells. The suspected impact of quercetin is through blocking the telomerase enzyme. Telomerase preserves the DNA in normal as well as in cancerous cells by adding non-coding, repetitive DNA segments after each DNA replication. If not for this enzyme, the DNA strand would become shorter with every replication. Apoptotic effects of quercetin were examined by fluorescence microscopy. I worked about 5 hours a day in the lab with seven co-workers, each day participating in different activities (DNA/RNA isolation, cytotoxicity experiments, PCR techniques). My colleagues spoke good English and were open-minded and very friendly. Izmir, in the West of Turkey, is a 4-million-metropolis with ancient history. Its climate is coastal, the inhabitants say: “Izmir has strong winds and beautiful women”. The Turks that I met there took real pride in being very European in their lifestyle and mentality. The city offers a lot for those seeking entertainment, relaxation as well as cultural and historic thrills (it’s one of the mankind’s oldest discovered settlements). It bears traces of Persian, Hellenic and Ottoman Empires. Traveling to Turkey went very smoothly. As a Polish citizen I had to buy a visa for 15 USD at the Istanbul airport. The social program was very rich and interesting, the hosting students at TURKMSIC showed a lot of dedication. Anyone thinking of spending some time in Turkey should take sporting clothes, a headdress and comfortable shoes. During my exchange in Izmir I stayed in the Ege University Dormitory in a part of the city called Bornova. It was comfortable with a convenient location. I also was lucky to have a whole room just for myself. Our international group of over 20 students received meal coupons for students’ canteen. The prices of food and the products of daily use were comparable to Poland.

Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

100

Magic Time in Prague with SCORE!

Research Project

Last year I participated in a research project titled “Mechanical Circulatory support systems in cardiac surgery and their application in bridging patients to transplantation” in Prague, Czech Republic. It was held by Professor Jan Pirk MD, DrSc at the Institute for Clinical and Experimental Medicine (IKEM). Everyday my three new friends and I could see a few heart surgeries. The purpose was to learn about and get hands on experience with mechanical circulatory support (MCS) system . We also had the option to see operations like heart bypass valves replacement. Most interestingly, we got to see a heart transplant surgery!

City and Country

The culture in Prague is very interesting. You can spend hours going around the same places, it’s so magical! The city is full of beautiful monuments and attractions, so every evening you can do something different: from water biking to picnics in Riegrovy Sady, travel to other cities! If you really don’t like to have a guidebook and map - no problem. Everyday you can join free walking tours with young guides telling interesting stories. And my best memories are connected with sunrises on the Charles Bridge. Preparations, Travel and Arrival My contact person tirelessly helped me with everything I needed. She picked me and my big luggage from the train station. As I was coming from Poland, travel by train was the best option.

Stay

• Lodging We were living in a dormitory - 4 people in one flat, with 2 people/ room, sharing the kitchen and bathroom. One desk for everyone, a lot of place for clothes. The people were the best I could have ever met! • Boarding We got pocket money and often were cooking to taste meals from all over the world - as everyone wanted to present his own country cuisine. We had many picnics as well, as Prague is full of beautiful gardens where you can lay and breathe fresh air. • Social Program So many things to say. We visited Prague, Cesky Krumlov and other countries as well. And the most important we are still in touch and will meet again all this year. www.ifmsa.org

Ola Kolarczyk NMO: IFMSA-Poland University of Silesia in Katowice, Poland olakolarczyk@yahoo.pl


( M S I

101

3 0 )

EMR10 Regional Meeting in Kuwait

Maysah Al-Mulla SCORE RA for EMR ra.score.emr@gmail.com

A huge success would be an understatement to describe the SCORE sessions in our Regional Meeting last January in Kuwait. The level of enthusiasm and dedication from our EMR members was just beyond incredible. It was my first time to actually run the SCORE sessions in an EMR meeting, and it was a wonderful experience. Having the sessions combined with the SCOPE committee was delightful. Further, the collaboration with SCOPE and the amount of work my fellow SCOPE RA (Anthony) put in just made the five days fly by so quickly. We had an amazing contribution from our one and only Omar to talk about the new database and answer any questions. We also had a joint session with SCOME which was very beneficial and entertaining.

The small working groups (SWGs) included highly important topics such as academic quality and NMOs problems. The main aim behind the SWGs wasn’t just to teach the members new things, but also to break the ice between them and help them think analytically regarding different items which they can apply later within their NMOs. The projects fair was incredible, and although we had few SCORE projects, the versatility of ideas throughout the fair was magnificent. And who can have an IFMSA meeting without some fun activities? A SCORE and SCOPE dance session was carried out on the last day as final reward for all the hard work and effort the members have put into the sessions, by being there and voicing out their opinions.

Medical Students Worldwide | Taiwan AM 2014


A u g u s t

2 0 1 4

102

European Regional Meeting 2014

Jorge Meneses Luiza Alonso SCORE Co-RAs for Europe ra.score.europe@gmail.com

The European Regional Meeting was held in Warsaw, Poland from April 30th to May 4th 2014. The sessions were joint with SCOPE and we had workshops, ideas cafĂŠ for brainstorming, Small Working Groups and trainings on subjects, such as academic quality, communication, database and handover between officers, all of which are important for exchange programs. We divided the sessions into beginner and advanced-level courses due to the varied knowledge levels among the participants. We received great input in all sessions and it was really interesting to hear what everyone had to say. It was a really productive meeting with around 40 participants!

www.ifmsa.org


( M S I

3 0 )

medical students worldwide | AM 2014 Taiwan


A u g u s t

2 0 1 4

www.ifmsa.org


( M S I

105

3 0 )

Introduction from the

SCOPE International Team

Farhan Mari Isa

SCOPE Director 20132014 scoped@ifmsa.org

Dear SCOPEan family all around the world,

It is with great pleasure that I present to you the PeriSCOPE publication for the 30th MSI. I want to personally thank the motivated writers, the amazing SCOPE editorial team, especially Tade Adesoji, and the publications division of the IFMSA. When IFMSA was founded in 1951 in Copenhagen, Denmark, SCOPE is the first standing committee that was built by the founders. It had the aim to reach the international level and to work with people all around the world. Since then, SCOPE has kept growing bigger just as IFMSA has. With over 9,000 medical students all over the world participating in it per year by exchanging their university, city, and country to get a broader perspective on the differences in medical healthcare, SCOPE in many countries represents the largest medical students exchange program. Nowadays, SCOPE has a broader purpose and more goals to achieve. The main purpose is to promote the cultural understanding and cooperation among medical students and other health professionals through the international exchanges. Amazingly, it is organized entirely by medical students with the help of their medical faculties to provide wonderful experiences to any students who are involved in the program, ultimately making them more sensitive to the differences in healthcare across the globe. Another goal is to emphasize the work of SCOPE officers all around the world to get the recognition from their universities. Good news that happened a while ago is that SCOPE, along with SCORE exchange program, was recognized by the World Federation for Medical Education (WFME), which increases our motivation to work more on the recognition on the exchanges.

I’m also happy to deliver the news that more countries have joined and will join SCOPE these past years. Among them, we have United Arab Emirates and Dominican Republic. At this moment in which I’m writing this message, we’re working on Albania, Guatemala, Nigeria, and Ukraine to join SCOPE, which will make around 98 countries involved in IFMSA SCOPE exchange program. Through this publication, I hope you will gain some knowledge how the students and people that are involved with SCOPE share their amazing experiences; experiences that will open your eyes about the exchange world within SCOPE and IFMSA. Last but not least, I want to express my gratitude to the SCOPE International Team this year; the Regional Assistants (Rizki, Nikos, Jack, Lartey and Whitney) and the Support Divisions (Mladen, Safa, Joel, Kamila, Soji) that worked together tirelessly day and night to make all the achievements we have in SCOPE right now happen. I couldn’t ask for a better team. I wish you all a very pleasant and interesting reading.

Farhan Mari Isa On behalf of the SCOPE International Team Ivana di Salvo (Liaison Officer to Research and Medical Associations), Whitney Cordoba (Americas), Kwabena Lartey (Africa), Rizki Meizikri (Asia-Pacific), Anthony Ballan (EMR), Nikos Kintrilis and Giacomo Cinelli (Europe), Mladen Jovanovic (Academic Quality), Germán Emanuel (Marketing and Publications), Ahmed Salih Ali (Information and Technologies), Safa Halouani (Research and Development).

medical students worldwide | AM 2014 Taiwan


A u g u s t

2 0 1 4

106

Dear SCOPEans,

It is with great pleasure that I present you the SCOPE section of the MSI. SCOPE has made medical students partake from the emerging global village, where medical practice goes beyond the borders of ones’ country. Professional Exchange has also given us an opportunity to learn and have a good vacation, both at the same time.

Tade Adesoji

NMO: NiMSA-Nigeria periSCOPE Editor-in-Chief

This edition would take you through different continents of the world as our members explore medicine sojitade@gmail.com in a different style. It also showcased SCOPE projects and SRT. I appreciate the authors who took time to take us into the world of SCOPE through words and pictures. I would also like to thank the IFMSA publications team. I hope that you enjoy reading as much as we have enjoyed putting it together.

Tade Adesoji

Jamaica:

Welcome to Paradise in the Caribbean

When Queen Isabella of Spain asked Christopher Columbus to describe the island of Jamaica, this famed explorer struggled to find words to justify its’ beauty. (The Jamaica Gleaner Special Series, March 2003) Jamaica is an island rich in history, culture and beauty. First populated by Arawak Indians, the word Jamaica is from the Arawak word “Xaymaca” which means “Land of Wood and Water”. The capital, Kingston, is the largest English-speaking city in the West Indies. More than 10.990 square kilometers, Jamaica can be easily traveled. The sites and experiences there will keep you wanting for more. Besides the warmth of the island and the charm of our people, Jamaica is a desired location for both studying and living.

Kevouy Reid

NMO: JAMSA-Jamaica University of the West Indies, Jamaica kevouyreid18@hotmail.com

Nestled in a valley surrounded by Long Mountain on the south and the infamous Blue Mountains on North, is the University of the West Indies (UWI), Mona Campus. Mona is the flagship campus of the UWI, which has campuses in Trinidad and Barbados. The Faculty of the Medical Sciences (FMS) at the Mona campus is also the first faculty of the UWI carrying the mantle of first class education and research. This creates a unique environment for many Caribbean students to study.

Tropical Medicine Research Institute (TMRI), and the new Basic Medical Sciences Teaching and Research Complex. The new complex consists of 5 lecture theatres, 25 tutorial rooms, 45 small research laboratories and 12 large research laboratories. All labs are stocked with the latest medical equipment and the lecture theatres are equipped with multimedia technology. The three-storey library contains the latest in medical literature with a computerized records system for ease of location. The library has a computer lab which is opened 22 hours a day and the HD Hopwood Education Centre which makes use of technology as a teaching support tool. Adjacent to the FMS, the University Hospital of West Indies (UHWI) is the clinical training site for health professionals. UHWI is a Type A hospital with over 570 beds, covering specialties such as Orthopaedics, Otolaryngology, Dermatology, and others.

The medical faculty has produced internationally recognized research on Sickle Cell Anaemia and Human T-cell Lymphoma Virus. Professor Manley West developed the drug, Canasol, from the Cannabis plant (marijuana) which is now used to treat glaucoma. Notable research facilities associated with the university include the Sickle Cell Unit, the

In addition to the many places to work, Jamaica offers many social hotspots especially in the Kingston and St. Andrew corporate area, where visitors can easily soak up the infectious Caribbean culture. Devon House is a particular favourite, where unique ice-cream flavours and sweet treats keep visitors coming back for more. If you have enough time, you can tour the island and see for yourself why Jamaica is one of the most desired places to vacation. Make Jamaica your next destination and like Columbus you too will be speechless.

www.ifmsa.org


( M S I

107

3 0 )

The Polish Experience Nikos Kintrilis

NMO: HelMSIC-Greece SCOPE RA for Europe 20132014 ra.scope.europe@gmail.com

Regional Assistants came up with two levels of workshops – designed for newcomers and advanced participants- in order to meet the level of experience and needs of each and every one. From the simplest – setting up exchanges - to the most complicated – mission and vision of SCOPE and SCORE - , all workshops and small working groups helped us all develop and nurture ideas and skills to embark with even more excitement on our Exchanges journey.

What did we know about Poland before going there? Well, we knew Fryderyk Chopin was Polish, Marie Curie was also Polish (but wait, wasn’t she French?), and they have one of the most amazing vodkas in the world. We were in for a nice surprise as IFMSA was holding its’ 11th European Regional Meeting in Warsaw, just away from the Baltic Sea on May 1st- 4th 2014. Dedicated to the training and team building of its members, the European Region brought together a series of Standing Committees sessions, Training sessions, Program Presentations, European Region Plenary and an interesting, up-to-date Theme Event focusing on the 2014 being declared as Year of the Brain in Europe. Hold on, am I forgetting something? Ah, right, thanks for reminding me; the social program. Four unforgettable nights gave us the opportunity to meet and cherish the Polish culture and make bonds with each other-bonds that will last. Furthermore, the three parallel joint sessions conducted gave us the opportunity to share some intercultural love and hear new ground-breaking ideas from our fellow Standing Committees. Who can be better at Peer Ed than SCORAngels? Who can help us with higher standards for Intercultural Learning if not the SCORPions? And who can offer a hand of help in achieving Recognition other than SCOMEdians?

As for the Exchanges sessions, SCOPE and SCORE joined forces for one more year and more than some time will be needed for those memories to fade out. Shall it be the morning dance routines, the well-organized sessions, the educational and inspiring trainings or the Exchange Fair that caught your attention, the event will definitely go down as a success as it has achieved its goal in providing the SCOPEans and SCOREans with the skills and capacities that they will find useful during the entire IFMSA journey. Well, waking up might have been a little difficult (although that breakfast really paid off, huh?) and the weather might not have been the best but the spirit of the Exchanges participants was alive and kicking every morning! The Exchanges

No matter how good the academic parts of the sessions were, a meeting can never be complete without Team Building and the amusement that comes out of it. The social character of the IFMSA meetings is long appreciated and the moments of this EuRegMe XI will long be cherished in our hearts. Singing by the piano, lots of dancing, never-ending hugs, kisses, and random encounters during the social program are a few only of the memories that will go down in the diary we all keep in our hearts. Only our best experience so far. Until the next one..

medical students worldwide | AM 2014 Taiwan


A u g u s t

2 0 1 4

108

Global Surgery:

A True Exchange of Ideas

Access to basic surgery procedures is currently a significant challenge to public health for diverse populations. It is estimated that currently 1 in every 25 people is subjected to a surgical procedure and 11% of the global disease burden is due to injuries that require surgery for correction. However, 2 billion people live without access to surgery and many still do not know the impact that basic surgical procedures could cause in society. Imagining that surgery is a global challenge to be included on the post-2015 health agenda is difficult for all those who believe that preventive medicine is done only with procedures of low complexity and cost. We must undo the prejudice that surgical procedures can only be performed by surgeons and they necessarily involve high costs to the health systems. In fact, many surgical procedures require only a basic infrastructure available in many countries and its impact can be as cost-effective as immunization for measles. Cataract surgery, which can cost as little as $35, could result in correcting a problem of about 20 million blind children and adults, who continue to be blind unless they can undergo a simple correction procedure for their vision improvement. What can we do, as medical students, to promote this so important theme to overall health? The first step is to disseminate it within our own country. Thinking about it, at the national meeting of local committees of IFMSA Brazil held in Marília, São Paulo, in April 2014, a joint session between SCOPE and SCOPH proposed to unit two committees to expose the importance of global surgery and the need to discuss this topic within our NMOs. One possible idea that emerged from that union of committees – one that works directly with public health, and the other that enables medical students to be the best and most comprehensive professional

www.ifmsa.org

Daniel Fernandes

NMO: IFMSA-Brazil Federal University of Rio Grande do Norte, Brazil npo@ifmsabrazil.org

through medical internships – is creating exchanges approaching the global surgery. How about we create internships that can empower medical students in simple surgical procedures? Or even accomplish projects involving medical education and public health through the development of strategies for training of medical students for these procedures? The global surgery demonstrates that it is possible to join various IFMSA committees towards a common goal. This is a topic that deserves to be discussed not only within the SCOPH sessions, but must cross barriers and borders, invading the remotest territories inside and outside our institution. Therefore, the orange spirit of SCOPH must be present in all of us, as well as the oceanic expanse of the blue SCOPE should be part of our vision as exceptional medical students. Joining ideals, we can make the world a place where health is an omnipresent color in all societies.


( M S I

109

3 0 )

From Tehran to Göteborg Zahra Zeinali

NMO: IMSA-Iran Iran University of Medical Sciences, Tehran zr.zeinali@gmail.com

I am Zahra Zeinali, a 6th year medical student from Tehran, Iran. Last year, I decided to go on a professional exchange and experience a different clinical environment. Luckily, I ended up spending July 2013 in the beautiful city Göteborg, Sweden. Sweden’s NEO and LEOs were friendly and helpful from the moment I got my acceptance card. Besides helping me with my visa process and changing the department, the LEOs of Göteborg had made a Facebook group for all the exchange students of that July to get to know each other and ask common questions before their arrival; which was a brilliant idea as they also added a lot of the Swedish students who were available that summer to the group to help us with urgent questions that ranged from weather questions and finding our way in the city to where to hang out after the hospital or who’s free to grab a bite! As soon as I arrived at Göteborg’s train station, my contact person was there to pick me up and take me to my dorm. He handed me the keys, a bus pass valid for a whole month and a city map. I was welcomed to my room with a nice letter from the former resident, mentioning tips and tricks like good museums to visit or how to book the laundry room. I was placed at the emergency room of the Sahlgrenska hospital, which is the main hospital of Göteborg. I was assigned to a nice young ER doctor who took the time to explain everything to me and translate the patient histories she took in Swedish (many patients were fluent and willing to speak in English), and also asking the patients to let me examine them as well. The ER experience at Sahlgrenska was sure different from back home, yet very educational. I got to know the

efficient Swedish healthcare system that is based on primary healthcare doctors who refer the patients to the specialists and hospitals, lowering the overall costs. As far as I understood healthcare is free for the patients in Sweden. Another interesting point for me was how all the patient information, lab data, history, and other information was stored in online files, making it convenient for the ER doctor to check the patient’s last visits, last lab data, or usual complaints when visiting their primary healthcare doctor. We were given lunch and fresh scrubs at the hospital as part of the exchange package. The hospital itself was huge and very beautiful, as well as having friendly staff who took the time to get to know us. The LEOs also arranged a lot of different fun social programs on any free time we had and many Swedish students joined us every time. They took us to picnics, seaside, amusement park, summer houses and much more, which was all free of cost and a lot of fun! Last but not least, what made this month so memorable are the other 11 exchange students that quickly became a lovely family. Sweden really impressed me and made me fall in love with its beautiful nature and nice people. Make sure to pick Göteborg as your next exchange destination!

medical students worldwide | AM 2014 Taiwan


A u g u s t

2 0 1 4

110

Psychiatry in Casablanca “The real voyage of discovery consists not in seeking new landscapes, but in having new eyes” - Marcel

Proust. If you ever have a chance to visit Morocco, be sure that you’ll feel renovating not just your eyes, but of other four sense also. Still there in my thoughts and dreams, I cannot imagine a better place to visit for admirers of modest eastern beauty, authenticity, and hospitality. My name is Evghenia Chibikova. I’m a 22 years old Russian medical student and I had the chance to spend one month in Morocco, last July 2013. Frankly speaking, I still have no idea what predetermined my choice: intuition, divine intent. or something else; somehow or other, on the 1st of July 2013, I opened a door of the hospital “CHU Ibn Rochd Casablanca” and started feeling my mind to change. Among white one-storied buildings, buried in verdure and flowers, there was one with its special aura - a department of psychiatry. Contrary to stereotypes, there was no oppressive bars, no ropes for fixation; thus, there was nothing that could make patients suffer more than outside.

Evghenia Chibikova NMO: HCCM-Russian Federation

Samara State Medical University, Russia jesuiscocquelicot@gmail.com

A despair wasn’t waiting around the corner: professional doctors, polite personnel, and cleanness just seemed to make the inherent storm calm. To my delight, I was allowed to talk to all the patients, work with their case histories, assist to doctor on duty, participate in supervisions in art-therapy atelier under tactful observation of Dr. Bouchra Benyezza, and even assist on ECT seances. When I was leaving my department in the afternoon, the most unforgettable adventures were waiting for me outside. The ancient elegancy of Casablanca with it’s gorgeous french accent , the pattern of its mosques, the charm of its narrow white streets, and a soft wind right from the Atlantic ocean - all this formed one huge reason to love this city. Sunny Casablanca was gladdening me on the weekdays. On the weekends, I was finding new impressions in Rabat, Marrakech, Fes, Chefchaouen... Morocco is a perfectionist’s Eden: every city is “dressed” in its own color. When you look at this, you feel like absolute beauty is filling you and you never want to leave. After touching the old walls of medinas, palaces, and churches you realize that the memory they keep and the beauty that they’re covered with are stronger than time. On the other hand, virgin moroccan nature reminds you that you’re part of it. When you find yourself sitting on the terrace of small cozy hotel, eating tasty food, drinking magic moroccan tea, and having an endless pleasant conversation with your new hospitable friends, you’re ready to confess that your own conception of history and geography is ready to change. One more thing that should be appreciated is the tolerance that all Moroccans have. This little country has so many groups of population and they all live in peace and their guests can see it too. That is where you feel like a real citizen of the world, that is the country you should definitely choose as a destination for your upcoming professional exchange.

www.ifmsa.org


( M S I

111

3 0 )

SRT in Istanbul:

Exchange We Need!

Alzbeta Tylova

NMO: IFMSA-Czech Republic Charles University in Prague, Czech Republic alzbeta.tylova@seznam.cz

The Sub-Regional Training on Exchanges took place in Istanbul, Sile from 26th to 29th April 2014. Over 50 participants from 14 countries took part in making this experience truly unforgettable. Five trainers from five countries lead trainings on teambuilding, intercultural learning, avoiding burnout with time management, leadership and motivation, and handover. During these trainings the participants had an opportunity to improve in soft skills, work on their weaknesses and bring home useful tips for real life as well as for the IFMSA work. Moreover, there were four small working groups focused on academic quality, national social program, promotion techniques and cooperation with other youth groups. This was a chance for us to share a wide range of problems we all face in different areas and talk it through with other people trying to find the best solution. It was a great opportunity for both new and old LEOs, LOREs and all the people interested in exchanges to share knowledge and experience to help improve exchanges in their NMOs. For me, as a newbie in the SCOPE world, it was the most amazing time. It was my first international IFMSA event and I couldn’t have wished for a better start. I came home motivated and inspired in so many levels and immediately started

o think what can we do differently and/or better. What I loved about it the most is that even though there were people from so many different countries in the end we had so much in common. It was really just a bunch of great people with shared interest, ready to work during the days and party during the nights. I think we really fulfilled the international aspect of IFMSA, making friends all around the world. I want to use this opportunity to say a huge thank you to the TurkMSIC-Turkey OC team. They worked hard for months to ensure everything goes smoothly and it did. Including airport pickups, social program changes because of bad weather and even a broken leg. There was always somebody asking if we have everything we might need. I am sure they will be just as great hosts for the next March Meeting 2015 which will take place in Antalya. During the last day some of the participants attended the optional Istanbul tour. Firstly, they had a boat tour alongside Bosphorus. Then they went to see Hagia Sophia, Basilica Cistern and Blue Mosque. The tour finished in Grand Bazaar. And since one day is not nearly enough to explore this beautiful city, my guess is that many of us will return to see more of it. I came home with memories I will cherish and many new friends I hope to see again as soon as possible. To anybody out there thinking about attending an international IFMSA event - don’t be scared and use the chance, you will certainly not regret it!

medical students worldwide | AM 2014 Taiwan


A u g u s t

2 0 1 4

112

EXPEDITION:

Exchange Promotion and Poster Design Competition

EXPEDITION is one of the flagship projects in my local committee, Brawijaya University, Indonesia. As we can see from its name, EXPEDITION aims to promote exchange programs (either Professional or Research) of IFMSA to the students and also to increase their interests toward exchange by organizing a poster design competition. Why so? In poster design competition, participants were competing to make a poster on “Why you have to choose this country as exchange destination”. Then, how do we promote exchange programs to the students? By making an exchange expo! Held from May 24 - 26th 2014, this exchange expo contained all information relating to exchange as well as displayed the results of the poster design competition, in which the two winners were chosen by voting. Themed superhero, the committee decorated the expo with superhero characters such as Superman, Spiderman, and Iron Man. They also added photo booth outside the expo and action figures in some spots. In the expo, the committee had set up a plot so visitors who come didn’t feel confused and lost. It started with registration, visitors got one questionnaire, one superhero sticker (to vote on the poster), and one mini flag to write comments and suggestions regarding the event. The first destination was ‘vote for the best poster ‘ in which the committee had been put the posters and visitors were asked to put the sticker below their favorite poster. After that, they were directed to the exchange flowchart. Uniquely, the committee had made the chart into a comic, where Gatotkaca (Indonesia’s original superhero) applies to go exchange to USA! Complete with the information

www.ifmsa.org

Sefrina Trisadi

NMO: CIMSA-Indonesia Brawijaya University, Indonesia sefrinatrisadi26@gmail.com

and some examples of the documents needed like Exchange Condition, Application Form, Card of Acceptance, etc. This comic got a lot of appreciation from the visitors. Third stop was the ‘world map’, where visitors could stick the notes that had been prepared to the country they want to visit someday. They wrote down their hope and the reason why they choose that country. The journey ended in exchange corner, which was an exchange consultation desk. The highlight of this event was on the last day of the expo since there was churros party! So anyone who came on that day could enjoy free churros. Besides, the winners of the poster design competition were announced as well. They received money and merchandise as the prizes. Overall, this project is well done. Approximately 274 people who came agree that the event was very useful and they hope that this project will be held again next year. Some also felt that with this project, their interests to apply for exchange were increased. It can be proved from the number of exchange applicants who had reached the target and increased from the last year. Moreover, EXPEDITION had been selected as the Best Project Fair in SCOPE CIMSA Weekend Exchange Training 2014. Hopefully this project can be beneficial and inspires beloved SCOPEans out there!


( M S I

113

3 0 )

In the Heart of Europe: From Spain to Austria

Sara Correia

NMO: IFMSA-Spain University of Santiago de Compostela, Spain saraeacorreia@gmail.com

In the summer of 2013, I had the time of my life. In only one month, I was able to discover central Europe, meet the most amazing friends and experience a cool and useful clinical clerkship! My exchange was in Vienna, Austria. I was really excited to go there and it would be my first trip alone! I have to admit that I was a bit worried about the language barrier but everyone speaks fluent English there, so that was never an issue. In the first day of the clerkship, I was mesmerized with the size of AKH (Allgemeines Krankenhaus), the hospital. Later, it came to my knowledge that it is one of the biggest hospitals in Europe! It is also very practical; right at the entrance, you could find a supermarket, a bank, a post office, and it even has its own Starbucks! I was placed in the Anesthesiology department.

All the exchange students stayed in a modern dorm in single rooms with a shared bathroom. The dorm was very cozy and had a kitchen in every floor. The social program was very organized: every week, we had at least two different activities planned. Since Austria is located in the heart of Europe, every weekend we organized a trip to a different country or city in Austria… we visited Salzburg, Innsbruck, Germany, Slovenia, Czech Republic, and Hungary. Besides Vienna is such a beautiful city and with so much to discover that, I believe that one month there was not enough to see everything there is to see! All the things mentioned above would not be the same without the amazing group of people with whom I shared this experience with. Together we created unforgettable memories and bonds that are still tight today even though so much time has passed since the exchange. I highly recommend everyone to go on an exchange! It’s a life changing opportunity you don’t want to miss!

During my exchange, I came to realize that there is a big difference between Spanish and Austrian medical education: while in Spain hospital practices are mainly theoretical and observational, in Austria, students are expected to actively participate since the beginning of their medical career. With this being said, at first I was quite surprised how independent Austrian medical students were compared to me, but on the other hand, at the end of my clerkship ,I was as good as most of them. My tutor was a really good teacher, had a great sense of humor and lots of patience. I spent all of my time in the OR where I was allowed (with his supervision) to ventilate and intubate patients, put i.v lines, draw blood… Plus, I watched many different kinds of surgeries and most of the surgeons explained me the procedures while they were operating. Overall, I think it was a very complete clerkship and I feel I couldn’t ask for more.

medical students worldwide | AM 2014 Taiwan


A u g u s t

2 0 1 4

114

Get Prepared for Your Exchange:

Pre-Departure Training in Vienna

After completing a lot of work in Pre-Departure Training (PDT) at the March Meeting 2014 in Tunisia, we, SCOPE of AMSA Austria, decided to conduct a PDT for our outgoings in Vienna in cooperation with SCORE in June 2014. We organised a one-day workshop to inform and prepare our students for their exchange experience in the best possible way. At our PDT, we focused on 4 main topics: 1. Information: In an one hour presentation we explained to our outgoings what they will have to do before, during, and after their exchange. 2. Basic Life Support Training in English: As the time for practicing BLS is usually quite short at our med school, we did an extra workshop on BLS with our students. Additionally, the tutors provided them with the proper English vocabulary they will need in a case of an emergency. 3. Medical Languages: Workshops were held in four different languages (English, Spanish, French and Portuguese) to provide our outgoings with medical terminology in the language they will speak during their exchange. 4. Ethical and Cultural Differences: In an one hour session we tried to explain the main differences between Austria and the host region of our outgoings! Sessions were held for 6 different regions – Asia, America, Africa, Western Europe, Eastern Europe and EMR. The PDT took place in the Medical University of Vienna and in total we had 60 students attending the PDT. We provided food and drinks for them in the breaks between our workshops and at the end of the day the most famous professor for tropical medicine of the Medical University of Vienna gave a very humorous lecture about tropical diseases and their prevention.

www.ifmsa.org

Philipp Foessleitner

NMO: AMSA-Austria Medical University of Vienna, Austria philipp.foessleitner@amsa.at

The feedback we received was mainly extremely positive! The outgoings especially highlighted the medical language workshops and the session about ethical and cultural differences and we got the feeling that your outgoings are a lot better prepared for their exchange this year then the outgoings had been in the previous years without PDT – a huge benefit for them to make the most out of their exchange experience! So after having conducted and evaluated the PDT in Vienna, we can only recommend all NMOs to organize a Pre-Departure Training for their outgoings. Our outgoings are well prepared for their exchange now and we learned a lot on how to organize such events and how to hold such workshops – so everyone benefited from the PDT! And we are already looking forward to organize a PDT in Vienna again next year!


( M S I

3 0 )

Copyright Š Mohammed Yasser - Egypt, All rights reserved.

medical students worldwide | AM 2014 Taiwan


A u g u s t

2 0 1 4

Copyright Š MSSA-Menofia, Egypt, All rights reserved.

www.ifmsa.org


( M S I

117

3 0 )

Introduction from the

SCOME International Team

Stijntje Dijk

SCOME Director 20132014 scomed@ifmsa.org

Dear readers, It’s feels impossible that it has almost been a year already! But we’re here and incredibly excited for another General Assembly. In light of part of the theme, sustainability, what would be a better subject than talking about education! Creating awareness among the population - yes, that would definitely add in to the fight against climate change and its consequences, organizing a project for medical students to make them aware of health consequences-also. But actually implementing changes in the (medical) curriculum - now that’s sustainability and impact for the years to come! This is where SCOME comes around the corner. We work towards making a long lasting impact by raising future physicians with a broad view on health, who are able to take into account Global Health (global health education), who are able to work with other physicians (interprofessional education), and who are advocates for the quality education they need to keep up with the ever-developing world (advocacy, student representation, non-formal education and student rights). SCOME International also tried to work on the topics above, by supporting your work both locally and nationally, where the most important action happens, by providing you with materials and a forum to exchange ideas, and by working internationally with our partners and our members. We established new collaborations with external partners, such as the Medical Schools Directory, the survey on the health workforce, and of course the biggest highlight: the endorsement of our exchanges. We created groups to work on specific areas, such as Non Formal Education, Student Rights and Wellness, Interprofessional Education, Medical Science and Research, Reproductive Health Education. We also tried to see how we can make your work more practical: rewriting the SCOME manual, sending you monthly (video) updates and follow up reports, assisting you on the regional level were part of our efforts. In this Medical Student International, you will not only read about work from the international, but also the local level. And that, in the end, is what IFMSA is about! I hope you will enjoy reading the articles as much as I have.

terprofessional Education, Medical Science and Research, Reproductive Health Education. We also tried to see how we can make your work more practical: rewriting the SCOME manual, sending you monthly (video) updates and follow up reports, assisting you on the regional level were part of our efforts. In this Medical Student International, you will not only read about work from the international, but also the local level. And that, in the end, is what IFMSA is about! I hope you will enjoy reading the articles as much as I have. As for AM 2014, whether you already have white hairs on your head or you’re just peaking around the corner for your first General Assembly ever, enjoy it to the fullest! Be inspired, inspire others, learn, teach, exchange ideas and thoughts and start long-lasting collaborations that you will take home with you. That is what a General Assembly is about. Never hesitate to ask anyone for help, because this is the place for you to be with like minded, kind people who will only appreciate the effort you show. Take initiative, and you will get most out of your meeting! I can only say how incredibly proud I am of all the work you have been doing, even by seeing only the slightest flickers of it. You guys make Medical Education truly rock! All the best

Stijntje Dijk On behalf of the SCOME International Team: Agostinho Sousa (Liaison Officer to Medical Education issues), Scott Hodgson (Americas), Rasha Osama (Africa), Yameen Hamid (Asia-Pacific), Ahmad Badr (EMR) and Rachel Bruls (Europe).

medical students worldwide | AM 2014 Taiwan


A u g u s t

2 0 1 4

118

Accreditation in Medical Education:

MedSIN-Sudan SCOME National Conference Review

“Accreditation should be a concern of every medical student, mainly because it engulfs most of the student’s rights and has them not simply presented, but presented with the best quality available according to bi-national/international standards.” - Rasha Alkashif (SCOME RA for Africa) On the 1st of May 2014, the 3rd national MedSIN-Sudan SCOME conference took place at Al-Ahfad University for Women (AUW). This time the theme of the conference was: “Accreditation in Medical Education - National Highlight”. Before getting into details about the conference, why not have a slight overview of accreditation itself: Accreditation is a “formal approval for a stated period of time of an institute and its program by a recognized body after self-evaluation and external evaluation based on predetermined standards.” For example, “formal approval” is a national agreement that this faculty is to function, accept and graduate students with approved certificates. This approval could manifest as a certificate or a listing in a national-regional-global Accreditation board. The stated period of time mentioned above, is a generic term for “consistency/sustainability”. According to the regulation set by the local accreditation body (AB), there are periodic rotations in the evaluation of medical faculties to insure that the standards, approved by the (AB) are actually met .

Rasha Alkashif NMO: MedSIN-Sudan SCOME RA for Africa ra.scome.africa@gmail.com

A recognized body is an approved/formed body handed the authority to evaluate and accredit a medical institute and its programs. For an example, the AB in Sudan is the Sudanese Medical Council (SMC), an independent counsel with relative authority handed –believe it or not- by the ministry of higher education. The ministry of health (MOH) is only to monitor and provide feedback. An example of full authority is the one in the US, the AB has the full authority to shut down schools if they breached the previously set standards. The Self Evaluation Process is a preparatory phase provided for the medical faculty to revise the standards followed by them, ascertain and fix any defected element before the accreditation team performs the rotation. This phase’s duration is determined by the AB’s timeline. A report of self-evaluation is then sent to the accreditation team to be analysed prior to the rotation. External Evaluation is the basic rotation implemented by the accreditation team. Throughout the rotation, a predetermined evaluative spreadsheet is carried by team members who systematically evaluate the institute. Afterwards, a thorough analysis of the current situation of the institute is carried out, resulting in a report filed to the accreditation body (AB) to revise and issue the result - “Accreditation approved/denied”. Predetermined Standards for Accreditation:”The standards or criteria must be predetermined, agreed upon and made public. The criteria to be used as the basis for the accrediting process – for the self-evaluation, external evaluation, recommendations and final decision on accreditation – must be the WFME global standards for quality improvement in basic medical education, with the necessary national and/or regional specifications or a comparable set of standards.” – WHO-WFME Guidelines for Accreditation of Basic Medical Education, Geneva/Copenhagen 2005. To access the basic medical education standards, a free pdf is available at: http://www.wfme.org/standards/bme Now that we have a general idea of what accreditation is, allow me to elaborate more on our very own exquisite SCOME national conference. With spectacular guest speakers and impressive representation of the Sudanese Medical Council (SMC), World Health Organization (WHO) and Ministry Of Health (MOH) the first day included wholesome introduction to accreditation in Sudan, followed by a highlight on the current state of accreditation and the common obstacles facing the (SMC) when accreditation of Medical Colleges in Sudan is processed.

www.ifmsa.org


119

So far, an initial rotation of medical faculties in Sudan has taken place. Mark out that there are around 33 active medical schools in the country, of which around 16 are located in the capital only! 20 Medical Schools in Sudan received accreditation, a list of which was collected in 2014, and it can be viewed here: http://www.4icu.org/sd/ The accreditation system, adopted by the Sudanese Medical Council, is based on the WFME predetermined standards and guidelines. “From concept to practice”- Professor Mohammed Yousif Sukkar, SMC representative. “Continuous learning is a vital element, as if not monitored and updated, we could be teaching the wrong information for generations. Students will prescribe obsolete drugs and use historical old manoeuvres when dealing with patients. For that, it is of great importance to insure the curriculum contents are continuously updated.”

There are five Authorities and Policies set regarding Accreditation in Sudan: 1. Ministry of Higher Education Act: Assigns, Supervise and license the medical schools. 2. Commission on Evaluation and Accreditation status. 3. Ministry Of Health (MOH): Monitors and provides a feedback. 4. Standing Committee on Medical and Health Science Education. 5. Sudan Medical Council Act: The official independent accreditation body. Coordination of the process is done amongst Representatives and Joint committees. Thus, meetings with vice chancellors and deans of medical schools take place. Workshops by Educational development centers – EDCs - are held to insure transmission of basic information.

( M S I

3 0 )

Main obstacles facing the Sudanese Medical Counsel when it accredits are: lack of financial support, lack of authority to shut down a medical institute if accreditation was not obtained. One of the problems currently being solved is the recruitment of new accreditation staff targeting youth to insure sustainability of the process in the near future. Another event taking place is the preparatory stage for the second national rotation. Participants attending the conference had a rather general idea of what accreditation is and its current situation in Sudan. Having obtained that knowledge the day came to an end and it was time for participants to choose the workshop/training they see fit for the day that follows. I attended the “Accreditation Tool” workshop, chosen between the ”Students’ rights” workshop and the ”Study skills training” presented as alternatives. The workshop was prepared and presented by Doctor Abu Baker from the SMC. He is one of the youngest accreditation team members - quite exceptional, yet, predictable for a former IFMSA member and certified trainer. The workshop objectives could be summed up as follows: understanding of the concept of accreditation, knowing how it goes operationally, possible outcomes of the process, discussion of its value (Quality of Medical Education, Improvement in public health,etc.). In addition to the basic knowledge provided to the workshop attendees, various discussions on how important accreditation is for the sake of our community and us ,students, took place. A general discussion about the curriculum occurred as well, attendees were convinced of the importance of a regular update of the medical curriculum. Few colleges in Sudan have EDCs with curricular developmental approaches. Those few examples, however, resemble a guideline for fellow faculties to march on the same path. Accreditation is not simply a process to evaluate academic institutes; it is a guardian to insure the sustainability and upgrading of general public health by giving rise to perfectly competent physicians, brought up with an up-to-date curriculum, specifically designed environment for medical students with expert teaching techniques. Every medical student should learn about accreditation and approach appropriate facilities for the desire to enhance the quality of their college life. The fourth day of the conference started with a panel discussion.; An active discussion on the outcomes of each workshop was wholesomely concluded. Following the panel discussion and workshops’ outcome presentation, our awesome Liaison Officer Agostinho Sousa spoke about the student’s role in accreditation via an online webinar. Having an external to speak was a great motivation for the participants to form solid resolutions and map out plans to implement during the upcoming months. A great conference, to be honest, I extend my gratitude to the extraordinary OC and national SCOME team lead by the amazing national officer Zamzam Ismail, medical education could have never been presented better! What would I like to gain out of this experience? Not knowledge alone, but an example set for our SCOME-Africa to act upon, having a similar regional curriculum set as an example. My dear readers, aspire as much as you inspire and don’t forget to digest before you ingest! medical students worldwide | AM 2014 Taiwan


A u g u s t

2 0 1 4

120

The Brazilian Medical Student and The New National Curriculum Guidelines

Currently in Brazil, the new national curriculum guidelines (NCGs) have been one of the major debates among medical students. In this context, DENEM-Brazil has been promoting a campaign to debate the subject, so that the medical students would become acquainted with the new NCG and take part in the process of establishment.

Ighor Rezende

NMO: DENEM-Brazil Fluminense Federal University, Brazil denem-brazil@ifmsa.org

About the Guidelines

The NCGs are rules that regulate and direct the undergraduate medical studies in Brazil defining the principles, foundations and practices that will reflect directly on the evaluation of the political pedagogical projects of the medical courses. They contemplate the graduation profile, the competences/ abilities/acts, qualifications and emphases, curriculum content, course organization, internship and extra-curricular activities, fellowships and evaluation. The first NCGs were established in 2001 as a result of a 10-year-long democratic process of debate that had as a result the NICMEE - National Interinstitutional Committee of Medical Education Evaluation from the 1990’s, in which DENEM-Brazil had a very important role.

lines and criticism that there was lack of democracy in the formulation process. Even with all these difficulties and the short deadline, students debated and formulated alterations of the proposed text.

How is our Campaign going?

As a strategy to promote the process of reformulation DENEM-Brazil has been producing texts, videos and manuals about what has been done and debated, and also the students’ demands in this process. These materials are produced by the Coordenação de Políticas Educacionais – CPE (Educational Policies Coordination). A video from the third phase of the campaign can be watched on the link: http://gomel.med.br/camde/2014/02/20/esclarecimento-da-denem-em-relacao-as-novas-diretrizes-curriculares-nacionais-parte-3/ DENEM-Brazil has been representing the Brazilian medical students in this process, and believes that the curriculum and the direction of the medical studies are important tools in the strive for a transformation in medical education. We believe that one of the main factors for this change is the understanding of the concept of health, and the application of this concept to shape doctors that will meet the needs of the population instead of the needs of a privileged group or short term political demands.

Why reformulate the NCG now?

The reformulation of the NCGs came as a surprise package of the “Programa Mais Médicos” (“More Doctors” Program) instituted by Federal law 12871 approved on 22nd October 2013. The National Education Council (NEC/MEC) was given 180 days to reformulate the new guidelines. DENEM-Brazil received an already made proposal in November, about the content of which we had neither been consulted, nor invited to participate in the composition of. Only after this initial draft other parties such as Associação Brasileira de Educação Médica – ABEM (Brazilian Medical Education Association) were asked to take part in the reformulation process. DENEM-Brazil itself had to demand an invitation. Given that, there was a lot of concern among the students about their role in the construction of the guidewww.ifmsa.org


( M S I

121

3 0 )

Global Health Education SWG Elizabeth Thomas

NMO: Medsin-UK University of Glasgow, UK beth.thomas1990@gmail.com

Global health is the “area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide” (1) . Global health impacts both our daily lives and our work as future leaders in healthcare; each medical student should be equipped with the right knowledge, skills and behaviour to aim for global health equity. We need to be aware of how health is affected by various global issues such as international trade laws, health systems, pandemics and migration. Yet global health is not solely about tackling international issues. It starts at the community level, backed with global knowledge, awareness and skills. With this in mind, we, the members of Global Health Education SWG, aim to cement global health education in medical curricula worldwide. This SWG aims to build on international work so far , including the Global Health Education Declaration 1.0 (2) for the establishment of global health education at universities worldwide. Released in 2012 at the World Health Summit in Berlin, it calls for change in core and optional medical curricula as well as in assessment. A list of global health learning outcomes (3), generated in the UK in 2011, outlines a possible syllabus for a course in global health to produce ‘health professionals for a new century (4). These outcomes were developed by medical students, for medical students. Demand is high among students for quality, targeted global health education. We are a group composed of six members from various NMOs: Medsin UK, AMSA Philippines, AMSA Australia, NiMSA Nigeria, IMSA-Iran and ACOME-Colombia. We are motivated and passionate about global health and were selected from a pool of applications after a call on the SCOME and Think Global servers.

Our vision is to improve global health education in medical schools worldwide; our mission to achieve this is to create a toolkit which will aid students in advocating for a change in their medical school curricula. To do this, we plan to collect case studies from students from all regions, from as many NMOs as possible, to find examples of strategies that have worked, but also those that have not been so successful. With this information, we plan to create an easy-to-apply, culturally accepted Global Health Education Toolkit to get medical students implementing Global Health Education in their routine studies. The core values of IFMSA recognise the importance of global health in our ever more globalised societies. The doctors of tomorrow need to be prepared for practising in an environment which is changing at an unprecedented rate. As medical students, we have a unique voice in advocating for change in medical curricula and need to be able to use our voice to its best effect. This SWG aims to give IFMSA members the tools to advocate to increase the quantity and quality of global health education in our curricula and to make real change to the education of medical students across the globe. This article has been written in collaboration with Kim Patrick S. Tejano and Zahra Zeinali.

References (1) Koplan, JP et al. Towards a common definition of global health. Lancet. June 2009: 373(9679): 1993 – 1995. (2) European Academic Global Health Alliance, Global Health Education Declaration 1.0, published 2012, WHS Berlin, found at:http://www.eagha.org/assets/files/Global%20Health%20 Education%20Declaration%201.0.pdf (3) Johnson, Bailey and Willott, Global Health Learning Outcomes for Medical Students in the UK, Lancet, October 2011, found at:http://www.thelancet.com/journals/lancet/article/ PIIS0140-6736(11)61582-1/fulltext#article_upsell (4) Frenk, Chen, Health professionals for a new century: transformingeducation to strengthen health systems in an interdependent world, Lancet, November 2010 376: 1923–58 found at: http://www.thelancet.com/journals/lancet/article/PIIS01406736(10)61854-5/fulltext?_eventId=login

medical students worldwide | AM 2014 Taiwan


A u g u s t

2 0 1 4

122

The Missing Numbers:

Measuring IFMSA’s Impacts on Quebec Medical Students Core Curriculum Competencies

Interest in global health from the medical field has been increasing, with a growing students’ engagement in international activities and student organisations such as IFMSA and its national member organisations, filling the gap in global health education. Trying to assess its impact on medical students and to gather the missing numbers, IFMSA-Quebec has conducted a one-year long study on its students involved as local coordinators for one of its seven standing committees. The study was based on the CanMEDS core competencies, defined by the Royal College of Physicians and Surgeons of Canada, and guiding medical education in the country. Students, enrolled as local coordinators, were surveyed twice 8 months apart in order to assess their competency in the thematic areas of the CanMEDS competencies: leadership, communication, management, professionalism, understanding of the global, cultural and social aspects of health, and perceived impact as health advocates. The survey consisted of self-assessment in each area on a unit scale of 1 to 7. 41 responses were received upon the first survey administration, 35 upon the second, 32 of those responses were matched. The participating student’s results indicated increases in perceived CanMEDs competencies. In fact, participants demonstrated the following levels of growth on the 7-point scale. Leadership: +0.63. Communication: +0.56. Team management: +0.66. Impact as health advocates: +0.75. Most importantly, students reported having increased their understanding of the global and social aspects of health, respectively and similarly, by a factor of +0.91 each.

www.ifmsa.org

Claudel Desrosiers IFMSA VPE-Elect 20142015

claudel.pdesrosiers@gmail.com

This study illustrates that student engagement in extracurricular global health activities increases their perceived confidence in key areas of medical education. It is important to note that a) the survey was administered solely on a group of students, not to be perceived as a representative of the medical student population and that b) there was no control group. Additionally, given that students were attending medical school concurrently to the implementation of the survey, we naturally expected some increase in CanMEDS competencies. However, this study demonstrates that global health oriented student-run programs contribute to the development of certain medical competencies that are challenging to implement and evaluate in medical curricula. The results of this study are very encouraging and will prompt the authors to follow up with a case-control study matched for year of study, comparing students engaged in leadership positions in IFMSA-Quebec and others that have not expressed such an interest in global health. We are confident that IFMSA-Quebec has been able to effectively build global health education and training programs for Quebec medical students. In our globalized and increasingly connected world, we believe such programs are necessary for all physicians–in-training and we call for a greater support of universities and other organisations in pushing forward the development of an integrated global health approach in the medical curricula.


( M S I

123

3 0 )

DisasterSISM:

Teaming up for Excellence!

Eleonora Leopardi

NMO: SISM-Italy Università di Roma - La Sapienza, Italy nome@sism.org

DisasterSISM is a project that aims at reducing mortality and morbidity related to natural and man-made disasters, and mass casualty incidents. To achieve this result, we have identified education of medical students as a key priority. When this project started, in 2007, we looked for a partner that could share with us expertise in emergency and disaster medicine. Eventually, we discovered CRIMEDIM. CRIMEDIM is a research center of the Università del Piemonte Orientale, Novara, Italy, that dedicates its activity to providing scientific evidence in disaster and crisis management, with also a special focus on education and implementation of new technologies in training. SISM-Italy got in touch with CRIMEDIM and proposed to create a course in disaster medicine, specifically tailored for medical students. In 2008, the first DisasterSISM was carried out. That was just the beginning of a 6 year-long partnership that’s still incredibly fruitful and mutually inspirational. DisasterSISM is now a well-established reality in our NMO, with three different levels of training: Basic DisasterSISM, Advanced DisasterSISM, and a 7 month-long train-the-trainer course: DisasterTEAM. The broad topics covered are: pre-hospital disaster management, hospital disaster preparedness, national and international disaster response. There is also another topic for those attending the DisasterTEAM course: peer education and training methodologies. After completing the DisasterTEAM course, the TEAMers, as we call them, become the trainers of the Basic DisasterSISM. Both the Advanced DisasterSISM and the DisasterTEAM are instead held by CRIMEDIM trainers, recognised as top-notch experts in disaster medicine education. I keep thinking that meeting CRIMEDIM was the best thing that could possibly happen to us. Not only are they a center of excellence in this field, not only are

they extremely up-to-date and informed of all new relevant evidence, but they are also so well connected with the international experts in disaster medicine that they participate in arranging the European Master in Disaster Medicine. What makes our partnership unique is that CRIMEDIM embraces our ideals in medical education and constantly applies them to the courses we have built together: interactive approach, use of e-learning, steady monitoring of the activity and evaluation of results, peer education teaching method, experiential learning with simulations, and so on. Thanks to CRIMEDIM’s professionalism, DisasterSISM has reached over 25 medical schools all over Italy and trained more than 600 students. Several papers on our experience have been published (1,2), a poster, discussing the latest results, has been accepted for presentation at the AMEE Conference 2014, and we plan to keep this level of excellence in the future! However, why am I telling you all this? Because SISM-Italy and CRIMEDIM are willing to take a step forward, making DisasterSISM international! In the next months, we aim to create the first international 7 month-long DisasterTNT class, made of 30 medical students willing to become disaster medicine trainers in their NMOs. So, is disaster medicine your passion? Do you want to become an expert? Do you want to help lowering the health burden of disasters? If so, keep in touch, because this is the perfect activity for you! References (1) Ragazzoni L, Ingrassia PL, Gugliotta G, Tengattini M, Franc JM, Corte FD. Italian medical students and disaster medicine: awareness and formative needs. Am J Disaster Med. 2013 Spring;8(2):127-36. (2) Ingrassia PL, Ragazzoni L, Tengattini M, Carenzo L, Corte FD. Nationwide program of education for undergraduates in the field of disaster medicine: the development of a core curriculum centered on blended learning and simulation tools. Prehosp Disaster Med. 2014 [in press]

medical students worldwide | AM 2014 Taiwan


A u g u s t

2 0 1 4

124

Violence Against Women:

An Approach in Medical Education

Domestic violence performed by the intimate partner is a phenomenon of great impact on the health of women and children in their care. Its prevalence may range from a quarter to half of the users of health services with experience of physical or sexual violence by their partner at some point in life (Schraiber and D’Oliveira, 2003). However, several studies emphasize the unpreparedness of most healthcare professionals, with little or no specific practical knowledge on the subject. Given the lack of knowledge on how to act in such cases, silence and invisibility of the problem prevail and entails the suffering. The “Flores de Março Project” arose from the desire of students of the Faculty of Medicine of the Universidade Nove de Julho (Uninove), members of IFMSA-Brazil, to continue to address the issue of violence against women. The project got this name because it was held close to the International Women’s Day. In partnership with the Gynaecology and Obstetrics group of students and the college professors the counter of a project was born, specifically tailored for students in the areas of health at Uninove, especially the medical school, which allowed access to relevant information and training to academic debates. The question the “Flores de Março Project” brought up to its participants is: what do you need to know, as a health professional, to ensure a more humane and integral assistance to women involved in violent situations?

www.ifmsa.org

Jacqueline Forti di Creddo

NMO: IFMSA-Brazil Universidade Nove de Julho - São Paulo, Brazil jfdic.jacqueline@gmail.com

Lasting a week at lunchtime and open to other college students, the course addressed the topic in aspects such as querying the victim, the general impact of domestic violence on the Brazilian health and healthcare beyond the psychological and legal aspects of the theme. The result was an exceptional increase of awareness of students and faculty itself to the importance and relevance of the subject. Besides helping to understanding the importance of the subject, this course showed that cultural and philosophical aspects may interfere in society and especially in health. Moreover, projects like this not only complement to the training of our future doctors and give preparedness to act adequately in similar situations, they also target a humanitarian-based medical care approach to women who have suffered violence by offering comfort and guidance.


( M S I

125

3 0 )

Medical Bioethics Valdone Kolaityte

NMO: LiMSA-Lithuania Lithuanian University of Health Sciences - Kaunas, Lithuania valdonekolaityte@gmail.com

Bioethics is one of the most significant rapidly developing fields as the number of scientific achievements and their application in practice increases. For this reason the study combines the topics of life sciences, value systems, both personal and interpersonal morality. What is more, bioethics is immensely important when creating sustainable development of science, society and the environment. All of these reasons influenced LiMSA SCOMEdians’ decision to introduce a new event for medical students - “Medical Bioethics”. The aim of the event is to provide future healthcare professionals with a moral compass through forms of discussions and workshops with professionals of various fields. LiMSA-Lithuania established a partnership with the centre of bioethics in Lithuanian University of Health Sciences. Seminars and practices are organized on a monthly basis. So far we had six successful national and local events to tackle problems of abortion, euthanasia, sustainable development, palliative care, cancer, and organ donation. Here are some interesting trends that we observed during the events: • 70 % of doctors agree that there is a need for the procedure of abortion, but only 30% would willingly perform it. • Regardless of the fact that specialists thoughts there is a need for a regulation of DNR (Do Not Resuscitate) practice, Lithuania has had a law project for euthanasia rejected, and doctors performing passive euthanasia are punished with the suspension of license and incarceration.

Media has the most influence on perpetuating the myths within the society that organs are stolen during regular surgeries and that a person possessing a donor card will not receive proper treatment in cases of emergency. The myths have to be busted by current and future doctors!

During the events we try to raise awareness and to provide participants with the social, medical, philosophical, religious, historical, legislative and economic points of view. After the experts’ talks, a discussion is encouraged. In addition to that, a pilot research is conducted every time by providing students with a questionnaire. We perform it in order to analye the differences of opinion on various topics and if such events change the opinion of students. We seek to expand our event and analye more of the topics! After all – it is us – future health professionals, who will shape the landscape of the new age medical practices!

medical students worldwide | AM 2014 Taiwan


A u g u s t

2 0 1 4

126

Make The Right Move, Decide Now! Our lives are not much different from a chessboard. A single wrong move can result in a devastating catastrophe; a single wrong or untimely decision can alter the course of our entire future. In today’s world, the professional and academic aspect of our lives is undoubtedly the most significant aspect, and hence, it is imperative for our students and young professionals to be well-equipped with the weapons of information and knowledge to “make the right moves” when it comes to career-related decisions. As an antidote to the general lack of awareness of medical students with respect to the post-graduation career opportunities available for them, International Federation of Medical Students’ Association – Pakistan, organized a “Career Guidance Seminar for Medical Students”. More than 400 medical students from all over the city attended the seminar.

Haleema Munir

NMO: IFMSA-Pakistan Allama Iqbal Medical College, Pakistan publications.ifmsapakistan@ gmail.com

Pakistani medical students strongly believe in the concept of global health; hence, after graduation, many of them go abroad for further education, serving humanity worldwide. In this context, four different speakers depicted and analysed the amazing contributions made by Pakistani medical professionals in the United Kingdom, Australia, the United States of America and Middle East by relating their personal experiences in the medical systems of the respective regions for the benefit of the eager audience. The seminar ended with an interactive question-and-answer session in which the medical students attending the seminar cleared any ambiguities that they still had after being aptly guided by the distinguished speakers. The follow-up of this seminar showed tremendously positive response from all fields of health personnel, and formed the basis of setting up of a department of career guidance that holds weekly sessions for all the medical students who are seeking guidance with respect to their careers. The resource list provided by the organizers of the event included the email addresses of spokespersons of the event, ensuring better communication between the informers and those in search of the information. This Career Guidance Seminar truly fulfilled the demands of its motto that went as “Make the Right Move, Decide Now”.

The seminar was opened with a detailed presentation about the importance of career guidance, paying special focus to how each field suits people of different personalities and natures. The people who have a generally caring and kind nature are believed to be better paediatricians as compared to those who enjoy working under stress - the latter prove to be better surgeons. The seminar followed a conceptual pattern for career guidance, beginning with the career opportunities provided by the basic sciences. The eminent speakers elaborated on the post-graduation opportunities that invite medical students of Pakistan. The main aim was to highlight the national and international study programs that welcome medical students with open arms, and empower these students to give their best back to their nation and to the world at large.

www.ifmsa.org


127

IFMSA Team of Officials 2013-2014


medical students worldwide | www.ifmsa.org


medical students worldwide | www.ifmsa.org


medical students worldwide | www.ifmsa.org



Issuu converts static files into: digital portfolios, online yearbooks, online catalogs, digital photo albums and more. Sign up and create your flipbook.