The Medical Student International 34

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Issue 34 August 2016

Global Vaccine Action Plan

MSI 34

Medical Student International

IFMSA Imprint Editor In Chief Mustafa Ozan Alpay - Turkey Content Editors Franchesca Choi - Taiwan Zenia Poladia - India Cover Photo UNICEF Zambia - photos/ibm_media/14055287598/ Layout Mustafa Ozan Alpay - Turkey

MSI - Medical Student International ©1995-2016 ISSN 1026-5538

Publisher International Federation of Medical Students’ Associations (IFMSA) International Secretariat: Ms. Iris Tomlow c/o Academic Medical Center Meibergdreef 15 1105AZ Amsterdam, The Netherlands Phone: +31 2 05668823 Email: Homepage:

The International Federation of Medical Students’ Associations (IFMSA) is a non-profit, non-governmental organization representing associations of medical students worldwide. IFMSA was founded in 1951 and currently maintains 127 National Member Organizations from119 countries across six continents, representing a network of 1.2 million medical students. IFMSA envisions a world in which medical students unite for global health and are equipped with the knowledge, skills and values to take on health leadership roles locally and globally, so to shape a sustainable and healthy future. IFMSA is recognized as a nongovernmental organization within the United Nations’ system and the World Health Organization; and works in collaboration with the World Medical Association.

This is an IFMSA Publication


© 2016 - Only portions of this publication may be reproduced for non political and non profit purposes, provided mentioning the source.

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 herein lies with the reader.

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.

Some of the photos and graphics used in this publication are the property of their respective authors. We have taken every consideration not to violate their rights.


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Words from the Editor in Chief

President’s Message

Words from the IFMSA President

Message from the Prof. Erik Holst Fund Global Vaccine Action Plan

Articles on the theme of the August Meeting 2016

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Rex Crossley Awards




Morning SCOPHian






The SCORPion

Find about activities competing for the Rex Crossley Awards

IFMSA Programs

Get involved with IFMSA Programs

Capacity Building

Find about the capacity building activities from the globe


The guardians of medical education share their stories

Go travelling with SCOPEans on their professional exchange

Meet SCOPHeroes who save the day with their Orange Activities

Welcome to the world of the SCORAngels

Have you ever wondered what SCORE exchanges are all about?

Learn about Human Rights and Peace efforts worldwide

( M S I 34 )

Editorial Mustafa Ozan Alpay

IFMSA Vice-President for Public Relations & Communication 2015 - 2016 Uludag University, Faculty of Medicine

Dear Reader, It is such an excitement and honor for me to write these words for the 34th issue of our biannual magazine - the Medical Student International.

our Standing Committee Directors and their International Teams, we have tried to provide the most objective evaluation and aimed to serve you our best.

We have a unique chance to represent the voice of Medical Students from all over the globe on different hot and interesting topics with every new issue, share the experiences from different countries, cultural backgrounds, views, local backgrounds and standing committee related projects.

Also, it would be a shame not to mention the amazing help and dedication of our Content Editing Team Members, Zenia and Franchesca. I cannot thank them enough for their hard work, enthusiasm, commitment, and their incredible support. This issue would not be here without them.

We are excited to get each and every submission to our article and truly wish we had as big of a publication to accommodate them all! We would like to thank once more to everybody who submitted their incredible work and encourage to share it widely on various publications, newsletters, social media and national media, not only to share good practices, but also to spread widely the news of medical students’ contribution to the society.

We hope that you would enjoy this issue of Medical Student International, and we wish you a pleasant reading time. If you have any feedback or comments, please don’t hesitate contacting me and the International Team. We are always open to your input! Warm regards,

The selection process was a real challenge, since all your contributions are worth sharing! With the help of

We apologise for the mistake on the 77th page of the MSI33. Ms. Chioma Audrey Amugo’s name, NMO and University was written wrongly due to a technical error. The updated online version is available at IFMSA Online Platforms. 2 3

medical students worldwide | AM 2016, Mexico

August 2016

President’s Message Karim M. Abuzied

IFMSA President 2015 - 2016

Dear Reader, It is with such an honor that I am presenting to you the 34th edition of IFMSA Medical Student International Publication as a continuation of the IFMSA tradition over the years. Medical Student International is the official international publication of IFMSA. It is currently issued twice a year before IFMSA General Assemblies and it is such a privilege to be able to write this introduction for the 34th Issue of our official publication. Going back in the time when MSI was first created back in 1991 with the slogan of “Communication, Creativity, Continuity, Companionship”, you will be able to understand why IFMSA spends so much effort on the creation of this publication. MSI was created as a rejuvenation of the IFMSA Publication of the 70’s under the name of INTERMEDICA. It was planned with the aim of being an informative, interesting and lively newspaper containing articles from all the international medical Student organizations. This legacy over the years, and after editions and editions of MSI can only symbolize the motivation, dedication and enthusiasm of medical students across the different eras that IFMSA has passed through. It started with a printed copy of 16 pages that is mailed via post services to National Member Organizations until it reached its current shape of more than 100 pages, covering topics from all of our Standing Committees and all IFMSA Regions. This edition is only another step on the path of continuity and sustainability of our federation.



One fourth a century after the issuing of the first edition of IFMSA Medical Student International, here we deliver to you the 34th edition of our official publication that was only possible to be brought to light through the inspiring cooperation between medical students from 119 countries across the globe, writing articles, sharing creative ideas and valuable experience, working on the proof reading and designing till it ended up with the product you have in front of you right now. All of those priceless efforts would only be rewarded by the time you would take to go through the interesting articles shared over the different sections of this unique edition of MSI. Finally, I would like to wish you a pleasant experience surfing through the following pages. I am quite confident that it would be an enriching experience that would only add to your knowledge and challenge your mind. We will be waiting for your feedback and most importantly your contribution to our next edition of MSI. “Learning never exhausts the mind” Leonardo da Vinci Best Regards, Karim M. Abuzied IFMSA President 2015-2016

( M S I 34 )

Message from Prof. Erik Holst Fund Dr. Konstantinos Roditis, MD, MSc

Chair, Prof. Erik Holst Fund Board of Directors

Surendra Sapkota NMSS-Nepal

Prof. Erik Holst Fund is always proud to witness the progress of its past awardees. This is why we report from the participation of our 2015 awardee Mr. Surendra Sapkota from Nepal at the World Humanitarian Summit (WHS) in Turkey. Erik Holst Fund will always be on its awardees’ side, to assist them whenever needed, as well as to watch as they move forward in fulfilling their aspirations. “The first ever WHS on May 23-24 convened by UN Secretary-General, Mr. Ban Ki-Moon and hosted by the Government of Turkey brought together approximately 9000 participants from 173 Member States, including 55 Heads of State and Government, representatives from the private sector, civil society, NGOs, media and academia, as well as youth advocates and activists. The objective of which is to identify solutions to reshape the humanitarian system to efficiently address the growing humanitarian needs through closer partnerships and a strengthened principled basis. The world humanitarian summit was preceded by youth pre forum on May 21/22 that gathered around 200 youth delegates from around the world.

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I did get selected through IFMSA and received my invitation letter for the WHS long time ago. It was a pleasure to see, learn many things through hundreds of side events, special sessions and round table talks, the theme of which revolved around humanitarian issues including natural disasters that is having a major impact around the world affecting an average of 218 million people every year leading to an economic impact of some $250 to 300 billion per year, Climate change which is already affecting millions of people, Migrants, Global health, Providing education in crisis, Regional action for global challenges and many more. While we witness and hear thousands of lives being lost in war hit zones, or due to Ebola outbreak in Africa or the earthquake in Nepal or civil war in South Sudan, as a medical doctor and health professional we understand

that people lose access to health, education and food. Bombings of hospitals has brought health crisis in war affected countries. Children are the one who are severely affected. UNICEF estimated earlier this year that nearly 250 million children live in regions affected by conflict. More than half of the world’s 60 million displaced people are under the age of 18. Many commitments were made during the summit a few being Education cannot Wait fund, Grand Bargain, Global Preparedness Partnership and One billion coalition for resilience. During the summit IFMSA has also stressed upon these humanitarian issues. “As future health care professionals, we call upon states and civil societies to strengthen cooperation with all relevant stakeholders’ military and community leaders to regain respect of the International humanitarian law and medical ethics to put an end to the epidemic of violence on health care workers” said Karim M. Abdeltawab, IFMSA LRP at the WHS plenary. It was a moment, truly inspiring and motivating to see UN Secretary General addressing the closing ceremony. He urged action on New Crisis Prevention and Aid Distribution Promises made at World Humanitarian Summit. As he said this summit is not an end point but a turning point.”

medical students worldwide | AM 2016, Mexico

IFMSA 65th General Assembly August Meeting 2016

In this section you will find articles on the theme of the August Meeting 2016: Global Vaccine Action Plan.

( M S I 34 )

A Decade of Prevention A Lifetime of Protection

Arshiet Dhamnaskar

Medical Students’ Association of India Maharashtra University of Health Sciences, Nashik

For over centuries, mankind has been plagued by diseases which were signs of certain death for every person afflicted with them. The world felt a wave of helplessness, with no weapon at their disposal; no cure at all. It was then that we realised, that to win, we must not fight, we must train. Train our own body to fight off these adversaries, by informing it of them before they arrived. While claims have been made that inoculation existed since times immemorial, (and that such could be deduced from traditional practices around us), and while these claims continue to be questionable; what cannot be denied is that when Edward Jenner showed the world his cowpox-derived vaccine for smallpox, he had presented us with a gift. Since then, this gift has manifested itself over the years as a saviour of numerous lives. (Keep in mind, the CDC has declared that smallpox has been eradicated from the world.) Jenner himself might not have imagined this, but we as a society must consider the extrapolation of a simple artifice to a large-scale defensive measure.

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The Global Vaccine Action Plan (GVAP) seems to be our major line of defence. Its goals could be summarised in one mission, ‘Sustainable Immunisation for All’. To be clear with what the Plan aims to achieve, we must be clear about this mission. To make something sustainable, we should ensure that it is available, affordable and accessible. As per the WHO’s strategic objectives for the GVAP, it seems that it seeks to aim just for that. It hopes to manufacture and invest in development, production and distribution of new vaccines — vaccines against other preventable diseases that are rising among the world’s population — because the world needs to be on its toes to avoid newer enemies. Guarding ourselves only against our old nemeses and ignoring incoming threats would be a foolish gamble indeed.

Then, with these weapons stocked up in our arsenal, we could begin marching off to war. This would involve guaranteed availability and effective administration of the vaccines for everyone, regardless of nationality, race, caste, creed, or any other basis of discrimination. This venture, though, cannot be undertaken by a single organisation alone. The WHO thus calls upon every entity which could possibly be enrolled to step forward and join this initiative. What can we, as medical students, do to be a part of this mission? We may not have the training or resources to deliver the vaccines to the public, but we can, by all means, prompt them to demand these for themselves. We can certainly instill a sense of awareness among them that a vaccine is not a mere commodity, but a right. A right to life. The question arises then is that whether awareness is effective enough. Case Study: India In India, a country struggling with the health issues of over 1.2 billion people, the disease, poliomyelitis, has been eradicated — a feat the WHO aims to extend to the world through the GVAP. Studies indicate India might have achieved it through its strong mass campaigns,the pulse polio drives, led by a slogan of ‘Two drops of Life’. (The ‘two drops’ refer to the vaccine doses, which emphasizes upon the little quantity needed to ensure complete protection against the deadly disease.) Awareness, though, can only be successful if complemented by vaccine efficacy. In India’s case, the BCG vaccine is very much a part of its Universal Immunization Programme. However, tuberculosis continues to destroy 1.4 million lives, a majority persistent in the country for long, with newer cases popping up every year. While the country has switched over to promoting its National Tuberculosis Control medical students worldwide | AM 2016, Mexico

August 2016 Programmes, one flaw that should probably be explored is the inability of the BCG vaccine to provide protection against latent pulmonary TB infections, a prime cause of the disease. Hence, it could be futile to advertise an inefficient vaccine, but nevertheless, we must remember that effective awareness is paralleled by none when it comes to promoting the Action Plan. Speaking of promoting vaccines, we must first be sure whether they are any useful in the first place. Of lately, there have been a few social-media uprisings and silent protests against vaccination. Many claim it to not only be worthless, but also accuse it of being a cleverly-devised strategy of the health organization and the pharmaceutical industries, with one ulterior motive – money. And this might be shocking, especially since human lives are at stake. While truth behind such conspiracy theories continues to be sought after, what one cannot deny is evident statistics. The number of deaths caused by vaccine-preventable diseases has dropped from 0.9 million in 2010 to 0.4 million in 2010. Similar significant findings, such as the decline in child mortality over the last decade, also strengthen our observations on the efficiency of vaccines. This is, perhaps, also the reason why the WHO has chosen the current decade (2011-2020) to put into action the GVAP; it is a good idea to propel a concept that has already gained momentum. Does this decade bear for us any fruit then? Truthfully speaking, even if we can afford to dream of a diseasefree world, a Utopia per se, we still cannot promise it to ourselves. It must be agreed upon that one cannot triumph in the battle against Nature. There will always arrive an infirmity that prevents our immortality. But with this Action Plan, we target not the laws of Nature, but the acts of neglect. Take a look at what exactly we are fighting for over here. It is not a rare genetic disorder that involves years of genetic research and complicated gene therapy, or a virtually incurable disease asking for better palliative care for the patient (both, with due respect, important concerns for us too), but we speak of almost completely preventable diseases that reign in today’s world because humankind foolishly stands with its face turned away. While pondering over the meaning of life continues to be a philosophical concept, the idea of a good living does not. Everyone deserves to be shielded against disease, everyone deserves a healthy life. And if efforts are taken by us together, we can at least achieve the



world where no life leaves us because of indifference. Perhaps, this decade is a wake-up call for us. This decade does promise us with a better concept of health. No, it is not a decade which vows to provide us with cure, but a decade that calls upon us to establish a stronghold of prevention of disease. This decade of prevention might have what it takes to provide us with a life of better healthcare, a living free of worry, and a lifetime of protection. References 1. vaccine_action_plan/GVAP_doc_2011_2020/en/ 2. 3. 4. PMC4078488/ 5. h t t p : / / w w w . s i m s . e d u / w p - c o n t e n t / uploads/2015/04/8_SIMSJMR_Iss1_Paper6_Pg4147.pdf 6. Agrawal, D.P.; Tiwari, Lalit. “Did you know that smallpox inoculation started in India before the West?” 7. Pious_Fraud_The_Indian_Claims_for_pre-Jennerian_ Smallpox_Vaccination 8. vaccines/bcg/en/ 9. vaccines/polio/opv/en/ 10. vaccines/poliomyelitis/en/ 11. overview/disease-facts.asp 12. 13. 14. policy-and-issues/who-cer tifies-india-poliofree/ article5839833.ece

( M S I 34 )

A Polio Free World Just 2 Countries Far!

Aeman Muhammed Asif EMSS - United Arab Emirates Dubai Medical University

We have finally entered the last phase of freeing the world of the crippling polio virus. One of the six targets of WHO’s Global Vaccine Action Plan, ‘complete polio eradication by 2018’, has indeed been a challenging journey, but the continuous struggle was worth it, as we have come from 125 polio-endemic countries in 1998 to just two today (Afghanistan and Pakistan) – which means we have reduced the cases by 99.9% in the last three decades! However, we can not celebrate yet. Despite the progress, if we fail to completely eradicate this highly contagious disease, we could witness a comeback of 200,000 new cases annually, within a decade, all over the world. Hence, crossing the finish line should be our greatest priority at present. Now is the time we must not fail. To attain our goal, every child in the remaining polio reservoirs, i.e. Pakistan and Afghanistan – must be vaccinated. Albeit the regular mass vaccination campaigns in both Pakistan and Afghanistan, conflict, insecurity, targeted attacks on health workers and/or a ban by local authorities on polio immunization results in difficulties in reaching target populations. Moreover, the proximity of the 2 countries has led to “shared wild poliovirus (WPV) circulation in the two corridors with a Ping-Pong phenomenon between the bordering areas of the two countries” as stated by Dr. Michel J. J. Thieren, a WHO Representative in Pakistan.

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So to make the campaigns more successful, WHO, along with UNICEF, the Centers for Disease Control and Prevention, Rotary International, and the Bill and Melinda Gates Foundation have been working in cooperation with both national governments and community leaders for decentralized planning and outreach to reach the remote areas of the countries to boost demand for OPV and improve public acceptance of the vaccine by guiding them on its importance.

Moreover, WHO is currently working to support the training of 65,000 Afghan frontline polio workers on a newly-revised curriculum to reinforce their skills in vaccination, surveillance for cases of acute flaccid paralysis, campaign monitoring and interpersonal communications. While in Pakistan, WHO is collaborating with the Government of Pakistan and other partners to help vaccinators be trusted and accepted by their community, so as to encourage the vaccine seeking behavior of parents. Also, installation of fixed vaccination teams at Afghanistan-Pakistan border crossing points has helped to reach children on the move. The campaigns have also started a genius ‘revisit strategy’. “Vaccination teams are re-visiting households with absent children at the end of every campaign day. There is also a revisit day at the end of each vaccination campaign on Fridays to reach out to families at picnics, public markets and mosques, to give OPV drops to children who may not have been at home when the teams first visited,” explained Dr Richard Peeperkorn, a WHO Representative in Afghanistan. “This type of ‘mop-up’ activity has been very effective in reducing the number of missed children,” he said. But besides eradicating the virus from these 2 countries, a surveillance should be conducted in in countries with declining immunization rates so as to be reassured before declaring them polio free.

References newsstories/The-Final-Frontier-in-Polio-Eradication/ tabid/526/news/1374/Default.aspx medical students worldwide | AM 2016, Mexico

August 2016

Vaccination Policy

of the Australian Medical Students’ Association Stephanie Davies

AMSA - Australia Monash University

Vaccination is one of the most important public health interventions for the prevention of communicable diseases and has been responsible for a 99% decrease of these diseases in Australia alone. This success has largely been due to high childhood vaccination rates across the country, however, recently a number of groups have been identified as falling short of the target vaccination rates[1]. This diminishes the efficacy of herd immunity, which for most diseases requires a population vaccination rate of at least 90% to prevent disease transmission[2]. Children from families of low socioeconomic status, Aboriginal and Torres Strait Islander children and children of conscientious objectors have all been identified as those least likely to follow the childhood immunisation schedule[3,4]. For example, 88.19% of Aboriginal and Torres Strait Islander children between 12-15 months are vaccinated compared to 91.69% of non-Indigenous children[5]. Additionally, higher socioeconomic suburbs in Melbourne and Sydney have vaccination rates below 85%, which may be attributed to higher rates of conscientious objection[3]. AMSA believes that vaccination is a critical tool in the maintenance of health equity and the prevention of communicable diseases which still pose a threat to both developing and developed countries. As medical students with a vested interest in global health as well as issues that will affect their future practice, vaccination is an area that AMSA feels the need to advocate on. AMSA’s vaccination policy passed in March this year, calls upon Australian government to improve access to health services, particularly in rural and remote areas. This is to address some of the common barriers to vaccination, particularly for low socioeconomic groups



and Aboriginal and Torres Strait Islanders. Through increasing health service access in remote locations, improving access to transport and improving affordability of these services, the level of healthcare these groups receive will improve as well as their vaccination rates[6]. Another barrier to improving vaccination rates has been identified as widespread misconception about the efficacy and safety of vaccines[7]. AMSA calls not just on the Australian government to educate the Australian public about vaccination, but also on universities to include training on counseling parents and providing vaccinations in their curriculum. It is important that from the start of their medical career they are confident in providing information about vaccination and addressing parents’ hesitations towards vaccination. The Australian, State and Territory governments have already introduced a number of laws and initiatives in an attempt to raise vaccination rates. For example, encouraging general practitioners (GPs) to take a more proactive role in vaccination and follow up, the Australian government introduced a financial incentive for following up vaccinations more than 2 months overdue. The Australian government also introduced the ‘no jab no pay’ law, which prevents families from receiving certain family tax and child care benefits if their children are not sufficiently immunized or on a catch up schedule[8]. In addition to these financial incentives, the Queensland and Victorian governments took a social approach with their ‘no jab no play’ policy. ‘No jab no play’ excludes unimmunised children without medical exemptions from accessing early childcare services. However, Queensland service providers may also choose to accept unimmunised children at their

( M S I 34 ) discretion[9,10]. As there is yet to be conclusive evidence on the efficacy of these strategies, AMSA will continue to monitor new research as it arises. It is important however, to remember that Australia not only has a role to play in improving its own vaccination rates, but also in supporting vaccination efforts globally. This includes funding vaccine development and research, and increasing accessibility in the context of delivery to remote locations both in Australia and overseas.

References 1. Immunise Australia Program [Internet]. Place unknown: Australian Government Department of Health; 2015. About Immunisation; 2015 Apr 20 [cited 2016 Apr 22]; Available from: http://www.immunise. Content/introduction-ai 2. Immunise Australia Program [Internet]. Place unknown: Australian Government Department of Health; 2015. Why immunise; 2015 Apr 20 [cited 2016 May 3]: Available from: immunise/publishing.nsf/Content/why-immunise 3. Hull BP, Dey AD, Menzies RI, Brotherton JM, McIntyre PB. Immunisation Coverage, 2012. Commun Dis Intell [Internet]. 2014 [cited 2016 May 3];38(3):E208-E231. Available from: nsf/content/cda-cdi3803-pdf-cnt.htm/$FILE/ cdi3803e.pdf 4. Immunisation position statement [Internet]. Place unknown. Royal Australian College of Physicians; 2012 Oct [cited 2016 May 3]: Available from: advocacy-library/immunisation-position-statement.pdf 10 11

6. Hendriksz T, Malouf PJ, Sarmiento S, Foy JE. Overcoming patient barriers to immunizations. AOA Health Watch [Internet]. 2013 [cited 2016 May 3];8(3):9-14. Available from: aoa/healthwatch/oct_13/print3.pdf 7. Cooper LZ, Larson HJ, Katz SL. Protecting public trust in immunization. Paediatrics [Internet]. 2008 July [cited 2016 May 3];122(1):1-5. Available from: h t t p : / / w w w. c h i l d r e n s m e r c y. o r g / C o n t e n t / uploadedfiles/AAP_Immunization.pdf 8. Immunising your children [Internet]. Place unknown. Australian Government Department of Human Services; 2016. About childhood immunisation register; 2016 Feb 26 [cited 2016 Feb 28]: Available from: http://www.humanser subjects/immunising-your-children 9. Vaccination matters [Internet]. Queensland, Australia. Queensland Government; 2015. Childcare requirements; 2015 [cited 2016 Feb 28]: Available from: 10. No jab no play [Internet]. Victoria, Australia. State Government of Victoria; 2015. No jab no play; 2015 [cited 2016 Feb 28]: Available from: https://www.

5. Immunise Australia Program [Internet]. Place unknown. Australian Government Department of Health; 2015. About the program; 2015 Apr 20 [cited 2016 May 3]: Available from: immunise/publishing.nsf/Content/about-the-program medical students worldwide | AM 2016, Mexico

August 2016

Half-way Through the Decade of Vaccines

Are we going in the right direction?

Ema Causic & Hana Lucev

IFMSA Program Coordinators on Children Health and Rights & Healthy Lifestyles and Non-Communicable Diseases, Collective recognition of vaccines as the most powerful and cost-efficient public health measure has led to development of global and regional action plans and objectives for the Decade of Vaccines (2011 - 2020). Developing the plans has brought together multiple stakeholders involved in immunization, including governments, health professionals, academia, global agencies, development partners, civil society and media. As a result, the Global Vaccine Action Plan (GVAP) was created and proposed as a framework for future actions in extending the full benefits of immunization. GVAP has set ambitious but achievable goals ahead of us, with a list of strategic objectives that will help us accomplish them, and act as a guidance for actions that will lead towards reaching the goals. 4 out of 5 goals in GVAP for the Decade of Vaccines are: achieve a world free of poliomyelitis; meet vaccination coverage targets in every region, country, and community; meet global and regional elimination targets; develop and introduce new and improved vaccines and technologies. If these immunization-specific goals are achieved, immunization will contribute to another goal of GVAP: to exceed the Millennium Development Goal 4, target for reducing child mortality (and the Sustainable Development Goal 3 that succeeds it). Achieving the goals of the decade of vaccines will only be possible if all stakeholders take action and regularly monitor and evaluate the process towards the six strategic objectives. First being ‘all countries commit to immunization as a priority’ with a presence of a legal framework or legislation that guarantees financing for immunization. It is necessary for the individuals and communities to understand the value of vaccines and demand immunization as both their right and responsibility. This objective stresses the importance of understanding both the benefits and risks of immunization, as well as the



demand and the level of public trust in immunization. The Objective that the benefits of immunization are equitably extended to all people, needs to cover gaps between low, middle and high income countries, including discrepancies between urban and rural areas. Furthermore, populations who carry heavier disease burden need to be reached (eg. transitory migrant populations, people affected with natural disasters and conflicts). Strong immunization systems are an integral part of a well-functioning health system - this objective implies the introduction of new vaccines in national immunization programs, regulation of information and supply chain systems, human resources and overall program management. The complexity of the system requires multidisciplinary approach and attention, in order to build a cohesive and well-functioning program. Another objective was that immunization programs need to have sustainable access to predictable funding, quality supply, and innovative technologies. Some of the strategies to enhance access to affordable vaccines worldwide include promoting price transparency, increasing competition through an expanded manufacturer base and creating new models of vaccine development. And finally, the last GVAP objective is that country, regional and global research, and development innovations need to be maximized for the benefits of immunization. In 2015, SAGE (Strategic Advisory Group of Experts on Immunization) made an Assessment Report to evaluate the progress of the GVAP and how does it stand in terms of reaching the goal for 2020. Good progress has been made in some countries, but there are still two major problems which are holding back the progress.

( M S I 34 ) One of them is the need for further implementation and resourcing of neonatal and maternal tetanus, measles and rubella. Tetanus is a bacteria which can not be eradicated, but simple measures of clean birth and umbilical cord, together with mothers’ vaccination, can make it preventable. Unfortunately, at this point, there are 24 countries which did not reach the target of eradication by the end of 2015, which was set as one of the GVAP goals. 6 of those countries are affected by their political situation, which certainly has an impact on their health care system.The bigger issue represents the funding gap, estimated at $130 million to eradicate maternal and neonatal tetanus all around the world. Compared to the money already spent for underused vaccination programs only in last year, this number is not so high. As for measles and rubella, the plan was to ensure eradication of rubella in at least two WHO regions by 2015, but only the Americas Region succeeded. The others are missing their target, don’t have an established elimination goal or don’t have a set timeframe at this point. The vaccination rate for rubella is only 46% around the world, and there are still 54 countries which don’t include the rubella-containing vaccine in their national schedule.

in some countries, the political situation is slowing down the fulfillment of the goal. Weakening of the healthcare system and/or insufficient funding, pose limitations to successful vaccination coverage. External sources could provide the money, but there is an issue with sustainability of the process, since the healthcare system by itself is not working in the best way. At this point, every country should have their own vaccination plan, led by the regional framework and coordinated by GVAP. Current situation is the least beneficial to countries where the healthcare system is already falling behind and the inequity is widespread, making the population there more prone to communicable diseases. Immunization programs have led to an enormous decrease in morbidity and mortality rates from communicable diseases in the past, and are still highly relevant. However, the implementation of GVAP is still far off the track which implies that immunization issue has to be re-evaluated and tackled with greater effort and multi-level approach. We, as medical students, have the opportunity to be leading voices with the efforts that need to go beyond the Ministers of Health. We have to engage all stakeholders, communities, and families, for the purpose of achieving ambitious goals set out for us with the GVAP.

The Eastern-Mediterranean region, Europe, and Western Pacific set their goal to eradicate measles by 2015 as one of the GVAP goals. This was missed, since the need of 95% vaccination coverage for measles is still not achieved. As a matter of fact, it has flatlined for the past couple of years at 85%, and the measles are starting to flare up in already eradicated places, mostly due to imported cases from countries where vaccination rates are not high enough.

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This is not the only example of unsuccessful vaccination rates around the world. There are 7 countries in the world where more than 50% of children did not get their DTP3 vaccine and the current migrant crisis produces a lot of displaced children who do not get their scheduled vaccines. The second problem is the need for monitoring and accountability of GVAP since it has gaps which inhibit its real implementation. The accountability in the past few years has changed a little, still not enough to serve the GVAP in the ways it should. Unfortunately,

References (1) Global Vaccine Action Plan 2011 - 2020, WHO 2013. Retrieved from immunization/global_vaccine_action_plan/GVAP_ doc_2011_2020/en/ (2) 2015 Assessment Report of the Global Vaccine Action Plan - Strategic advisory group of experts on immunization. Retrieved from immunization/global_vaccine_action_plan/SAGE_ GVAP_Assessment_Report_2015_EN.pdf?ua=1 medical students worldwide | AM 2016, Mexico

August 2016

Vaccination Coverage

Among Medical Students

Mora-García Andres & Navarrete-Santiago Jose David

IFMSA - Mexico Veracruzana University The medical students interact with patients during their clinical rotations and internship, due to which they are constantly exposed to biological hazards. The occupational infectious risks of the HCWs justify the establishment of specific vaccine recommendations for these. Knowledge on occupational immunization is globally insufficient among healthcare students. Students are explicitly included in the definition of health care workers from the United States Centers for Disease Control and Prevention. If we choose to ignore this issue,then that may result in a fatal and costly outcome like a nosocomial outbreak. Do medical students fall sick? Yes, and I’m not talking about the medical school syndrome [1]. They interact with patients during their clinical rotations and internship, due to which they are constantly exposed to biological hazards. Yet, because their task is to learn about the sick and injured, and provide them the right kind of treatment, they usually view themselves as ‘immune’ beings to injury or illness. In fact, taking Mexico as an example, the coverage for Td vaccine among the population with more than 20 years of age is 67.3%, for MMR vaccine is 49%, and the people who have both of them comprise 44.7%, which is far from the 95% of the expected coverage. 45.6% of them do not have their National Health Cards [2]. Owing to their occupation, the health- care workers are at a constant risk of being exposed to infection.

This justifies the establishment of specific vaccine recommendations for those who directly provide care or work in institutions that provide care to patients, which also includes medical students that come in contact with patients or biologically hazardous material on a daily basis. If we choose to ignore this issue, it may result in a fatal and costly outcome, like a nosocomial outbreak. This could spread the disease in all the natal cities, we should remember that often the students come from various regions of the country or are foreign students [3,4]. In the United States, recommendations are edited by an advisory committee of the Centers for Disease Control and Prevention, whereas Europe does not have specific recommendations for health care workers at the European Union [5]. During the last influenza pandemic, many people, including the health- care workers, were reluctant to get the 2009 A/H1N1. Coverage rates were highly variable throughout the world, but several studies found that medical and nursing students had a rather high rate of vaccination, around 60%, compared to 40.3% for health- care workers in the United Kingdom and 9% for the general European population [5]. Was this coverage enough? A more aggressive vaccination policy could have avoided at least 1 of the 14,286 deaths [6]. Knowledge on occupational immunization is globally insufficient among healthcare students. Students of first year of medical or nursing school have often very poor knowledge on the vaccines and the diseases they can prevent[5]. In the project ‘Transmitiendo Prevencion’ (transmit prevention), the authors found that 66% of the medical students on the Universidad Veracruzana, Mexico, who are in their clinical rotations, could not identify the actual vaccination plan for adults. Every person involved in healthcare is worth his/her weight in gold. The WHO reported a global shortage of health personnels, which had reached crisis level in 57



( M S I 34 ) countries[7]. We cannot afford to lose any of them, because in some places the students act as a work force, while they are still learning. Some argue that occupational health and safety guidelines cannot be applied to students as they are not employees, but students are explicitly included in the definition of health care workers, as per the United States Centers for Disease Control and Prevention[8]. Often the students that are starting their clinical rotations have a more altruistic/ risky/ heroic pattern of behavior, placing benefits of the patient before his own. This is usually how a doctor’s role is projected in the media. However, a lot of freshers, who are new to the profession, tend to commit errors at times, with regards to taking adequate measures for protection, in order to avoid transmission of disease[9]. Should patients be considered priority before one’s self? Yes, but not at the cost of risking one’s own health in due course of treating an infected patient. Health protecting health-care workers and medical students contribute to provide quality patient care and health system strengthening[10]. The same measures to protect patients from infection, such as adequate vaccination, should be applied to healthcare workers and students as well, to protect them from diseases. Conclusions • Vaccination programs are an essential part of infection prevention and control for healthcare students. • In some places the vaccination coverage goals are not accomplished. • The responsibility to prevent occupationally acquired infections among persons in training, are vague. • Efforts should be made to educate medical students on vaccines.

References 1. Roger Collier, R. .G. Imagined illnesses can cause real problems for medical students. CMAJ-JAMC. 2008;178(7): 820. 2. José Luis Díaz Ortega, Elizabeth Ferreira, and fellows. Vacunación en adultos (20 a 59 años): una visión hacia la mejora de las políticas públicas. Mexico: Salud Pública de México; 2012. 3. Poland GA, Nichol KL. Medical students as sources of rubella and measles out-breaks. Arch Intern Med 1990;150(1):44–6. 4. Sienko DG, Friedman C, McGee HB, Allen MJ, Simonsen WF, Wentworth BB,et al. A measles outbreak at university medical settings involving health care providers. Am J Public Health 1987;77(9):1222–4. 5. Pierre Loulergue, Odile Launay. Vaccinations among medical and nursing students:Coverage and opportunities. Vaccine. 2014;32(32): 4855–4859. 6. “ECDC Daily Update – Pandemic (H1N1) 2009 – 18 January 2010” (PDF). European Centre for Disease Prevention and Control. 2010-01-18. Retrieved 2010-0118. 7. World health organization. The world health report 2006: working together for health. Geneva, Switzerland: WHO Library Cataloguing-in-Publication Data; 2006. 8. Centers for Disease Control and Prevention Immunization of health-care workers: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practice Advisory Committee (HICPAC). MMWR Recomm Rep 1997; 46 (RR-18): 1-42. 9. deVries B, Cossart YE. Needlestick injury in medical students. Med J Aust 1994; 60: 398- 400. 10. Ohn shimwell, edr/emro. Occupational health: A manual for primary health care workers.: World Health Organization (WHO); 2001.

• More rigid measures should be taken to ensure the protection of the students 14 15

medical students worldwide | AM 2016, Mexico

August 2016

How Anti-vaccination Movements Threat Public Health and the Role of Medical Student Journals Joana Branco Revés

ANEM/PorMSIC - Portugal NOVA Medical School Opposed to what is currently believed, anti-vaccination movements began long ago in the 19th Century, their foundation being strongly related to the first vaccination policies. Vaccination began in 1796 with Edward Jenner’s experiments. Although, Jenner did not discover vaccination, he was the first person to confer scientific status on the procedure1. However, vaccination was not accessible to all people by this time. Only in 1840, when the first Vaccination Act was published, were set up the first public vaccination services. In 1853, a new Vaccination Act was released making vaccination compulsory for all infants and settling some punishments for defaulting parents. For some, these commitments meant a threat to personal liberty and choice and so anti-vaccination movements contesting the sanctions predicted for conscientious objectors began2. These movements continued to grow around Europe and in 1885, a royal commission was convened to inquire and report the consistency of anti-vaccinationists’ objections, and the usefulness and safety of vaccination. In its final report in 1896, the commission demonstrated the efficacy of vaccination, but recommended the abolition of cumulative penalties due to non-compliance with these laws2, 3. More recently in 1998, Andrew Wakefield and 12 of his colleagues published a case series in The Lancet suggesting a connection between the administration of MMR vaccine and the occurrence of autism and some forms of colitis. However, immediately afterwards, epidemiological studies were conducted refuting the proposed link, and 10 of the 12 co-authors of the paper retracted their interpretation of the original data. Moreover, it was also soon unveiled that Wakefield had failed to disclose a major conflict of interest - he was receiving a remuneration of 81.800 euros by lawyers who had been engaged in lawsuits against vaccineproducing companies. The Lancet completely retracted Wakefield’s paper in February 2010, and he was guilty



of serious ethical violations, scientific misrepresentation and deliberate fraud, being restricted from practising medicine in the UK3, 4. As seen, anti-vaccination has been a highly discussed topic throughout times. However, its impact on society has exponentially grown due to current improvements on information sharing, particularly on social media, allowing the dissemination of anti-vaccine ideals. Most of these ideals are parents’ reports of what they believed to be a vaccine reaction3, 5. Nonetheless, through a brief review of published medical literature on the subject, not even a single reference is seen arguing in favour of antivaccination movements, proving how these arguments lack scientific support. Despite, major improvements on information sharing, the arguing basis of these groups has remained nearly unchanged2. (See Table 1 for the most common objections to vaccination and their counterarguments). Regardless of being discredited in medical literature, anti-vaccination movements seem to be leading to a significant impact on vaccination intentions, as seen in one study where beliefs in anti-vaccine conspiracy theories were demonstrated to be associated with reduced vaccination intentions7. Other study also provided strong evidence of a causal relationship between movements against whole-cell pertussis vaccine and pertussis epidemics by comparing two groups of countries with different attitudes towards pertussis-vaccination8. Thus, vaccination conspiracy theories have led to the introduction of a new concept of ‘vaccine hesitancy’ defined by WHO as a ‘delay in acceptance or refusal of vaccines despite availability of vaccination services, including factors such as complacency, convenience and confidence9.’ Moreover, due to the increased relevance of this subject, vaccine hesitancy and demand for immunization became one of the monitoring results addressed in the Global Vaccine Action Plan (GVAP), which is a framework adopted at the Sixty-fifth World Health Assembly in May 2012, with the mission of

( M S I 34 ) Table 2 - Top three reasons reported for vaccine hesitancy by high-income and middle and low-income countries Top three reasons reported for vaccine hesitancy High-income countries

Middle and low-income countries

Risk/Benefit (23%)

Knowledge/Awareness (18%)

Beliefs, attitudes about health and promotion (15%)

Risk/Benefit (17%)

Religion, Culture, Gender and socioeconomic factors (8%)

Religion, Culture, Gender and socioeconomic factors (12%)

improving health by eliminating vaccine-preventable diseases until 2020. In order to fulfil this mission and to extend the benefits of immunization to all people, the GVAP has set five goals and six strategic objectives10.

One of the strategic objectives addressed in these campaigns for immunization demand, intends to highlight the importance of seeing immunization both as a right and as a responsibility. As so, two indicators used

Table 1 - Most common objections that anti-vaccine advocates express regarding vaccines and their responses Free adaption from Bedford et al. Concerns about immunization. BMJ 2000;320:240–3 Objection

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The disease is not serious

Measles can kill healthy children.

The disease is uncommon

Diseases such as measles, diphtheria,and polio are common in the unimmunised population and can easily spread worldwide. Vaccination achievements and its impact on disease pattern has lead to this misconception.

The vaccine is ineffective

Before their introduction, all vaccines undergo rigorous trials to show that they are effective.

Large pharmaceutical companies and governments are covering up information about vaccines to meet their own sinister objectives.

As other conspiracy theories, vaccination conspiracy theory tends to be associated with a mistrust of science. However, there is overwhelming scientific evidence that vaccines are effective, safe, and necessary.

The vaccine is unsafe.

Before their introduction, all vaccines are assessed for safety,and monitoring continues after their introduction.

Other methods of disease prevention, such as homoeopathy, are preferable over immunization.

The Faculty of Homoeopathy supports the use of orthodox vaccines — there is no evidence that homoeopathic vaccines confer long term or short term protection.

Vaccination leads to overloading or damaging of the immature immune system.

Vaccines have a carefully controlled dose of antigen that is small compared to the number of antigens that infants are exposed to daily.

medical students worldwide | AM 2016, Mexico

August 2016 to monitor vaccine confidence were developed, being the first one dedicated to assess the top three reasons for vaccine hesitancy and the second one devoted to determine the level of hesitancy in vaccination at the national or subnational level. The first indicator allows the monitorization of determinants of vaccine hesitancy over time and the second one allows the visualization of the trend in the percentage of Member States that have assessed confidence in vaccination at subnational level10, 11. Regarding the reasons for vaccine hesitancy, they may be allocated into three different categories - Contextual influences; Individual and group influences and Vaccinespecific issues - each of these divided in specific subcategories, such as “fear of side-effects of the vaccination, lack of knowledge of vaccination programmes, low perceived risk of vaccine-preventable disease, religious reasons and the influence of anti-vaccination reports”. Although it is sometimes assumed that vaccine hesitancy is only a concern of high income-countries, due to the role of media and anti-vaccination lobbies, it is interesting to notice through this results the similitude of reasons expressed by high-income, and middle and low-income countries for vaccine hesitancy (Table 2), proving that this is a subject for global concern11. As seen, there are many reasons leading to a reluctance to vaccinate which is mining the proven benefits of vaccination on society’s health. Nevertheless, misinformation and misconceptions about the severity and prevalence of vaccine-preventable diseases are still key aspects of these movements. It is the responsibility of health care workers and medical students to spread scientific based information, in order to facilitate decisionmaking experience in the context of overwhelming and contradictory vaccine information. Indeed, medical journals, particularly medical student journals, may have a central role in this process. AMP - Student, which is a recent section of Acta Médica Portuguesa, the scientific journal of the Portuguese Medical Association, and the only medical student journal in Portugal, is already dedicated to the spread of reliable scientific information on vaccines, through the publication of online posts in this subject, intended to inform the youngest population and to allow them to deconstruct some of the arguments of the anti-vaccination movements. It is crucial to restore and ensure strong ties between the medical and scientific community, and general public.



References (1) Riedel S. Edward Jenner and the history of smallpox and vaccination. Proc (Bayl Univ Med Cent). 2005;18:21-25 (2) Wolf RM, Sharp LK. AntiVaccinationists past and present. BMJ. 2002;325:430-2 (3) Tafuri S, Gallone MS, Cappelli MG, Martinelli D, Prato R, Germinario C. Addressing the anti-vaccination movement and the role of HCWs. Vaccine. 2014; 32:4860–4865 (4) Rao TSS, Andrade C. The MMR vaccine and autism: Sensation, refutation, retraction, and fraud. Indian J Psychiatry. 2011; 53:95–96 (5) Shelby A, Ernst K. How providers and parents can utilize storytelling to combat anti-vaccine misinformation. Hum Vaccin Immunother. 2013. 9:1795-1801 (6) Bedford H, Elliman D. Concerns about immunization. BMJ. 2000;320:240–3 (7) Jolley D, Douglas KM. The Effects of Anti-Vaccine Conspiracy Theories on Vaccination Intentions. PLoS One. 2014; 9 (8) Gangarosa EJ, Galazka AM, Wolfe CR, Phillips LM, Gangarosa RE, Miller E, et al. Impact of anti-vaccine movements on pertussis control: the untold story. Lancet. 1998; 351:356-61 (9) World Health Organization (WHO). Immunization, Vaccines and Biologicals: Addressing Vaccine Hesitancy. Geneva: WHO; 2015. Available from: http://www. hesitancy/en/ [accessed 11/02/2016] (10) World Health Organization (WHO). The global vaccine action plan 2011–2020. Geneva: WHO; 2013. Available from: http://www.who. int/immunization/global_vaccine_action_plan/ GVAP_doc_2011_2020/en/index.html [accessed 14/05/2016] (11) World Health Organization (WHO). Global Vaccine Action Plan - Secretariat Annual Report 2015. Geneva: WHO; 2015. Available from: http://www. gvap_secretariat_report_2015.pdf?ua=1 [accessed 14/05/2016]

( M S I 34 )

From Smallpox Eradication to the Global Vaccine Action Plan

Amine Lotfi

Regional Assistant for Capacity Building for the EMR IFMSA - Morocco Faculty of Medicine and Pharmacy of Casablanca Smallpox was one of the deadliest diseases known to humans, afflicting millions each year regardless of age, race, or socioeconomic status, but it is also the first human disease to have been eradicated by vaccination. Eradication of smallpox has been called one of humanity’s greatest triumphs, and has been accomplished through a global immunization campaign led by the World Health Organization (WHO). However, it all started with a tale. A tale that was popular in 18th century rural England, where dairymaids were said to be naturally protected from smallpox after having suffered from cowpox, a viral disease of cows’ udders which, when contracted by humans through contact, resembles mild smallpox. This tale stirred the curiosity of Edward Jenner, an English physician and scientist, who postulated that cowpox not only protected against smallpox but also, could be used as a deliberate mechanism of protection against that deadly disease. Indeed, at that time in Europe, 400,000 people died annually of smallpox, and one third of the survivors went blind.1 In May 1796, Jenner inoculated a young boy with cowpox, then, after he recovered, inoculated him with smallpox. The boy didn’t develop the disease, which confirmed Jenner’s theory. The Latin word for cow is vacca, and cowpox is vaccinia; Jenner decided to call this new procedure vaccination.

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From Jenner’s experience to smallpox eradication, the road was long and tricky. Vaccination alone was insufficient to eradicate the disease. Due to vaccination, mortality from smallpox declined in many countries, but recurrent epidemics in Africa and the Indian subcontinent showed that the disease was still not under control. In the early 1950s, 150 years after the introduction of vaccination, an estimated 50 million cases of smallpox still occurred in the world each year.2

What was needed at that time was a global coordination mechanism, as well as international political will to eradicate the disease. It happened in 1958 when Professor Viktor Zhdanov, Deputy Minister of Health for the Soviet Union, called on the World Health Assembly - the highest governing body of the WHO, to undertake a global initiative to eradicate smallpox. The proposal (Resolution WHA11.54) was accepted in 1959.3 The reasons why smallpox was a suitable candidate for eradication were the absence of reservoirs or vectors other than humans, the distinctive rash making it easy to diagnose, and the efficiency of a single vaccination, that could provide immunity for at least a decade. In 1967, the World Health Organization launched the Smallpox Eradication Program (SEP), and a new surveillance-containment strategy called ‘ring vaccination’, was successfully implemented to control smallpox. when an infection was diagnosed, all people who were or may have been exposed were identified and vaccinated. This strategy worked and led to a major discovery; the disease could be eradicated without vaccinating every single person. Furthermore, endemic countries were supplied with vaccines and kits for collecting and sending specimens, and vaccination was made easier by the provision of the bifurcated needle. In 1977, the last case of smallpox was reported in Somalia. For the first time, a major disease has been completely eradicated. Dr H. Mahler, WHO Director General at that time, described the Smallpox Eradication Program as “a triumph of management, not of medicine.” Finally, on 8th May 1980 and after two years of surveillance and searching, the eighth plenary meeting of the thirty-third World Health Assembly declared that smallpox had been eradicated globally by adopting the resolution WHA 33.3, which declares solemnly that “the world and its people have won freedom from smallpox, which was the most devastating disease sweeping in epidemic form through many countries since earliest medical students worldwide | AM 2016, Mexico

August 2016 time, leaving death, blindness and disfigurement in its wake and which only a decade ago was rampant in Africa, Asia and South America.”4 There are a lot of lessons to be learned from the smallpox eradication programme. Much of its success is attributed to political commitment and leadership from the WHO. Moreover, benefits of eradication are far greater than illness or death prevention. Monetary benefits can be substantial, with a study estimating that if measles were eradicated by 2010, the United States could save $500 million to $4.5 billion.5 Eradication programmes have also the potential to further develop and strengthen health systems functions, such as surveillance, human resource development, management, health infrastructure, and contribute to other improvement in public health.

right to health. Ultimately, we, as future health workforce and providers of immunization, must take responsibility in achieving this vision. After all, our role will be to facilitate the implementation of the Global Vaccine Action Plan by providing high-quality immunization information and services to our communities, ensuring a safe and healthy future for all.

References 1. Barquet N, Domingo P. Smallpox: the triumph over the most terrible of the ministers of death. Ann Intern Med. 1997;127(8 Pt 1):635–642. [PubMed] 2. “Smallpox”. WHO Factsheet. Archived from the original on 2007-09-21.

We are not more than halfway through the Decade of Vaccines envisioned by the 65th World Health Assembly, laid out in the ambitious primary goal of the Global Vaccine Action Plan (GVAP) which is “extending by 2020 and beyond the full benefits of immunization to all people, regardless of where they are born, who they are, or where they live.”6 In order to achieve this vision, increased coordination among the partnership of actors is needed, emphasizing on providing support to national government towards investing in health, immunization programs and human and institutional resources.7 Low and middle income countries will need technical and financial support now more than ever, in order to achieve universal access to immunization for their populations, which will improve the lives of millions of people around the world. The global health community, with the World Health Organization as leader, should work along with all partners – governments, health professionals, academia, manufacturers, global agencies, development partners, civil society, media and the private sector – to ensure immunization becomes a core component of the human



3. Fenner, Frank (1988). “Development of the Global Smallpox Eradication Programme”. Smallpox and Its Eradication (History of International Public Health, No. 6). Geneva: World Health Organization. pp. 366–418. ISBN 92-4-156110-6. 4. Pennington H (2003). “Smallpox and bioterrorism”. Bull. World Health Organ. 81 (10): 762– 7 5. Miller MA, Redd S, Hadler S, Hinman A. A model to estimate the potential economic benefits of measles eradication for the United States. Vaccine. 1998;20:1917–1922. 6. World Health Organization. Geneva: WHO; 2013. Global Vaccine Action Plan 2011–2020. Also available from: URL: immunization/global_vaccine_action_plan/GVAP_ doc_2011_2020/en/ 7. Department of Health and Human Services (US), National Vaccine Advisory Committee. Enhancing the work of the Department of Health and Human Services National Vaccine Program in global immunization: recommendations of the National Vaccine Advisory Committee. Public Health Rep. 2014;129(Suppl 3):12– 85.

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The Global Rise of the “Anti-Vaxxers” Bhavi Trivedi

Medical Students’ Association of India Smt. NHL Medical College

An increasing number of parents have been refusing to vaccinate their children. This is largely due to the work of ‘anti-vaxxers’, groups of campaigners against immunization, whose message has been spreading, and with it, diseases. The members hold onto largely disproven beliefs like vaccines cause autism or can overload a child’s immune system, and that ‘natural’ immunity is better than immunity acquired from vaccines. For some, it is an issue of risk versus benefit, why take the small risk of the vaccine if the disease isn’t around? Just like many medicines, vaccines have the potential to cause adverse reactions in a small number of people, but the accepted scientific research shows that the benefits far outweigh the risks. Vaccines help the body develop immunity toward certain pathogens by imitating an infection. This imitation does not cause sickness. Instead, it helps the body recognize and prepare to fight against certain vaccinepreventable diseases. These disease fighting injections boost individual, as well as, the community or herd immunity. When most of the population is immunized against a disease, its spread falters, indirectly giving protection to the immuno-compromised, pregnant women and infants who are unable to receive certain vaccinations.

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That leaves us with few questions. Why is there still an anti-vaccination movement given the tremendous amount of research in favor of vaccination? What fuels it? The movement stems from the work of Andrew Wakefield, a gastroenterologist, who in 1998, published a falsified research in a British medical journal, the ‘Lancet’ that linked the measles vaccine to the rise of autism. His work was discredited and his medical license was revoked, but the damage had already been done. Vaccination rates dropped all over Europe and his theory lived on the internet and

even among some highly educated people who distrust mainstream medicine. During the 2015 measles outbreak in America, the Republican Party politicians, who represent the group of Americans known to be conservative and for prosmall government, spread anti-vaccination messages. New Jersey Governor Chris Christie and Kentucky Senator Rand Paul announced that they believe parents should be allowed to choose whether or not they want to vaccinate their children. Christie told reporters that parents should have ‘some measure of choice’ in the matter and Paul claimed the decision was ‘an issue of freedom’. In a recent debate, the republican presidential nominee, Donald Trump breathed life into this movement by embracing the false claim that vaccines cause autism. This new trend in science and politics goes to exemplify the success of the anti-vaccination movement. William Schaffner, Chair of the Department of Preventive Medicine at Vanderbilt University in Nashville, Tennessee, has rightly said that “We have become prisoners of our own success”, whilst referring to the fact that most mothers do not know what measles is and as they do not see it as a threat, their children go unvaccinated. The resonance of the anti-vaxxers message can be heard throughout the international community and skepticism about the safety and effectiveness of vaccines is on the rise. A World Health Organization working group was created to study the phenomenon of vaccine hesitancy, which was defined as adelay in acceptance or refusal of vaccines despite availability of vaccine services. After more than two years of work, they found that it is ‘complex and context-specific, varying across time, place and vaccines’. The anti-vaccination epidemic has taken a hold of the entire globe as evident by the several countries, both developed and developing, that have had to deal with this problem in the recent past:

medical students worldwide | AM 2016, Mexico

August 2016 Nigeria In 2003, political and religious leaders encouraged citizens to stop taking polio vaccinations in order to oppose the efforts of the West. Although there was nothing wrong with the batch of vaccines, the leaders claimed that anti-fertility, HIV, and cancerous agents were mixed in the vials. This resulted in a sharp drop in vaccinations and polio cases ensued. India The district health administration of Malappuram, Kerala, has been persistent in its efforts to eradicate diseases such as diphtheria that are still prevalent in their community. Unfortunately, two locally powerful and orthodox groups have been leading a successful resistance against immunization. “It is hard to convince the opposers, who claim themselves to be educated” says the District Medical Officer, V. Ummer Farook. Thus, thousands of children are left un-immunized and some of them die every year of vaccine preventable diseases. This problem is not restricted to that particular district; cases like this are tragic commonalities in districts throughout India. United Kingdom In UK, religion is playing a role in acceptance of vaccines. Prominent Muslim doctors in United Kingdom have raised objections against the use of porcine gelatin, which is used to stabilize nasal flu vaccine, as their religion prohibits the consumption of pork. This led to a drop in vaccinations among the Muslim community. Brazil After recognizing the success of the Tdap vaccine which provides immunity against diphtheria, tetanus and pertussis in pregnant women in the United States and United Kingdom, Brazil adopted it into its own immunization plan. It was introduced just months before the outbreak of Zika- virus which led conspiracy theorists and anti-vaxxers to propagate false claims that the vaccine caused the virus. The World Health Organization hopes to tackle the problem of anti- vaxxers through the Global Vaccine Plan of Action. They plan on conducting communications and social research to identify people’s concerns against vaccinations specific to different countries. To address the concerns and promote immunization, they will draw on the experiences of other innovative public health campaigns and take advantage of social media and new internet technologies. Multisectoral approaches such as including lessons on vaccines



and immunization in primary school education curriculum, and female education and empowerment will also help improve utilization of immunization and health services in general. Hopefully through these efforts people will soon realize that, “The science is clear: The earth is round, the sky is blue, and #vaccinework”.

References • S.W. Roush, T.V. Murphy, Vaccine-Preventable Disease Table Working Group, Historical Comparisons of mortality and morbidity for vaccine-preventable diseases in the United States, JAMA, 298 (2007), pp. 2155–2163 • R.T. Chen, B. Hibbs, Vaccine safety: Current and future challenges, Pediatric Annals, 27 (1998), pp. 445–455 • E.W. Campion, Suspicions about the safety of vaccines, N Eng J Med, 347 (2002), pp. 1474– 1475 • “What’s behind the ‘anti-vax’ Movement?” BBC News. N.p., 5 Aug. 2015. Web. 6 June 2016.

Rex Crossley Awards

Rex Crossley Awards (RCA) are an award provided by IFMSA in recognition of the work and achievements of the best Activities of IFMSA National Member Organizations. You can find the top ten submissions to the AM2016 Rex Crossley Awards in the upcoming pages!

( M S I 34 )

Introduction to Rex Crossley Awards Petar Kr. Velikov

IFMSA Vice-President for Activities 2015-2016

Back in 1951 Rex Crossley became the first IFMSA President. In his honor and out of the need for recognition of the hard work of IFMSA NMOs, the Rex Crossley Awards were born as an IFMSA Transnational Project during the 52nd March Meeting General Assembly in Parnu, Estonia. Today RCA are an award provided by IFMSA in recognition of the work and achievements of the most impactful Activities of IFMSA National Member Organizations. The awarded Activities have meaningful impact on the local, national and/or international society. During the 65th August Meeting General Assembly we have pre-selected 10 Activities to compete for the Rex Crossley Awards. Each of the Activities will be presented during the General Assembly as part of the RCA Presentations. The Activities will be judged based on their design, quality of implementation, evaluation methodology and impact on society by the IFMSA Standing Committee Directors of the 6 Standing Committees. In the next pages you can read an introduction to each of the top 10 Activities in IFMSA for the 65th August Meeting General Assembly! Warm regards, Petar Velikov

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medical students worldwide | AM 2016, Mexico

August 2016

Circle of Health Katja Cic

SloMSIC - Slovenia

Cardiovascular diseases are the 1st most common cause of death amongst men and women on a global scale and are also the number one killer disease in Slovenia. They are a large health, social and economic burden, for the patients, doctors and the whole health system. A characteristic of chronic cardiovascular diseases is that they are caused by risk factors from unhealthy lifestyle spectrum and also biological risk factors, such as high blood pressure, elevated cholesterol and blood sugar levels, as well as obesity. CVDs occur insidiously, so that their beginning in the individual is often not noticed early enough. Because of these chronic diseases that affect mostly adults, but can start as early as in newborns, have a large influence on premature dying and deteriorating quality of life. Therefore, it is important to discover early risk factors, promote the meaning of prevention and recognize those individuals who are more at risk to suffer from these diseases. By adopting a healthier lifestyle, accepting changes and conducting quality screenings a large part of risk factors could be controlled and preventing and treating CVDs would become easier and more effective. According to a research conducted by the National Institute for Public Health in Slovenia that included

more than 500 000 individuals, more than 5% of them had an already established advanced form of CVDs (heart attack, angina, stroke, etc) a form of premature cardiovascular disease was found in about a quarter of those reviewed. 22,8% of the individuals involved in the research were smokers, physical activity of 46,4% was highly inadequate, 30% were obese. Very worrying is also the situation in areas of excessive levels of cholesterol in the blood – found in 69,2% of all individuals, and high blood pressure, which was measured at 34,6% of screened people. All the data shows a high prevalence of risk factors for CVDs and determines CVDs as the leading cause of morbidity and mortality in the developed world, their frequency also increasing in less developed countries. The project Circle of Health operates under the auspices of a larger project umbrella called “Think of Your Heart.” We are aware that the fight against CVDs is laborious and slow, and also that healthcare professionals need a lot of patience and strategy to deal with this problem. Circle of Health is a one-day event, with 20 stands placed in a circle (hence the name) in the center of the capital city, dedicated to raising the awareness about cardiovascular diseases and their issues, prevention and risk factors, as well as offering passers-by free measurements of cholesterol, blood sugar, pressure, body fat, CO content in exhaled air and Ankle-Brachial Index Test. Members of the project also carry out a flashmob – a simulation of a heart attack, First Aid and AED use in the middle of a crowd, thus effectively bringing the issue closer to the laic population. With this event and it’s activities we are able to reach people of all ages and spread the knowledge about CVDs and prevention even further, convincing the people of the benefits of a healthy lifestyle and it’s positive impact on our health and future.



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Health: Everyone’s Right Ana Pamela Gómez Sotomayor ODEM - Dominican Republic

Can you imagine being able to eradicate preventable diseases such as Hepatitis B, Poliomyelitis, and Tetanus? Together, we can! The Standing Committee on Human Rights and Peace (SCORP) of Organización Dominicana de Estudiantes de Medicina (ODEM) – IFMSA Dominican Republic, started the national project “Health: Everyone’s Right” with the support of the country’s Expanded Program on Immunizations. This World Health Organization program is present all over the world. With your health and our added medical student involvement project, we may be able to eradicate diseases off of the face of the planet! The purpose of this project is to reduce the incidence of preventable diseases while promoting the Right to Health by providing free vaccinations in different sectors of the Santo Domingo city. With help from your country’s EPI, it is easily reproducible and adaptable to your context. Would you like to take part in it? Through it, we have trained just over a hundred students from five medical schools in the country. Who have collaborated in three phases to administer vaccinations to more than a thousand participants of neglected communities, as well as school children, pregnant women, teenagers and university students, faculty members and workers of the country’s capital.

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With four vaccine outreach programs so far, SCORPODEM looks to recruit new SCORPions by giving students the opportunity to develop their general and pediatric clinical skills while promoting a humanitarian perspective that recognizes inequality and protects rights in the doctor-patient relationship. Our member and non-member volunteers were trained in history and progress of immunization in the Dominican Republic as well as fundamental concepts and vaccination techniques by the Expanded Program on Immunization (EPI) on February of 2015. Currently, we are working to develop the program as a permanent outreach in the two campuses of Universidad Nacional Pedro Henríquez Ureña (UNPHU) to reach even more community members with this preventive medicine initiative under the supervision of licensed nurses and medical doctors. The focus vaccines we have provided are: Hepatitis B, Diphteria, Tetanus, Whooping Cough, Poliomyelitis and Influenza. We were also able to provide vitamins and deworming medicines to pediatric participants. SCORP-ODEM considers developing projects that allow medical personnel to give health services characterized by their excellence and efficiency as well as providing and raising awareness between the population of their rights as patients as an essential NMO objective. Do you agree? The national project Salud: Derecho de Todxs (Health: Everyone’s Right) is being led by UNPHU-LORP Ana Pamela Gómez along with UNIBE Graduate Dr. Gabriela Urcuyo. Our hope is that other NMOs across the world will be interested in reproducing our project in their countries so that together we can advance de Global Vaccine Action Plan goals! For more information,




medical students worldwide | AM 2016, Mexico

August 2016

Inside Out Hana Lucev & Katarina Mandic CroMSIC - Croatia

How often, during your lifetime, have you heard that you have to take care of your mental health? Do you have any idea what does that actually mean? To be honest, one year ago, when somebody asked us about that, we didn’t have any clear definition to share. We had some ideas, but there wasn’t any secret formula that could indicate whether we are on the right track or not. During that time, when we started thinking about this project, the only thing we had in mind were all those young people struggling with everything happening in their heads and in their lives during their adolescence. We saw ourselves, and the fights we fought during those years. We saw young people that couldn’t find a way to deal with all of that and tried to run away from themselves - into addiction, loneliness or even death. It didn’t took us much to decide to find a way to help them. We designed series of workshops, lectures and trainings with one ultimate goal – to give high school students an opportunity to discover what mental health is to them. Workshops, led by educated medical students, were a tool that enabled students to take a minute, stop with everything they are doing and take a closer look inside them. In order to discover what is mental health to them, they were supposed to think about their emotions, behavior in different situations, their habits and relationships, and understand what stands behind all of that. That process of understanding themselves was the key for self-development. Sounds easy, huh?



Actually, there isn’t anything that hard as facing your inner self, especially when it comes to things you are embarrassed about, hard times in your live or some disappointments you had to face. But at the same time there isn’t anything more inspiring than realising that you found a strength not only to accept your past, but to accept your true self.

That was the experience we’ve had with this project, and it was better than we could ever dream of. After finding a strong team of students that were educated to give peer–to-peer workshops to high school students, and started finding support we were surprised by the number of partners and doctors contacting us, people that recognized the existing need for tackling this issue and the quality of project itself. Everything was designed to answer students needs, and we made sure that the evaluations and questionnaires they were given were giving them the opportunity to express whether they honestly think they benefited from the participating or not, and numbers we got were just a confirmation of something our educators realized during every workshop – that we often forget about ourselves and our mental health, and think that we have to do something special to be happier person, but honestly you just have to do one thing – take a look inside yourself and find something special that moves you. And work with that. Inside out.

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Invisible Ones Hellen Meira Gois IFMSA - Brazil

Vulnerable social groups are a minority who do not have equal access to universal goods and services, they suffer social, material and psychological exclusion. Social exclusion is constructed through a cycle of poverty which includes unemployment, violence, social injustice, social disqualification, educational inequality and precarious health maintenance. These groups are excluded from public policies, even the health related ones. Their health is worsened when we pair their difficult access to the health system with their miserable life style. The local committee IFMSA Brazil UFMT, through Atenção Integral a Grupos Sociais Vulneráveis project, intervened on two vulnerable social groups, due to local demand: street people, through clinical care and health promotion, and young offenders in fulfillment of socio-educational measures, through lectures on sexuality education, in Cuiabá. To intervene and track the main diseases in homeless people, as hypertension, STDs, tuberculosis, leprosy, among others, the project members had two months of theoretical preparation. Along 6 months, we realized 6 interventions with street people until now. We have talked to them about STDs and infectious diseases prevention and provided clinical care, focusing on mental health evaluation.

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Concerning to the teenagers, complementing their social educative measures, we discussed sexuality education. Such program intended to provide adequate knowledge about sexuality, allowing them to reintegrate society with a healthier sexual life. To evaluate their previous knowledge and the effectiveness of our action, it was applied a questionnaire before and after the activity.

besides health professionals, totalizing 46 members. The participants gained lots of knowledge through theoretical capacitation, but mainly through the health care we provided to the homeless. 79 people were attended. It was observed, through a partial analysis of our data, the prevalence of: infectious diseases (16%), ophthalmologic problems (10%), dermatologic affections (10%), neuropsychiatric diseases (8%), chronic disease (7%), nutritional alterations (6%), allergy (5%), back pain (5%), physical trauma (5%), gastric disturbs (5%), headache (3%), others (19%). During the intervention, 51% of the problems were solved. 25 young offenders participated of our action. Only 20% participants had adequate knowledge about sexual organs anatomy and physiology, presenting an improvement of 11,25% after the intervention. Regarding to knowledge about sexual acts and fecundation, there was an increase from 34% to 50%. Only 38% knew how to make an adequate intimal hygiene. They presented a better knowledge about STDs symptoms and preventions, with 78% hits. Regarding to our job with the homeless, we concluded it is necessary a better understanding of the social dimension of this group, so the public policies are improved. Our intervention was an ancillary measure, that did not answer all of its group demand. We expect that our data collection helps the construction of specific health policies. Through sexual health lectures, the adolescents had the opportunity to solve their doubts on sexuality, however, to obtain a better impact on their consciousness about safe sex and others sexuality aspects, it is necessary a longer intervention.

As results of our project, we observed an academic integration among medical, nursing, psychology, public health and nutrition graduation students, medical students worldwide | AM 2016, Mexico

August 2016

Knowledge Attitude Practice Study Chinmay Jani

MSAI - India

Diabetes is one of the major non communicable disease affecting a huge population of the world and also India. It affects many different organs of our body. The macro and micro vascular disorders are main amongst them. Knowledge Attitude and Practice study of diabetic retinopathy and awareness programme is aimed at creating awareness about the various hazard of diabetes which the people are still not aware about. The medical students took the task of going into the community,urban as well as rural, focusing the population of various economic strata of the Indian community. With the help of different power point presentations, posters and various other materials, they tried to create awareness amongst the community regarding the same. It was found that even the diabetic population were not aware about the regular eye examination for prevention of the diabetic retinopathy. Awareness was created for the prevention of the disease rather than the cure. Its a common practice observed that the patients will go to an ophthalmologist when their vision starts getting affected, but in such cases the disease has already entered into the proliferative stage. Our goal behind this event is to collect data from all the states of the countries and based on the analysis, plan for the further campaign of decreasing the prevalence of the retinopathy by imparting proper knowledge. Currently we have collected data if 1200 in 15 days



from 9 different states. Our aim is to collect data of atleast 3000 people by the end of 4 months from entire country. We have used validates Knowledge Attitude Practice questionnaire of diabetes and diabetic retinopathy as it contains all three different aspects related to the disease. It will also help in comparing the information available between the diabetic and non diabetic population of the community. We will also inform the helath ministry of the Indian government and take help of the media to spread more awareness even to the most remote place of this country. It still happens in the rural part of the country, where diabetics are yet not aware about their condition because of lack of information. We want to eradicate that condition using our project and make India a better place to live in.

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NCDs Combating Tobacco Consumption Omnia Ibrahim IFMSA - Egypt

NCDs are a massive burden, in many countries including Egypt and are a truly rising burden. Specifically going to tobacco consumption, it is of a huge threat to know that tobacco consumption in Egypt affects generations: from university students and mothers to kids! IFMSA Egypt performed two ways of needs assessment: A KAP study in medical schools which are 23 in number and the ministry of health statistics. The results of the KAP survey revealed that the huge threat resides in the fact that tobacco industry are actively playing their role very efficiently and are attracting everyone through indirectly showing in drama scenes. Also, the ministry of health alerted us with an alarming statistics tat 1 in 2 kids aged between 6 to 12 has at least smoked once. Additionally around 11% of mothers are smokers. This is from where our efforts started. One primary goal we have is to raise the concerns of medical students in Egypt towards the threatening figures of tobacco consumption by the end of July 0217. This is because, as future health care providers, today’s medical students will be the ones educating public and their patients about healthy living and disease prevention, and they themselves are not properly educated how to transmit these messages. It is necessary to train the future doctors to be agents

of change and advocates for healthy living conditions and not just well trained clinicians. What was done was the establishment of interactive awareness campaigns in university campuses advocating for tobacco fighting with the slogan: Tobacco Industry kills its best costumers. Also having another goal of reaching out to the public and fighting tobacco industry we started advocating for Tobacco Free University Campuses was on top of our list because it influences the whole project. Having to see workers, nurses and doctors smoking in the area where all public reach for healthcare services manipulate their behavior towards the act of tobacco consumption as way in their daily lifestyle. Also, the establishment of Tobacco Quitting Clinics in university hospitals is crucial because then the patient can know that tobacco consumption treatment is as important as cardiac problem or any other health problem treatment. One spot light was IFMSA Egypt policy statement about how tobacco industry manipulate its costumers through indirect advertisement in stores and drama scenes. Actually the policy took a whole success level when the ministry of health approved it, as well as, many other coalitions and NGOs in Egypt. Now the ministry are taking decisions towards fighting this greedy industry and we never stop monitoring. This project’s timeline will end by August 2017, where we are going to evaluate all our continuous monitoring and re-posting to all activities and which we are going to announce all our measurable results nationally and to the EMRO office.

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medical students worldwide | AM 2016, Mexico

August 2016

PROLACTIN Sirin Salsabila

CIMSA-ISMKI - Indonesia

The high incidence of breast cancer (35,86% according to Departement of Health Surabaya) and the lack of awareness about breast cancer in Surabaya, are the two main background of PROLACTIN (Protection for Limiting Breast Cancer with CIMSA UNAIR); a community development project of CIMSA UNAIR in collaboration with Department of Anatomic Pathology, Faculty of Medicine Airlangga University, Department of Oncology RSUD Dr. Soetomo Surabaya, and RnG healthy catering company. Creating an idea based on the importance of early detection to tackle this threatening disease, PROLACTIN has a main goal to increase 20% early findings of breast cancer in RW XII Pacarkeling, Surabaya in 2015-2017. Pacarkeling itself is one of the top three administrative villages with the highest numbers of breast cancer. The target community in Pacarkeling is a cadre group consisting of 20 middle aged passionate and active women. As cadre, they play a significant role in spreading the importance of SADARI (Breast Self Examination/ BSE) and knowledge about breast cancer. Through bonding and trainings, these cadres are expected to raise awareness of the community about breast cancer. They are also helped by facilitators, a group of medical students who had previously been given the upgrading

about breast cancer and peer education that act as mediators between the cadre and the lecturers. The first engagement to the community is through fun and inclusive bonding, such as gymnastics, healthy cooking class with RnG healthy catering, and breast cancer-related games. These are important for a stronger relations between CIMSA UNAIR, the facilitators, and the target community. We also had sharing sessions with the cadres and throughout of it, we noticed their high awareness of the jeopardy of breast cancer. To improve the cadres’ knowledge, we invited the expert of breast cancer from Department of Anatomic Pathology, Faculty of Medicine Airlangga University as speaker and also NORA (National Officer on Reproductive Health Including HIV and AIDS) to provide the material on peer education. Through this, the increment of knowledge of the cadres as much as 50% and 70% of the cadres can practice SADARI correctly. The follow up system of this activity is by using Kartu SADARI (BSE cards) that is regularly checked every month. These cards are filled by women in Pacarkeling if they have done SADARI and whether found any irregular mass on their breast, after previously informed by the cadres about SADARI. The results are exemplary as the cadres have successfully wielded Kartu SADARI to help achieving the early detection of breast cancer. On the first follow up, we have found 2 early findings that signifies breast cancer out of 26 Kartu SADARI. These 2 cases have also been consulted to the doctors of the Department of Anatomic Pathology, Faculty of Medicine Airlangga University. PROLACTIN has received massive appreciation from the doctors of Faculty of Medicine Airlangga University and Department of Oncology RSUD Dr. Soetomo Surabaya. It has also been discussed as a pilot method to help reduce the incidence of breast cancer throughout Indonesia.



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Smile-A-Mile Asma Ahmed IFMSA - Pakistan

It started out as a feeling Which then grew into a hope Which then turned into a quiet thought Which then turned into a quiet word And then that word grew louder and louder ‘Til it was a battle cry I’ll come back when you call me No need to say goodbye (The Call by Regina Spektor) The above lyrics very aptly describe the idea behind Smile-A-Mile (A Health Awareness Project). It literally brewed over a cup of tea between friends during the first ever IFMSA National General Assembly I attended. It was the urge to do something valuable for Pakistanis as future, aspiring doctors which translated into the project today! The standard of health is poor in many parts of the country but rural areas are especially being targeted because more than 70% of our population resides in villages. So the hope is to reach maximum amount of people in areas that are not as well equipped with proper hospitals, rural health centers or even the most basic of health facilities and to raise awareness about issues like healthy

lifestyle, hygiene, nutrition, breastfeeding, immunization, reproductive health etc with great emphasis on prevention. With a rising population of 190 916 866 and a growth rate of 2.10% it sometimes dampens your hope to ever see Pakistan completely disease-free but every drop makes an ocean and this is enough to keep us going. Smile-A-Mile has its own set of challenges, from the language barrier with the locals to worrying over the final turn out of the people but it is all the effort which goes into facing and finding innovative ways of bypassing these hurdles which makes every visit fun and such a success! Some think the title is rather eccentric but the numerous smiles we received from the locals at the end of our very first visit to the village of ‘Burj Kalan’ and the fact that travelling is an interesting part of the project is how “Smile-A-Mile” came into being. From providing free general health checkups to gifting fruit bags to the locals we are Spreading Rainbows one village at a time! The plan is to hold similar sessions all over the country and to take it to an international level making it a sustainable entity. It was my first major IFMSA-Pakistan project & the enormous positive response we received from the locals really led me to believe that IFMSA can play a huge role in filling in the deficiencies of our health systems. It has encouraged us to keep trying to do good for humanity and that you really do not need a ‘reason’ to help people.

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medical students worldwide | AM 2016, Mexico

August 2016

Strengthen Our Society Thatchanon Asawalertsaeng

IFMSA - Thailand

The purpose of S.O.S. project is to survey pavement accessibility for wheelchair users in 8 streets located in the fourth largest town of Thailand: Khon Kaen, and to display the gathered information in form of a map. The survey was done every ten metres and accessed by the evaluating accessibility form which based on the accessibility for the sisabled by United Nations. According to the criteria, the accessible pavement must have more than 150 cm. width, smooth and non-slip surface. Also, there must be a slope on unleveled path. For the surveying result, the inaccessibility was found 35.10% from all surveyed pavements. Inaccessible pavements mostly caused from the obstacles by 67.15%. There are two kinds of obstacles, pavement furniture and pavement clutter. Pavement furniture include post office boxes, phone booths, electricity posts, lamp posts, traffic signs, guide posts, bus stops, static council bins and trees. Pavement furniture are in responsibility of local authorities. They have to be in particular order and a space of 150 centimetres or more must be left on the pavement so wheelchair users can get past. Pavement clutter are from property owners and private. Pavement clutter include advertising boards, tables and chairs, selling vehicles, jardinière and bins, etc. The most common cause of obstacle was from pavement clutter by 66.30%. The slopes on unleveled path were found only 28.95%. The surface was suitable for wheelchair by 96.28%. Only 11.66% of surface was well maintenance



or just reconstructed. Parking on pavement was frequently found. There were 4 represented color on the map. Red was for 0-20% level which was no accessibility. Orange was for >20-50% level which was least accessibility, moderate degree of obstacles. Yellow was for >5090% level which was moderate accessibility, some degree of obstacles. Green was for >90%-100% level which was near complete accessibility. Consider each pavement, the highest level of accessibility was >50%90% which represented on map as yellow color. The number of pavement with this level of accessibility is 7 from 16 pavements which considered as 43.75%. The map was finally created. The presence of map had been commented to be practically useful for estimating the outdoor travelling. For future action, local authorities should promptly repair the cracked or subsided surface and set regular maintenance schedule. The pavement furniture must be rearranged in order and left more than 150 cm. space of pavement. It will be better to envision a society in which wheelchair users could function independently, instead of viewing them with charity and pity. Empowering wheelchair user by removing the barriers in the environment and guiding the accessible wheelchair travelling route by creating a map, will certainly strengthen our society. Suggestions are extending S.O.S. project with collaborative partnership for further surveying all around Khon Kaen and other provinces in Thailand and creating a map and implementing the map in social media for easily approach. Finally, let accessible community for all be the one of sign for healthy society.

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The MVP Project Sheng (Alex) Yang FMS - Taiwan

FMS-Taiwan, together with PSA-Taiwan (Pharmaceutical Students’ Association of Taiwan) and TVMSA (Taiwan Veterinary Medicine Students’ Association) held its 3rd MVP workshop on ‘One Health’ during March 2016. Founded in 2014, the MVP workshop aims at achieving the concept of ‘’One Health,’’ which is ‘’to recognize that the health of humans is connected to the health of animals and the environment.’’ As medical students and future health workers, we believe that optimal health of human can never be achieved without the wellness of other animals and the environment we live in. This year, the MVP workshop started with lectures from experienced professors from medical, pharmaceutical, and veterinary field to share their opinions on the importance of future interdisciplinary collaboration regarding ‘‘One Health.’’

In ‘’MVP Role-playing game’’ participants are assigned various health workers roles like doctors, CDC, government officials, NGOs, companies, and they have to work closely to prevent and manage an outbreak. In ‘’One Health PBL,’’ small groups of MVP students work to come up with possible solutions on health topics in Taiwan. Aside from indoor sessions, we also have an institutional visit to ‘’LiFu Museum of Chinese Medicine’’ to learn about the history and practice of Chinese medicine and traditional herbs on human and animals. We’ve created an open dialogue between MVP students through workshops, team work, and activities. However, we should not stop here. Currently, we are working on extending our reach to students majoring in public health, bio-statics, economics, politics in future MVP workshops, hoping to include as many voices as possible.

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medical students worldwide | AM 2016, Mexico

IFMSA Programs

In the upcoming pages, you can find the overview of the IFMSA Programs, their aspects, activities and much more. Enjoy!

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What are IFMSA Programs? Petar Kr. Velikov

IFMSA Vice-President for Activities 2015 - 2016

IFMSA Programs are centralized streams of activities, which are organized by IFMSA National Member Organizations (NMOs) and IFMSA internationally. IFMSA Programs address problems within a specific field that we as medical students and global health advocates stand up for while connecting local, national and international activities and opportunities that contribute to the final outcome. All IFMSA Programs connect the work of NMOs locally and nationally with the IFMSA vision and mission. NMOs decide which programs are to be adopted by IFMSA by voting on the Programs proposed by the Executive Board during the General Assembly. Programs are led by Program Coordinators and supervised by the IFMSA Standing Committee Directors and Executive Board to ensure their quality of implementation, consistency and sustainability of the programs. It is important to note that one of the major aspects of IFMSA Programs is to ensure a way to measure the impact of IFMSA and its’ NMOs on the societies we serve.

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All NMOs and members of NMOs locally and nationally are encouraged to join an IFMSA Program by enrolling their activities, whether that be projects, campaigns, celebrations, workshops, events, trainings or theme based publications. These activities are coordinated by Activity Coordinators locally, nationally or internationally with the help and support from Program Coordinator and the relevant Standing Committee Director. Internally, these activities don’t need to be just projects, campaigns, events, etc. but different research and capacity building activities as well as organized advocacy efforts on local, national and international level.

Structure of IFMSA Programs

IFMSA Programs encompass mutual efforts of the IFMSA Team of Officials, Program Coordinators and National Member Organizations (NMOs) in addressing different global health issues, including medical education through a wide range of activities related to capacity building, research and advocacy. IFMSA Programs are strongly linked with the work of the IFMSA Standing Committees and other capacity building streams in IFMSA ensuring that Programs receive the needed support in terms of scientific background and basic studies. Having a centralized stream of work in each field allows our Federation to monitor and evaluate the impact of mutual efforts of all NMOs towards solving emerging global health issues. IFMSA Programs also serve as a network between NMOs activities including them on a bigger picture corresponding to the role of IFMSA as a network of NMOs. With the IFMSA Impact Report, IFMSA showcases its position within the global society as a Federation by proving a needs assessment for other organizations working in a similar field, while increasing the organizational credibility.

medical students worldwide | AM 2016, Mexico

August 2016

Benefits for IFMSA and NMOs a. Recognition for NMOs and setting standards for the work of IFMSA Since Programs are a new platform in IFMSA, NMOs and Activity Coordinators who will enroll their activities in the beginning of the work are setting standards for the future work of the IFMSA in relation to Programs. IFMSA Programs will lead to an increase and improvement of collaboration between NMOs. This will happen by NMOs becoming aware of other activities being organized in IFMSA and give them ideas on how to use those initiatives in their own countries. Also, PC can help them by connecting different NMOs to improve collaboration, and if they have problems involving their activities, give them advice on how to resolve them.

b. Program Baseline Assessment and Program Impact Report One of the most important part about programs are Program Impact Reports, where all the activities that are enrolled in the Programs will be presented in a statistical manner and their impact - summarized. The reports will provide information on specific topics of each Program, how widely they are spread in the NMOs and what are the activities that NMOs are doing. The activities enrolled in the specific Program will be given permission to use the IFMSA logo in order to promote their activity. The Impact Report itself will be used to increase visibility of IFMSA, its’ NMOs and the Activities which we organize. Additionally NMOs can use the Report as means to fundraise in their countries.

c. External Representation and Programs Program are related to the external representation of IFMSA in several ways. By linking our global advocacy work with the real impact of the local and national activities that are enrolled in the Programs, we believe we can achieve a closer link between different parts of our work in IFMSA. This collaboration is an opportunity to strengthen the capacities of our members and provide a natural development path within specific global health topics. Furthermore, the impact of our external representation is anticipated to have a larger effect. Furthermore the increase in visibility will lead to the creation of new capacity building opportunities for our members on the national and international level.



d. Activities Database on IFMSA Website An upcoming initiative is the Activities Database of IFMSA Program and Activities enrolled under the relevant Program. The database will ensure a source of information for NMOs on Activities organized by other NMOs. The database will further serve to increase the visibility of all enrolled Activities. Finally it aims to facilitate communication with externals and present them our work on evidence-based way. It gives us more credibility when we have specific data on the activities. The collection of activities starts after the completion of the Baseline Assessment of each Program. This resource will not only be useful to make visible the work NMOs do to the external public, but to also the NMOs to gather ideas. The database will work as a source in order to get inspired and organize future activities. It is good to remember that the Program Coordinator can help with the communication of NMOs in the development on a certain activity.

e. Capacity Building Within the program coordinator duties, it lays the coordination of the organization of Capacity Building activities in the Federation and NMOs. As mentioned earlier this can be done in a variety of ways including the creation of training toolkits, sessions, workshops, meetings aiming to achieve the objectives set in the relevant Program. This will provide a new source of materials and content on a specific topic the IFMSA works on, giving opportunities to find external partners and to train future healthcare professionals on a field they’re interested in, building a community of medical students equipped with knowledge and skills on a specific topic.

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An Overview of

IFMSA Programs Children Health and Rights Ema Caušic - CroMSIC Croatia

Children Health and Rights Program focuses on medical students action in two very broad subjects of children’s health and children’s rights. The Program is proposed to encourage medical students and NMOs to create better conditions for children. End goals of the Program are to ensure accessible healthcare to children, create communities that are able to protect children’s rights, and provide medical students with sufficient knowledge of children’s health and rights. Focus of this program is medical students action in two very broad subjects of children’s health and children’s rights. Some themes were more frequent than others in activities done by NMOs - in children’s health focus was put on healthy habits (healthy eating, hygiene, physical activity), early childhood diseases (pneumonia, diarrhoea, malnutrition), mental health, dangers of substance abuse, early childhood vaccines and childhood vaccine preventable diseases. While in children’s rights focus was put on rights in general, and some specific rights such as the right to health and access to healthcare services, right to education, nondiscrimination, and non-violence.


Since there is a substantial number of NMOs already working in a large number of areas of this program, it is evident that we have a solid basis and possible major impact on children’s health and rights. Only by collaborating and working together we will be able to develop and enhance everything we have already done on this topic. This is a crucial moment in the development of this program because this Program will be able to showcase the incredible amount of work all of us are doing for improvement of the living conditions for children all over the world.

The topic of children’s health and rights is addressed by at least 87 NMOs through various activities. Children (being the center of this program) are the most common target group in these activities. However, there are many activities that target medical students, parents, and communities with the aim to educate them about the problems children are facing and possible solutions of that problems. These activities are done because children’s health and rights are usually affected by their surroundings and education needs to be aimed at adults as well as children in order to achieve the end goals of this program.


medical students worldwide | AM 2016, Mexico

August 2016

An Overview of

IFMSA Programs Communicable Diseases

Sirin Salsabila - CIMSA-ISMKI Indonesia

Communicable Diseases Program is a program that is intended to educate medical students and the general public on Communicable Diseases (CDs) and to strengthen student-driven interventions focusing on CDs in order to reduce the negative health impact of communicable diseases worldwide. IFMSA and NMOs in general had done lots of activities to support this program, such as; making policy statements related to communicable diseases, conducting lots of project, campaign, event, celebration, summer course, and even a tropical diseases exchange. After doing some research, turns out that for the past 2 years NMOs’ activities are mostly focusing on TB. However, each IFMSA Region has its own preference when it comes to tackling communicable diseases issues. Asia-Pacific is mostly focusing on tropical diseases & antibiotic resistance in 2014 and TB in 2015. Europe is mostly focusing on TB, Vaccination, & Tick borne diseases in 2104 and Ebola in 2015. Americas is mostly focusing on self-hygiene to prevent transmitted diseases in 2014 and dengue in 2015. Africa is mostly focusing on TB, Malaria, & Self Hygiene to prevent transmitted diseases in 2014 and TB in 2015. EMR were mostly focusing on TB in 2014 and Vaccination, cholera & antibiotic resistance in 2015. Most of these activities were concluded in a form of project and campaign. IFMSA also has an external partnership with; STOP TB Partnership, WHO (Communicable Diseases Department), Global Alliance on Rabies Control, Pharma and Veterinary Student Organization, World Veterinary Association, and World Medical Association. IFMSA is a member of STOP TB Partnership and will be more beneficial if most of NMOs’ projects are in collaboration with them. In implementing activities related to this program, NMOs had faced several challenges, such as empower society about things related to CD, find sponsors,



funding, and determine the best way to assess impact towards targeted participants related to this issue. Program coordinator is expected to collect more information about activities that hasn’t been reported and it is very important to empower medical student to take action in supporting this program. It is even more important to be able to measure the impact of these activities. It is extremely recommended to educate local in conducting proper impact measurement and evaluation so that would be easier for the program coordinator to measure general impact of this program. It is also important to connect NMOs’ activities with relevant IFMSA Team of Officials so they may have bigger chance on having collaborations with potential partners in order to create bigger impacts. Any collaboration should have clear goals and in line with program goals. We should encourage further NMO involvement and facilitate NMOs’ project in every possible aspect in order to reach this program goals.

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An Overview of

IFMSA Programs Comprehensive Sexual Education (CSE) Sanam Ladi Seyedian - IMSA Iran

Comprehensive Sexuality Education (CSE) program educate the general public by first educating the youth in the schools so that, in time, we have a public that is educated in the terms of sexuality and sexuality-related issues. Medical students would also be covered in this group because as future health care providers they are the key to making this program work. . This can be done by properly educating the peer educators in corresponding peer education trainings on a local level so that they can apply this knowledge in their communities. Peer educators need relevant data on all CSE-related topics in order to have an up-todate workshop. For this to work, an international team of volunteers is required to keep tabs on all the developments within the area of CSE. IFMSA policy statement on comprehensive sexuality education was adapted in 13th of March 2013 during IFMSA general assembly in Baltimore. IFMSA recognize that access to high quality, Comprehensive Sexuality Education is a right of young people. IFMSA further acknowledge that CSE provides young people with the opportunity to protect themselves from potential adverse sexual, reproductive and mental health outcomes. CSE views sexuality holistically, it does not only give biological information, but sets sexuality into a social and emotional context, emphasizing the importance of relationships and communication thus helping students to gain life skills and develop positive attitudes to enable them to enjoy their sexuality.

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areas and activities that the program allows; From establishing peer education training nationally and locally to contributing in advocacy or decision making processes nationally or any type of activity which relates to CSE such as campaigns, seminars, sessions at schools and etc. CSE related activities can be performed through Peer Education Training, Peer education lessons in schools, Campaigns, Workshops, Seminars and Show Talks, Advocacy, Capacity Building and Team Building, Small Working Groups, Theatre and Contest. The target groups of CSE program are children, adolescent, medical students, university students, parents, teachers, community and public. Based on the data collected from different NMOs, Asia-Pacific and EMR are lacking CSE related activities. Africa and Americas needs to promote CSE more to involve as many NMOs as possible. Europe has the largest number of NMOs involved. Generally about half of the SCORA related activities applied for activity fairs in IFMSA general assemblies are related to CSE. We still have a long way to promote comprehensive sexuality education in all continents and implement it as a right for each individual. Building and measuring our global impacts is one the key points. Share your activities, join the program and comprehensively educate the world. Please email the Program Coordinator at cse@ for questions and comments!

Planned Parenthood International suggests seven topics which should be covered in CSE: Gender, Sexual and reproductive health and HIV, Sexual rights and sexual citizenship, Pleasure, Violence, Diversity, Relationships Medical students are engaged in this program by two ways: First through capacity building processes like Peer Education Training, IPETs, regional-PETs and second through their participation in the different medical students worldwide | AM 2016, Mexico

August 2016

An Overview of

IFMSA Programs Dignified and Non-Discriminatory Health care

Paniz Motaghi - IMSA Iran

Providing equal and dignified health care services is one of the responsibilities of world’s health workforce which only achieves whit government support. We, The IFMSA members believe that every one has the right to access equal healthcare specially in emergent situation and this right must be respected at all situations. However, we see lots of people complaining about poor health services and suffering from discriminatory behavior of doctors and health staff. Medical student can play a significant role in finding health issues of their region which are caused by discriminations including Sexual, Religious and racial discrimination and stand up for the their right to access to health services. medical students can feel and reflect the pain of their patient and together they can take step to improve future healthcare.

Dignified and Non-Discriminatory Healthcare program also focuses on health issues of underprivileged area. the main goal is to raise awareness of medical staff about the right to access equal and non-discriminatory health care with specific attention to role of medical students in improving health services. The main goal of this program is to motivate medical students to care for the health status of all of their future patients regardless of their religion, color, financial or social condition and nationality. medical students must learn how to treat their patients in a dignified way and with patience and it must be practiced during years of medical education. Under this program we also aimed to encourage members with same concerns to share their activities and experiences with others. Hope that “health will finally be seen not as a blessing to be wished for, but as a human right to be fought for “ Kofi Annan

Dignifying and Non-discriminatory is a program that aims to empower students to advocate and work on providing an equal and accessible healthcare for anyone. This program provides a good chance for medical students to involve in volunteer activities related to migrants and refugees and other vulnerable population health.



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An Overview of

IFMSA Programs Environment and Health

Samantha De Leon Sautu - IFMSA Panama

The ultimate desired outcome of the Environment and Health (EH) Program is to achieve a state where communities worldwide exist in an environmentally sustainable manner where health is not compromised by climate change and other environmental issues. Pursuing this vision, the program unites NMO activities that

address climate change, urbanization and cities, road safety, water and sanitation, among many other topics. As this program set off to start, a Baseline Assessment was carried out to map out the current situation of the NMOs regarding these topics. Let’s see what we found out. We discovered that during 2015, about 9% of IFMSA activity addressed, or was intentionally related to, environment and health topics. This graph, taken from the EH Program Baseline Assessment, available online, assumes IFMSA activity as 42 the collection of sources gathered for the EH program Baseline Assessment (346 Activities registered to the 43 2015 Activities Fair, 181 Articles published in 2015 editions of the MSI, 49 valid Policy Statements, 214 NMO reports from 2015, and 140 Programs Baseline

Assessment Survey Entries). Most of the activities evaluated in the Assessment as pertaining to the EH Program theme, addressed climate topics (near 30%). Sanitation and road safety came next to the lead, followed by Urbanization and Food Safety and Environment. These activities were mostly campaigns and educational activities, followed by articles and publications. They mostly addressed medical students and the general population, but also decision makers. We discovered that less than 20% of reported activities are performing self-evaluation. Of all activities registered in the Activity Fairs of 2015, 3% addressed or were explicitly related to EH Topics, and covered mostly climate and sanitation. As per the MSI articles of 2015, 5% addressed EH topics explicitly described a link to EH, most commonly addressing climate change. Of our policy statements (PS), 20% either address an EH topics directly or describe a link to them. Examples of these are our Climate Change and Health PS or the Environmentally Sustainable Healthcare Facilities PS, also available online. At the end of each period, our NMOs submit a report on their activity. In the 2015 reports, 20% of reporting NMOs included EH topics as a prioritized area in at least one report, specially Energy and Climate, followed by Road Safety and Sanitation. IFMSA is involved with external partners for EH topics, such as the WHO Department of Environment and Social Determinants of Health (where we yearly send interns) and the Global Climate and Health Alliance (of which we are a founding member), among others. Starting from here, can you imagine what could be achieved during the 2016-2017 period? The building and measurement of our global impact starts now once more. Share your activities, join the program and shape your world.

medical students worldwide | AM 2016, Mexico

August 2016

An Overview of

IFMSA Programs Ethics and Human Rights in Health

Maria Golebiowska - IFMSA Poland

Ethics and Human Rights in Health is a Program which aims to equip medical students with knowledge on existing legal frameworks and skills on doctor-patient and among health care relationships in different settings, due to which future health care providers are able to question their professional behavior and decision-making and answer by ethical and human rights principles regardless of the situation. The first task of this term was the Baseline Assessment, which revealed that NMOs are most active in terms of Human Rights and Care for Specified Groups activities. Two international SCORP activities - World Human Rights Day and Training New Human Rights Trainers, 17 activities registered in the Call for Input, 98 EHRH activities were held by NMOs in year 2014/15, plenty of MSI articles being addressed to medical students worldwide with projects and ideas on how to create ethically-centered health care. Most of the outcomes, such as: making students aware on international legal frameworks, barriers to a rights-based approach; equipping them with skills to provide patient-centred care; creating respectful relationships in healthcare and empowering of medical students to take ethical decisions, are reached with the activities presented. Outcomes, which weren’t included in the area of NMOs work, are the advocacy on ethics in medical curriculum and the human rights approach in healthcare. When it comes to the achievements of this year, personally I am surprised by the variety of activities held under the Program - starting from awareness campaigns on improving healthcare-patient relationship, publication of Ethics Code and evaluation on its impact among the medical environment, workshops on care of vulnerable groups - sign language workshops, aspects of palliative care and communication with critically-ill patients to informative projects on importance of human rights in everyday practice. This is a proof that ethics and human rights can be presented in a practical way and the



advocacy on changes in perception of ethics are being made. Apart from the Enrollment to the Program, Ethical aspects of Medical Curriculum were also promoted during March Meeting, mostly in SCOME sessions as well as improvements on the Program structure were suggested during Small Working Group in SCORP Programs and during Joint Sessions, we had an unique opportunity discuss intercultural learning during IFMSA exchanges and its impact in ethical behaviour of future medical doctors. This August Meeting, practical tools for teaching and learning ethics and international law will be shared during SCORP sessions, and in the SCOME sessions we will discuss on how to fight for doctors’, patients’ and students’ rights. I truly believe that the Program has achieved a lot in this beginning term of its work and I hope that the efforts of Activity Coordinators will become an inspiration for NMOs to actively support and provide to their members projects related to ethics and human rights - two most important components which provides soul to the science of medicine. I would like to thank most active NMOs, including CIMSA-ISMKI, AMSB-Bulgaria, PorMSICPortugal, IFMSA-Poland, AEMPPI-Ecuador and Algeria LeSouk for their passion and commitment to the Program throughout this term!

( M S I 34 )

An Overview of

IFMSA Programs Gender-Based Violence

Safiya Noor Dhanani - Medsin United Kingdom

Although the Gender-Based Violence (GBV) Program is in its first year as an official IFMSA program there have been a number of exciting activities identified in the program’s baseline assessment on a diverse range of topics reflective of pertinent issues facing local communities or wider regions. Egypt had a transnational activity which not only aimed to increase awareness about the adverse effects of female genital mutilation but also prevent the practice by targeting key community members such as parents. An activity in Estonia aimed to raise awareness about and provide support for those affected by sexual harassment by launching an webpage for anonymous submissions of stories. The “She Project” in Tunisia aimed to engage men and boys to promote women’s rights and gender equity.

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One of the first tasks to establish the program was to conduct a baseline assessment, which is an impact assessment tool that provides a benchmark for what is currently being done by NMOs to address and ultimately prevent GBV. A total of 76 activities undertaken by 38% (47) of NMOs in 2014 and 2015 were identified with the greatest proportion of NMOs engaged as well as number of projects being conducted in the Eastern Mediterranean Region. The majority of the activities themselves were campaign or education based activities that focused on addressing GBV or gender equality as broad topics as opposed to specific topics such as intimate-partner violence, obstetric violence, honour crimes, sexual harassment and human trafficking. The overall results from the baseline assessment present an encouraging foundation for the development of the program and also highlight gaps in current work and as such exciting opportunities for future directions of the program. As the program becomes more established, gaps in the type of activity such as advocacy and research, the topics covered through activities such as mental health and psychological consequences of GBV as well as the

target audiences and beneficiaries of activities such as those who have experienced GBV, can be developed. On reflection however, the most important area I would like to see strengthened in the upcoming years is an exploration and effort to tackle the root causes of gender-based violence and promote gender equity. Often activities, like wider representations of GBV, focus

on its manifestation in a multitude of forms such as sexual assault and female genital mutilation however I would like to challenge activities to go one step further and ensure there is an awareness and a desire to take action on the root causes. As such an activity that promotes women’s rights and gender equity, as well as one which focuses on domestic violence both come under the umbrella of the GBV program however, one which considers how society’s intersecting inequalities and gender norms/ roles may act as a root cause of domestic violence is an even stronger activity. This same philosophy is mirrored in NGO best practice for tackling GBV where efforts to improve the status of women in a society i.e. through education or financial independence gained through micro finance programs actually increases the elimination of GBV.

medical students worldwide | AM 2016, Mexico

August 2016

An Overview of

IFMSA Programs Health Systems

Monica Lauridsen Kujabi - IMCC Denmark

A good health system delivers quality services to all people, when and where they need them. Health systems worldwide face various challenges; the budget is substantially low, the quality is insufficient, the medicine and technologies are too few and too expensive and it doesn’t reach out to the remote areas. Actions conducted by medical students are needed to counter these issues. From the baseline assessment mainly 5 areas that medical students work on to improve the health system has been identified; Rural Health, Access to Medicines and technologies, Global Surgery, Universal Health Coverage and Trade & Health.

to 2400 people. Moreover, epidemiological data are gathered and articles are made. Except for caring for the health of these populations the aim of the activity is to raise awareness to the public and amongst medical students and doctors on rural health. This is an excellent example of how medical students can learn about rural health, as this is not covered in medical curricula. AMSAAustralia is another example were 70-100 medical

What we do – Findings from the baseline assessment A Global Surgery working group consisting of 12 NMOs have joined forces to collect data to show the scope of the problem and are doing awareness raising campaigns as for example the IFMSA global surgery day. IFMSA European Region has specifically been active in addressing the TTIP agreement, by encouraging NMOs from the whole region to address the parliament members and advocate nationally. Building capacity of medical students to encounter the challenges of Health Systems is one of the core roles of IFMSA. As such, pre-GAs, trainings and webinars have been held, and toolkits on Rural Health and Global Surgery is in the making. At the international level IFMSA is strengthening its collaboration with WONCA (global family doctors) in a joined working group on rural health while ISfTeH (telemedicine and eHealth) supported IFMSA in developing a webinar for our members. The work within Health Systems provides new opportunities for IFMSA, partners and NMOs to lead the path towards better health for all. A few initiatives are chosen to showcase how medical students work on Rural Health; During the Medical Caravan, more than 50 doctors including specialists and medical students travel to a distant area to screen, treat and educate between 700



students meet during the 2-day Rural Health Colloquium to debate and learn about rural health solutions. CIMSAISMKI(Indonesia) is an example of an NMO with a huge rural population and high level of health literacy. Every project they do, whether it is about TB or smoking, has the overall goal of empowering communities to increase their quality of life, and making the right choices in health. By engaging in the program we hope activities will develop in new directions always aiming at having the greatest impact on society. We are looking forward to a closer collaboration with IFMSA-Morocco, CIMSAISMKI, AMSA-Australia and other NMOs enrolled in the program.

( M S I 34 )

An Overview of

IFMSA Programs Healthy Lifestyles and Non-Communicable Diseases Hana Lucev - CroMSIC Croatia

We are all aware that healthy lifestyles and noncommunicable diseases are an extensive subject. Based on our inspirience, we know that almost all the NMOs are doing activities on these topics, from World Diabetes Day to peer education. Those are all important activities, especially if they are tackling more than one condition or focusing on multiple prevention measures. However, the activity I’m focusing on here is somehow different. It caught my eye as soon as it has been enrolled in the Program. I can not really tell why, maybe because of the target group, or because the approach was different than any others, or the factors were combined. But let me tell you this - you’re gonna love it. The title of the activity is 1st Semmelweis Public Health Competition for High School Students. Very intriguing, right? The basic idea was to include high school students (1419 yrs) in a competition focusing on healthy lifestyles. First step was to deliver preventive lessons by medical students, mainly focusing on bad influences from media, how to eat healthy, how to avoid risk factors etc. Only the groups which had attended the sessions could participate in the next step. Those students were

then involved in an online competition, which had two rounds, and the best 20 groups were able to participate in the final round and win the prizes. In the first round there were 114 groups, which had to solve 6 short online tests. The best 40 groups were going to the second round which included 1 big online test. The final round was held in Budapest, and it had 12 interactive stations on problem solving, where more than a hundred high school students participated. It is a new way to deliver sessions to ensure the proper learning process, since the most interested ones were rewarded in the end. It definitely show a new approach to the education. We all know that when you put a bit of competition and offer prizes, everybody gets a little more interested, especially high school students. More than 1000 students were involved, from all over Hungary and from Romania. The evaluation was done by satisfaction questionnaires during the online test and with sharing notes and opinions, together with a questionnaire about the whole project, during the final round. Although HuMSIRC had some problems with finding sponsors, in the end their University helped and ensured the whole process to run smoothly. Finally, they’ve had more than 20 sponsors who provided the prizes. I would like to congratulate the team, made from 8 people, and another 100 members who jumped in and helped with the organization. This really shows the team spirit and how much can be done my medical students. I believe this unique activity deserves a lot of attention, and it can be done in every NMO.


If you wish to know more details about the activity, you can ask here:


medical students worldwide | AM 2016, Mexico

August 2016

An Overview of

IFMSA Programs HIV/AIDS and other STIs Ahmed Taha - IFMSA Egypt

HIV/AIDS and other STIs Program calls on providing a platform to educate, decrease the stigma and raise awareness within the general public, people at risk or those living with HIV/AIDs and other STIs. On the international level, IFMSA strongly works on advocacy. A policy statement was adopted on post 2015 future development goals in March 2015 and is committed to have an active action on implementation of sustainable development goals (SDGs). SDGs address environmental, structural and socio-economic factors which influence the spread as well as the reversal of the HIV/AIDS epidemic. SDGs can result in universal access to HIV prevention, treatment, care and support. Also HIV/AIDS is a crucial and intricate factor to promote all aspects of sustainable development and human dignity. We envision medical students whom have a wide knowledge on HIV/AIDS and other STIs, needs of people living with them and can provide non-stigmatized healthcare services. By doing so, we’ll hopefully reduce substantially the number of new transmissions as well as improve health assistance, treatment and general wellbeing of those living with HIV or with any other STI. The Baseline Assessment is a compilation of all the NMOs Activities; recorded in the NMOs reports and applications for activities fair and Presentations for AM14, MM 15 and AM 15, MSIs 30 & 31 editions, along with call for inputs from NMOs. Analysis had a qualitative approach made about IFMSA and NMOs actions and advocacy efforts in different areas of the program. A retrospective analysis into the efforts and measures taken by NMOs in the program has revealed that 63 NMOs actively engage in the program whether by celebrating the World AIDS day or through different initiative that do not necessarily coincide with World AIDS Day, the proceedings of the activities are publicized on social media outlets and among peers. This reflects a common understanding of the magnitude of the HIV/



AIDS and other STIs response in their respective regions. This asserts that the awareness of our NMOs on the importance of the program and our responsibility, as medical students, have within the International response agendas. On the other hand, the program addresses a wide range of target groups that are all involved in the in epidemic in different manners. The target groups are; Medical students, People living with HIV/AIDS and other STIs, People at risk of getting HIV or other STIs (People who inject drugs, Young women, Men who have sex with men, Adolescents and Children, Transgender individuals, Sex workers , Prisoners), general public, Policy makers. A key finding is that not all of the target groups are tackled in our activities, some were given more focus than others. This is demonstrated through the breakdown of the target groups addressed in the following chart.

( M S I 34 )

An Overview of

IFMSA Programs Human Resources for Health

Alberto Abreu da Silva - ANEM/PorMSIC Portugal

Human Resources for Health is not an easy topic, but hopefully its Program has shed more light in it! The Human Resources for Health Program (HRH Program) was adopted last August Meeting 2015 in Macedonia, endorsing the vision of the Federation that medical students worldwide must advocate for proper number and quality of health professionals, aiming at ensuring universal health coverage just like the populations need. At the moment, due to poor social and economic conditions, healthcare professionals are one of the professions with highest rates of migration, looking out for better job, career, research or family development opportunities, which creates a huge distribution problem of health professionals. This situation is the consequence of, amongst others, a great lack of healthcare workforce forecasting and planning methodologies worldwide, which leads to shortages and inequitable distribution of healthcare professionals, at the same time that assurance of the quality of medical education that meet the demands of healthcare delivery is paramount. After the adoption of the Health Workforce 2030: WHO Global Strategy on Human Resources for Health by the World Health Assembly in Geneva, medical students worldwide are expecting to see some of our direct recommendations as well as all the efforts put by the member states in tackling these concerns put to practice.

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like medical associations – for this issue. Mainly, there are three major kinds of activities that take place under this topic. One of these areas is the field of information, under which medical students worldwide organize campaigns for both students and the community or workshops to capacitate medical students on topics of HRH, like the one organized last March Meeting in Malta. This kind of activities aim at empowering medical students to tackle these issues nationally, by developing external representation activity as aforementioned. Sometimes there are even scientific publications and researches that feat these activities; for example, analysis of the motivation for mobilization of recent graduates, the quality of pre and post graduate medical education, etc. Hence, after a wide understanding and implementation of the HRH Program outcomes, our members will see their activities compiled in a single report, showing off the true impact that medicals students are having worldwide promoting this issue. In case you have any question, don’t hesitate and email

Within the federation and its national member organizations (NMOs), there is already a lot that is being done, which is showcased in the Baseline Assessment that was shared with our members some months ago. Despite the lack of structured presentation of such activities – as they mostly occur in a basal level and not as a well defined project -, there are many NMOs that are advocating locally – within, for example, their medical schools – as well as nationally – with governmental institutions and other organizations,

medical students worldwide | AM 2016, Mexico

August 2016

An Overview of

IFMSA Programs Mental Health

Victoria (Tori) Berquist - AMSA Australia

2015/16 has been a mixed inaugural term for the Mental Health Program. The key achievements of the program for this term are primarily focussed on the work that has been performed for the IFMSA rather than the initial program objectives themselves. This term, a Mental Health Toolkit was created for the benefit of prospective and developing activities. This includes briefings on the topic, examples of successful activities, resources to enable activity development and advocacy, as well as redirection to places to learn more. This toolkit has been created for the purposes of general distribution through the IFMSA’s networks as well as for any prospective activities that contact the IFMSA. In addition, a central repository of additional resources including workshop and activity outlines as well as presentation resources such as graphics and templates has been developed throughout the year and is available for interested persons who contact the program. This has been of benefit throughout the term. Discussions have been had throughout the term with Directors and Liaison Officers regarding developing mental health-specific relationships with externals. Connections were made with the World Health Organisation Department of Mental Health and Substance Abuse. In addition, as the Program Coordinator I have assisted the Program by developing 4 publication contributions for the MSI and IFMSA website. I feel it to be an important responsibility as a PC to maintain dialog regarding the topic of mental health within the Federation. Suggested avenues for the future would be fostering a dedicated community of individuals who are involved in mental health activities and are enrolled in the program. Value at the moment has been derived by NMOs in assistance from the PC in creating and scaling up their activities. A dedicated community would allow a place



for belonging and collaboration on further projects and as projects develop, providing a place to share work and achievements. Overall, the term has been an interesting learning experience in moving the program from the ground and creating a platform of opportunity and resources for future activities to embed themselves within. I have very much enjoyed working with members of NMOs all over the world in sharing and developing ideas for activities – the diversity and passion of the IFMSA when it comes to mental health is indelibly exciting. I look forward to seeing the program progress and flourish in further terms.

( M S I 34 )

An Overview of

IFMSA Programs Organ, Tissue and Marrow Donation Bing Yu Chen - IFMSA Quebec

Organ, tissue and marrow donation reflects the beauty of medicine and the generosity and kindness in human beings. A woman was yesterday taking her last breaths suffering from severe respiratory failure will be able to attend her professional and social duties and fully enjoy life tomorrow. There are probably endless examples of how organ, tissue or marrow transplantation could save or improve drastically the life of human being, who could be you, me, our brothers or sisters, or someone we love. However, for every recipient who can benefit from such a miraculous lifesaving operation, there must be a donor. Donors are unfortunately scarce, and a significant number of people die before receiving the much needed transplant. Whether it is public misconception about donation, inadequate training of healthcare professionals, or lack of equitable and centralized governmental structure, several barriers are simply waiting for us to solve them. The goals of the Organ, Tissue and Marrow Donation program are to connect and guide medical students worldwide who share the same passion, a passion that is not simply limited to raising awareness among the communities, but can be extended to government advocacy, medical education interventions and longterm sustainable changes!

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medical students worldwide | AM 2016, Mexico

August 2016

An Overview of

IFMSA Programs Sexuality and Gender Identity

Beatriz (Bea) Blanco Rojas - AECS Catalonia

The Sexuality and Gender Identity Program originates from the main assumption that there is a lack of knowledge about Sexuality and Gender Identity issues within Medical Students that may lead into future poor outcomes in Sexual Health and in violations of Human Rights. Therefore, the main goal of the program is to achieve an optimal Sexual Health, Equity and Human Rights preservation that is ensured for every person regardless their Gender Identity or Sexual Orientation, in society as a whole, but especially in the healthcare environment. During the process of the baseline assessment, there were found a total 73 NMOs who reported have been working on projects, events, conferences, trainings and/ or workshops in order to tackle the topics of the different areas of the program. The areas of the program on which the activities were established and its percentage among the total were: • Education and actions on sexuality in children, teenagers and elderly people (19%) • Gender identities (5%) • LGBT issues, such as homophobia, transphobia and biphobia, transgender issues, social exclusion, access to healthcare, bullying, considerations in the clinical consult and more (69%) • Sex workers’ health (1%) • Harassment and consensual sexual behaviours (0%) • Medical and healthcare curricula free of prejudicial and stigmatising contents, especially in those cases about LGBT+ individuals and/or sex workers (0%) • Advocacy for sexology and sexual rights, empowerment of LGBT+ individuals and/or sex workers and for decreasing the sexualisation and objectification of women (5%)



Four NMOs reported to have been working on advocacy by the active enrolment in government discussions and redaction of policies and statements within their countries. An interesting fact that should be studied in order to measure the impact of the five Policy Statements that the IFMSA currently has in line with the objectives and actions of the program. However, there’s still lack of information on the impact of the activities. The upcoming challenges will be to find a way of measuring the influence of the Medical Students Issue and IFMSA policy statements, and a way to encourage activity coordinators to enrol and report their activities, given that only nine NMOs reported an activity for the call for input of the baseline assessment and the current data collected is missing information on the number of individuals reached, number of people whose skills and knowledge have been improved and more. The measure of the impact shall be upgraded in the interest of knowing how far the Program reaches its objectives, and how is it improving or not society altogether.

( M S I 34 )

An Overview of

IFMSA Programs Teaching Medical Skills

Petra van Pijkeren - IFMSA The Netherlands

As a medical student I want to become a future doctor this world needs. Through my medical school I’ve encountered limitations to achieve this, such as certain skills not being taught (well). This has made me seek these skills with the IFMSA, especially SCOME and this Program. Maybe you’ve encountered a similar situation.

or they never thought they might have to go through such a difficult moment. To tackle this problem they started this activity.

In the following article you’ll find that this Program is gathering activities aiming for the improvement of our Medical Skills. I will give the example of how AEMPPIEcuador has done this through their project “An angel for the end” and at the end you can get into contact with me as Program Coordinator. We all have heard of the scenario: a newly graduated doctor or an intern in his first months of clinical practice finding it extremely intimidating. Our medical education should provide us aspiring physician with appropriate knowledge, skills and attitudes. It should create us into competent doctors who are ready for independent work right after graduation. In reality there is often we see a gap when it comes to medical skills education. We often don’t have enough opportunities for regular clinical practice or are taught using outdated methods. On top of that some other skills that are necessary for everyday work such as communication with patients are often unstructured and unspecified, assuming that students would acquire them spontaneously during their medical education and their work with patients, which is not always the case.

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An angel for the end is an example of an activity from AEMPPI-Ecuador under the Teaching Medical Skills Program. Pablo, the NOME has reported that they saw their health system was not the best when it comes to inform bad news to patients or their relatives. Sometimes, doctors didn’t have the abilities to handle these situations, even if they were brilliant in their work, since they never had the opportunity to acquire the skills

They give students the tools and skills for bad news telling in difficult medical situations. In order to succeed they must accomplish all the scenarios proposed during role plays. On top of that they raise awareness of the importance of understanding and feeling their own patients’ pain. Every activity in the event has this final purpose, participants will be able to do it once they complete the training. Last but not least they increase self confidence in participants, so they have a closer doctorpatient relation in the future. This will be measured by the feedback survey. Have you also encountered a lack of medical skills getting taught in your medical schools? Do you want to get help improving this or do you already have an activity doing this? I would love to be in contact with you through

medical students worldwide | AM 2016, Mexico

Capacity Building

( M S I 34 )


from the Vice-President for Capacity Building

Gustavo Fitas Manaia

IFMSA Vice-President for Capacity Building 2015-2016

Dear Trainers Worldwide, It’s a pleasure to present here this new section to the MSI. Capacity building does not merely support what we do. It is what we do. Every single activity in IFMSA aims to empower medical students from around the world to be agents of positive change in their communities. It is in our projects, our trainings, our activities, our campaigns and our workshops that the magic happens. During IFMSA Meetings, General Assemblies, congresses, and conferences, members have the opportunity to be trained in many different areas. Capacity building allow us to empower our members and find innovative ways to let their voices be heard in order to facilitate their roles as agents of change at the local and international level. Our capacity building efforts offer an engaging opportunity to empower members with the skills and confidence they need to efficiently carry out the tasks required in each of the different standing committees and other relevant activities. This concrete and hands-on approach has strengthened sentiments of common ownership among members, and as allowed IFMSA to grow as an organization. In this section you will find a small collection of Sub-Regional Training or Workshops from this term. We hope that they could inspire and motivate you to join us in this journey. On behalf of the Capacity Building International Team, Gustavo Fitas

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medical students worldwide | AM 2016, Mexico

August 2016


Ecuador 2016 Carlos Andrés Acosta Casas

SCORA Regional Assistant for the Americas DENEM - Brazil

Capacity building in the Americas has always been an important topic due to main facts. There is an unquestionable need of more spaces of this type that shuttles people to greatest discussions within the federation and the second factor being that the spaces existing know must seek comprehensiveness towards the regional topics and necessities found in the region. SCORA as a whole in the region has been very active in translating and follow international guidelines for campaigns and projects. Although this is great for us as a sustainable growth of activities in the region, we saw the opportunity of growing into templating these activities to our own production of ideals, searching deeper in these prevalent topics. Since I’ve been active in the IFMSA, there was always a certain ‘hole’ we needed to cover in our region by creating participatory spaces for members to share experiences. Under this context of having different needs than other regions and motivation to create deeper capacity building spaces we decided to have a space to build the Latin American Cooperation on Maternal Health and Access to Safe Abortion (LACMA). The creation of LACMA was initiated with the models of long lasting spaces in the European region SECSE and NECSE. The proposal of these spaces was tempting for our region. The idea of gathering different delegates from the regional NMOs to discuss a certain topic was adequate to gain confidence among the organizers of the event. The great discussions that were evocated in 2015 about maternal health including Zika virus and access to safe abortion changes in Latin American countries led us to think that SCORA in the region needed an increase of attention to maternal health as a whole but specially in access to safe abortion. While all this brainstorming was happening, our LRA along with Ipas (one of SCORA’s main partners) were planning on having an Ipas TOT for the region. Knowing



that the core area of the training is access to safe abortion then we idealized the best way of taking the training and the cooperation to a higher level of involvement and participation from the Americas members while integrating knowledge of the current situations occurring in the Americas. The conclusive idea was making the method exchange tactics of SECSE and NECSE in maternal health topics while having the TOT. LACMA has proven to be an innovation for the Americas as well for SCORA internationally due to the exploration of differentiated areas that we assume can enlarge the knowledge pool of our global action. As well it allows regional empowerment and for NMOs in the Americas to feel capable of hosting these types spaces and therefore create other types of forums, ideas, activities etc. I hope we can create tendencies out of LACMA for our capacity building spaces can be socially pertinent and with deeper discussions for us to have as well a vision of growth within the IFMSA.

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The Story Behind the First PRET in the Americas

Rodrigo Enrique Roa

SCOPE Regional Assistant for the Americas IFMSA - Brazil

Mbarete mbarete roguahê

Strong strong we arrived

Mbarete mbarete roguahê ko’apeve

Strong strong here we arrived

Ñane’a ñame’ê ipuku la tape

We give our knowledge, the road is long

Rojuma rojuma

We’re coming, we’re coming

Ñane korasô ñame’e

We’re coming to give our heart

HOOO!!! Paraguayan sapucai (haka in Guarani) From the 13th till the 16th May 2016, IFMSA Paraguay organized a Professional and Research Exchange Training (PRET) in Asunción, attended mostly by local participants with the addition of members from Brazil and Bolivia. It was the first IFMSA Meeting of its kind in the Americas Region and it was an honor for me to participate as one of the Trainers along with Felipe Cid (NEO IFMSA-Chile) and Mauro Camacho (SCORE RA Americas). Paraguay is a country in the center of South America, landlocked (no coastline), sometimes referred to as the “heart of South America”. To this day, Paraguay remains the only country in the Americas where a majority of the population speaks one indigenous language: Guaraní. Asunción, its capital and largest city, welcomed us with everywhere covered by their national flag: the celebration for Paraguay National

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Day, known in Spanish as ‘Día de la Independencia Nacional’, which celebrates the 205 years of Paraguay’s independence from Spain took place right during the PRET and events such as parades, fireworks and concerts were part of the social program. Inside all this nationalist spirit, the participants had the opportunity get to know better how our exchanges works, tools to guarantee and improve academic quality, learn more about global health and to take part on trainings sessions aimed at developing their soft skills, which they would use during their IFMSA Exchange. Small working groups aimed to improve our exchanges in different ways were coordinated by the participants. From the quality of the accommodation to the time management of the agenda, everything was perfect. A special thanks to the wonderful Organizing Committee for being involved with all the project and providing all the necessary logistics. We know that our exchanges aim to promote cultural understanding, so it was remarkable to share experiences among each other and discover more about our outstanding cultures. Thanks to all participants for their valuable inputs and feedbacks. I know that the outcomes will help us to improve IFMSA Exchanges in the Americas Region and I hopefully wish IFMSA Paraguay can keep going strong on Exchanges so we can start planning the 2nd PRET in Paraguay. medical students worldwide | AM 2016, Mexico

August 2016

Learning from Each Other

NMO Management Session at March Meeting 2016 Jiji Alexander Zhang

bvmd - Germany Ruprecht Karls University of Heidelberg

There are many reasons why we would attend a General Assembly, like the opportunity of getting to know each other, sharing all kinds of experiences and consequently making new friends from all across the world. Who wouldn’t want to talk about their own NMO, Local Committee, or acquired experiences in a certain leadership role? By making the exchange of experiences and best practices a primary aspect, the NMO Management Session at last March Meeting in Malta was all about these things.

on approach like group discussions, presentations or small working groups. By this, participants were asked to actively engage in the respective topic, share their own organizational experience and develop new, innovative concepts for a wide range of problems. Compact, concise and outcome-oriented training sessions were delivered by proficient trainers covering all these areas, ensuring that all participants were able to gain new ideas and experience, and that nobody left our session empty-handed.

Since last year’s August Meeting in Ohrid, Macedonia, a new capacity building concept was adopted for the NMO Management Session in order to make sessions more engaging and interactive: Trainings instead of presentations, more discussions and small working groups and lastly, active involvement of participants. The goal was to actually listen to each other, and by doing that, discussing common problems and developing suitable solutions together. In Malta, it was our belief that the best way was to build upon these changes so an appealing set of sessions could again be provided.

As already mentioned before, at the March Meeting in Malta we were very gifted to have our 12 extraordinary trainers and facilitators, who not only were able to conduct productive sessions, but also were true experts in their particular fields. With a broad diversity of backgrounds, experiences and skills, sessions were highly enhanced by their coordination and guidance to an even greater extent.

Since we all know that time is, unfortunately, more than limited at General Assemblies, it was our goal to keep productivity high at all times. This is why prior to the Maltese assembly, NMO reports from the last couple of years were assessed as a first step. After that, relevant focus areas were extracted which NMOs primarily struggled with in the past, which were topics about motivation, communication, handover, recruitment, financial management, fundraising and last but not least external representation. Apart from this, an open space session was also facilitated so other issues could also be enlarged upon. It was our aspiration to fit the agenda to the needs of every NMO- and LC-leader. For this reason, each session consisted of two coherent parts, first one being the more theoretical aspect as guidance and preparation, the latter a practical



You are a leader in your NMO or Local Committee and seek to share your experience and come together with other motivated, like-minded participants? Feel free to join the NMO Management Session at the upcoming General Assembly in Puebla, Mexico. We would love to welcome you there!

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Training 4 ALL Francisco Martinho Teixeira ANEM/PorMSIC - Portugal

Training4All is one of the IFMSA’s well-known SubRegional Trainings and Capacity Building events, responsible for educating and equipping medical students with useful tools that will help them have an impact on both local and international levels. It provides you with an incomparable experience, since it brings together the opportunity to take one of several training tracks plus a refreshing and inclusive environment that has been largely appreciated by those who have already taken the experience. As one past participant would say, “it’s not about what happened, but rather how it made you feel.” During last year’s four intensive working days, sixtythree applicants from fifteen different nationalities had access to seven different high-quality training tracks and acquire new perspectives of what being a change leader really. Not only were they provided with the remarkable and well-known Training New Trainers, Training New Medical Education Trainers, Training New Human Rights Trainers, Professional & Research Exchange and Peer Education Trainings, but also the very distinct Global Health and Lifestyle Medicine tracks. Only by gathering all these different areas in a single event we were able to promote the most comprehensive approach to every field of expertise, bring Portuguese medical students closer to the IFMSA and non-formal education, and greatly widen the pool of trainers within the national and international levels.

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Local and National Officers on General Training Skills, Medical Education, Human Rights and Peace, Global Health and Public Health Leadership. Along the city’s special atmosphere that is surely in accordance with Training4All’s framework, these are the reasons why we chose Évora to host the 2016 Edition. Évora is a city located in Alentejo – a large region of wide plains in the south of Portugal – and has a history dating back more than two thousand years, reason why it is still partially enclosed by medieval walls and is considered a UNESCO World Heritage site. Challenge yourself and take the journey – we assure you that you will not regret this choice. Come and see what Training4All has reserved for its participants! We are waiting for you.

And since a Sub-Regional Trainings is not all about accredited learning, there was also time to bond with other people and make new friendships in a unique open-minded environment, reason why Training4All got an overall evaluation of 4.5 out of 5. Therefore, it is with great pleasure that the Organizing Committee invites you to participate in Training4All 2016 Edition, between the 5th and the 9th of September, in Évora. This year, we intend to create medical students worldwide | AM 2016, Mexico

August 2016

Training New Exchange Trainers Koen Demaegd & Omar Cherkaoui IFMSA SCORE Director & IFMSA SCORE Director,

The IFMSA Professional and Research Exchanges (SCOPE & SCORE) have been developed greatly over the last couple of years, currently facilitating about 14,000 exchanges in almost 100 countries worldwide. With the high turn-over and switching of positions, there is a crucial need for a capacity building system that provides Exchange Officers with the skills & knowledge required for maintaining such a big exchange program. The Professional & Research Exchange Trainings (PRETs) are workshops that have been created a while ago for members interested in working with SCOPE and SCORE. They were aiming at increasing the knowledge about our exchange program, leading then to more skilled exchange officers, and therefore, improving the quality of the entire program. After several years of proposing this workshop, we have been faced by a big obstacle that was the need for qualified trainers who would be able to conduct the PRETs themselves. So far, all of them have only been conducted by experienced people, who do not necessarily have enough facilitation and training skills to transmit their knowledge to their participants in a way they would act

according to it. We therefore felt the need of creating a new training concept, in order to train our members to become themselves trainers in the exchange field so as to increase the quality of all the future capacity building events related to the exchanges. This is how the Training New Exchange Trainers (TNET) was born. Thanks to a small working group of motivated members, led by Maud Harding (IFMSA-NL) and Basma Lahmer (IFMSA-Morocco), the regulations and guidelines for this new workshop were created and the TNET was proposed for the preGeneral Assembly of the March Meeting 2016 in Malta. The TNET in Malta was coordinated by Maud Harding (SCOPE Regional Assistant for Europe 15/16), Luiza Alonso (SCORE Director 14/15), Koen Demaegd (SCORE Director 15/16) and Omar Cherkaoui (SCOPE Director 14/16). It has seen the participation of 18 motivated participants, who received during the three days workshop an intense training, covering topics going from soft skills as Facilitation and Agenda setting, over Global Health and Ethics in Exchanges, till hardcore Exchange-related subjects as Academic Quality and Recognition in Exchanges. The participants were not only teached about exchanges and ways of conducting trainings on this specific field, but they also got the opportunity to practice throughout multiple interactive sessions of the workshop. The first generation of Exchange Trainers has now been shaped, and we truly hope this concept will be further developed and improved in the future for a better quality of one of the biggest exchange programs of medical students in the world.



( M S I 34 )

Assessing the Impact of TMET Katerina Dima

SCOME Regional Assistant for Europe HelMSIC - Greece

Beginning with soft skills, 3 out of 11 participants were already trainers. It is quite visible from the before and after charts that there was a significant shift in confidence, moving from 44.5% uncertainty to a 9.1% (combining options 1 and 2). Consult the charts below for more details.

In August 2014, the Training Medical Education Trainers took place for the first time: students from all over the world had the opportunity to gather, learn and be empowered to impact their education. TMET since then has moved on to become a staple for IFMSA, particularly in the process of capacity building, creating a momentum that will only continue to grow.

There was also a very high confidence level on presentation and facilitation skills after TMET (only on post questionnaire) with mean scores of 5.27 and 5.09 respectively.

During preEuRegMe 2016 in Kastoria, Greece a TMET event was organized. As trainers, we sought to collect evidence on how exactly this experience affects students and track any significant change. For this reason, pre and post TMET questionnaire forms were built with a set of 10 identical questions, among others, to assess impact. All 11 participants filled in both forms and using a paired t-testing analysis we will present our main conclusions.

The most striking difference was measured in the field of advocacy. With a mean score of 2.36 before and an incredible 5.45 after the event, a 3.09 difference occurred - of extreme statistical significance. Differences of extreme statistical significance were also noted on the fields of curriculum, evaluation and assessment, student representation. Very statistically significant differences were measured in ethics and professionalism, teaching and learning theory as well as the individual’s confidence on impacting medical education. The table below presents the data collectively.

TMET has a set of mandatory topics: curriculum planning, development and implementation, ethics and professionalism, student representation and student involvement, evaluation and assessment, teaching Image 1 and learning, basic training skills. Using these topics as base, and building up with a few more questions, we compared the before and after confidence level of participants on a scale from 1 to 6. Image 1


Image 2


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A huge thank you to every participant of this event that taught me more than I ever expected.

Image 2



This analysis was only the beginning of TMET impact assessment. A unique difference was observed in participants before and after and we would like to call NMOs to consider TMET in their work; evidently, it is among the most powerful tools in our hands and not only in SCOME. However, the impact relies heavily on trainers’ preparation and effort; it is now up to the TO and PCs to ensure their capacities before undertaking such a task.

Amelie - Angel - Anna - Cem - Despoina - Dominique Lisanne - Ouriana - Panagiotis - Sara - Umberto - Yagan - Yazeed

medical students worldwide | AM 2016, Mexico

August 2016

The Incredible Kigali Experience Marwa Daly

IFMSA Liaison Officer to Student Organizations AssociaMed - Tunisia

“Life is so full of unpredictable beauty and strange surprises. Sometimes that beauty is too much for me to handle. Do you know that feeling? When something is just too beautiful? When someone says something or writes something or plays something that moves you to the point of tears, maybe even changes you.” - Mark Oliver Everett, Things The Grandchildren Should Know That’s exactly what I felt when I attended pre African Regional Meeting 2015. In December, Kigali was the host of the magnificent event. All together reunited for one cause, one vision: women and girls’ empowerment. I had the honor to get selected as a trainer of Training African Medical Young Leaders-TAMYL along with talented trainers Alaa Ibrahim, Joel Gasana and Hassen Jaffer. The training aimed to equip future African health professionals with the skills and knowledge needed to take on leadership roles locally and globally by providing a forum for students interested in global public health to network, exchanging ideas and learning about each others’ experiences of health. The agenda was based on soft skills such as communication strategies, leadership skills , project management, fundraising but also advanced such as negotiation skills, stakeholders’ mapping and from MDGs to SDGs. The outcomes of the workshop were: 1. Helping participants develop techniques and methods to increase the quality of the programs and activities offered by the national members organisations, and to train them in team building and leadership skills to ensure well supported projects locally, nationally and regionally; 2. Increasing collaboration between the national member organisations of the Region, in supporting



a the development of a network of the youthled initiatives showing the importance of extraorganisational approach; 3. Increasing visibility and greater representation of the African region members within the Federation activities; 4. Increasing self confidence of medical students in their abilities to become health leaders; 5. Ultimately, changing the culture and attitudes of medical students such that in the future, all students and doctors are able to consider their practice of medicine within a local, national and global context. The workshop was genuinely full of energy and potential with amazing participants who were not only engaged in the agenda but also came up with with tremendous initiatives afterwards. Special thanks to the incredible participants that are the ultimate success of the workshop and for making this training an incredible experience for all of us and the awesome co-trainers Alaa, Hassan and Joel who contributed so much to the agenda.


SCOMEdians are the guardians of our medical education; their mission is to improve the quality of curricula throughout the world. In the following pages, you will meet some courageous and inspiring members of the SCOME crew, who will discuss with you what they have been up to lately.

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from the SCOME Director Ying-Cing Chen Director on Medical Education

Dear SCOMEdians worldwide, This is an opportunity for medical students to share their experience, promote their opportunity, and let the world see the creation of medical student. Every SCOME member, no matter experienced or newly-engaged, can have the chance to shine on this international stage, and stand out for all the medical students. In SCOME, you can learn how’s the medical education system in other countries, and you can also learn how to fight for your rights by exchanging experiences with other SCOME members. We’re not just the students learning from textbooks, but thinking about why to learn, what to learn, and how to learn. We’re sensitive to the international issues, and we’re open to changes for the better. If you’re looking into the following articles, then I believe you are taking the responsibility, to fight for the tomorrows’ doctors, for the next generation, and for the better medical education. Welcome to join SCOME.

Best regards, Ying-Cing Chen (Angel)

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medical students worldwide | AM 2016, Mexico

August 2016

A Big Family Called SCOME Pablo Estrella Porter

AEMPPI - Ecuador Universidad San Francisco de Quito

Working in Medical Education is the key element for developing a new generation of global doctors. And that is what we have been working in with SCOME in the Americas and in my country, Ecuador. Medical students from all over the country, have worked together to make SCOME one of the most active committees, with more than 120 local and national activities per year.

In the Americas, SCOME is like a big family. We all work in different ways, with different tools, but with one same objective in mind. We want to be the positive change in our medical system worldwide. For that reason, we have developed a familiar work environment, where we share our ideas, experiences, successes and failures.

Our work in the committee has created projects, campaigns, activities, symposiums and much more, in order to improve medical student’s skills and complement the education received in classrooms. Now in Ecuador, we have lots of medical students working side by side with the LOMEs and the NOME, for achieving bigger goals and more ambitious projects.

We want to become a united region, that creates globalize students who love what they do. This is an open call for every medical student in the Americas and in the world, to join the IFMSA family and become a SCOMEdian.

We have been working to facilitate several tools and skills for advocacy and student representation. In that way, we want medical students to involve actively in the decision making process of their own medical education. It is a hard and long process that will be enhanced through time, but has already started.



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An Integrated Curriculum

To Introduce Freshmen Medical Students In Medical Universities Osman Ahmed & Soniya Shivnani EMSS - United Arab Emirates

In our reputed college, RAK Medical and Health Sciences University, the First Comprehensive Health Science University in United Arab Emirates, Integrated curriculum is a required and graded two year course which is designed to prepare medical students for the clerkship years. An integrated curriculum is described as one that connects different areas of study by cutting across subject-matter lines and emphasizing unifying concepts. Integrated modular curriculum of applied basic sciences has been proven to be more effective than other conventional methods such as Discipline based curriculum. Integrated Teaching is made up of ‘Modules’. A Module is the smallest unit of curriculum. Each module is based upon organ-system/s of the body and/ or processes. In each module, the basic and clinical sciences will be taught in an integrated manner.

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The benefits were such that when the students were taught through an integrated curriculum, they showed higher signs of retention at an increased rate and remain engaged in classrooms, which yields higher mastery of content standards than when an integrated curriculum was not implemented. The simple yet hefty reason for this was that they were able to closely relate to content and make real world connections in integrated curriculum approaches. For example, creating a proper medical case scenario and solving it, requires oral language communication and practice, reading comprehension skills and adequate knowledge, which engages students far more than just a lesson on that particular study of topic. The key benefit of an integrated curriculum is the ability of the students to view and experience skills multiple times. Instead of teaching comprehension strategies in just reading, teaching those strategies across multiple

disciplines can give students an opportunity to see and implement it more often. The repetition of the skills being taught creates a higher level of understanding and retention of information for students in the classroom. The main objective of medical education is to develop effective learning in students to understand physiological alterations that forms basis of a disease process. This can only be made possible when future doctors are aware of location, structure, function, derangements, diagnostic tests and plans required for treatment of the diseased. The unified curriculum is thus meant for better understanding of normal and disease process related study of a specific organ and is especially helpful for diseases which are not organ based for example diabetes. In such instances there should be case-based integration of cardiovascular, endocrine, metabolic, hematologic, renal and genitourinary courses, which might, in turn, help them perform better in future. It goes without saying, but this is basically how integrated system works: If you know the complete Anatomy of an area, along with the tiny Biochemical processes running the system and be aware of its Physiology to know the Microbiology residing or affecting it; then understanding the Pathology and applying the Pharmacology should be easier than slaying a dragon right? References • h t t p : / / w w w. rowa n . e d u / s o m / e d u c a t i o n / undergraduate_medical/pre-clinicalEducation. html • html • • medical students worldwide | AM 2016, Mexico

August 2016


A New Approach to Medical Curriculum Ana Rita Gonçalves da Costa Ramalho

ANEM/PorMSIC - Portugal

Not so many years from now, every graduate in medicine was supposed to have been exposed exactly to the same information as their colleagues. We were dealing with an outcome-based system which, because of the inherent difficulty of determining what should be the competencies of a physician, precipitated the need to define them. That’s when emerged The CanMEDS Initiative, which was successful in defining a list of essential ingredients for outcomes-based medical education1. This was in 2007, and in 2014 we could read a whole issue of AMEE reporting the role of electives in undergraduate medical education2. Due to the constraints of the increasing knowledge in health sciences, the diversity of interests of medical students, and the limited amount of educational time, we have seen an increasing investment of medical schools in elective courses. I bring the example of the Faculty of Medicine – University of Porto (FMUP), which has allocated 10% of ECTS in electives regarding clinical, biomedical, human and epidemiological sciences, in an innovative approach to medical curricula. But what are electives? What makes them so unique? Are they so different from the classic, nuclear classes? Absolutely! They are so distinctive that there isn’t even a standard definition of an “elective”. They are a part of the non-traditional curriculum, allowing medical students to simultaneously maximize and individualize their competences, to broaden aptitudes in a tailor-made curriculum according to personalized interests. The number of systematic reviews concerning the impact of electives in undergraduate medical students has been growing, reflecting the importance given to this new kind of non-formal curriculum. Those reports tell us that electives increase students’ self-reported confidence in their clinical skills (some even evaluated pre- and post-assessments to demonstrate improved skill level3),



they influence career choices by rising student interest in specific specialties, and they promote their wellness4. So, whether you are a passionate for global health and you are willing to understand different healthcare systems and to learn how to manage uncommon diseases, or your future career is still unclear and you prefer spending your time exploring different specialties, the electives are the answer that you were looking for. Our schools can facilitate the process, but the choice is up to us! We now have the ability (the capability was already in our hands) to decide what kind of doctors we want to be. This is no more a one-school decision; this is our decision. References 1. JR Frank, D Danoff. “The CanMEDS initiative: implementing an outcomes-based framework of physician competencies”. Medical Teacher, 2007. 2. Andrew Lumb, Deborah Murdoch-Eaton. “Electives in undergraduate medical education: AMEE Guide No. 88”. Medical Teacher. 2014. 3.

Morley SK, Hendrix IC. “Information Survival Skills: a medical school elective.” J Med Libr Assoc. 2012; 100: 297-302.


Agarwal A, Wong S et al. “Elective courses for medical students during the preclinical curriculum: a systematic review and evaluation”. Med Educ Online 2016, 20: 26615.

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Discussion About Teaching Methodology in Medical Schools

Marco AntĂ´nio CamarĂŁo Pinheiro IFMSA - Brazil

The Ministry of Health at Brazil hopes that within 10 years all the medical schools in the country can change the Traditional teaching method (used in most Brazilian universities) for the guided method in active methods, like PBL (Problem Based Learn) and TBL (Team Based Learn). In these methods, it is known that the student becomes more active in the pursuit of knowledge. Knowing the importance of this matter, students members of IFMSA Brazil launched a jury-simulated in order to approach and discuss the topic. The jury was composed by a defendant, who represented the active methodologies; a victim, who accused the defendant of being a bad method; and other people playing judge, lawyers and prosecutors, audience and jury, each one with their functions within the trial. Because of ParĂĄ State University is still undergoing a transition model of teaching methods, there are students in the old and new method concurrently. So, in the simulated-jury, students from the traditional method had to defend the active methodologies and students of active methodologies had to defend the traditional method. The activity began with a brainstorm for students to focus on the main ideas and fix their strands of thoughts, and then, start the discussion. In the end, the audience and jury were responsible for drafting an official document that represents the local SCOME coordinators in their opinions about what should be

done to improve all lines of application of the new method, as well as the response of the students toward the changes that have occurred. In this line of thought, we realize that we are responsible for changings too. The event was a success. About 20 students participated, and as feedback they reported the reflection made on their reality at the university and thoughts of how they can act to change some situations, like knowledge gaps between the students in different medical schools. In addition to creating their own opinions about the situation and thus be able to convince themselves and others about their views. Medical students and future doctors should live up to its role as a producer of knowledge in society, and should always reflect on any kind of event that surrounds them. Therefore, our committee feels pleased to be able to contribute to these very rich discussions in the university context, where an increasing amount of students need to renew their knowledge and life experiences. We are planning more activities with this kind of approach, addressing other issues as equal in importance and as controversial as abortion and legalization of drugs. All health issues and social questions are related to medical education, because medical students and physicians are important in the help people and society, and IFMSA as our representation by means of SCOME may give us this knowledge.

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medical students worldwide | AM 2016, Mexico

August 2016

Project “E.I.” Abhishek D. Bhatia

MSAI - India Dr. VM Govt. Medical College Engaging in conducting medical education enhancement programs, workshops and campaigns for the current medical students, we sure have forgotten one important phase of our lives. The phase when we had the first vibe of a dream. The dream of becoming an angel with a white coat and a stethoscope spreading happiness around the world with the magical wand of our skills. The dream with which we entered High School taking up Physics, Chemistry and Biology as our subjects of interest for the next two years. When big incomprehensible medical terminology used to be perplexing and intriguing. The dream which then was just a seed and we knew that with proper nourishment and cultivation, will PHASE A: Foundation PHASE B-1: Core Health Focus: Care Setting 1. Importance of three Focus: foundation subjects i.e. 1. Departments and strucPhysics, Chemistry and ture of the Hospital Biology in connecand Medical College. tion with subsequent Execution: subjects of the medical 1. Slideshow photofield. graphs of ICU’s, 2. Continuously evolving Wards, Radio-diagnonature of the field of sis Department, OPD’s health care. and the Lecture Halls, Execution: Practical Labs, Dissec1. Lectures, Videos, Pretion Halls. sentations and Group Discussion Culmination: A final assignment wherein each student describes the summary of the entire journey through the 3 phases Official Assistance for Phase A, B-1 and C: Incorporation of monthly lectures by collaborating with the Principal of the Schools/Junior Colleges Official Assistance for Phase B-2: Collaboration with physicians, surgeons and researchers



definitely grow into a wonderful, fruit-bearing and strong tree in the future. This pre-med education phase is the time when enthusiasm and motivation if sparked in those dreamy eyes, will have long term and sustained sense of a “Dr.” prefix before their name even before the prefix itself gets attached. In view of this, the medical students at MSAI-INDIA from Solapur, Maharashtra have jotted down the plan of this project and will soon start implementing it. The “Early Inception” or Project “E.I.” is divided into 3 Phases- A, B and C. The highlights of the individual phases are as follows; PHASE B-2: Shadow Learning Focus: 1. Experience the health care environment 2. Volunteer in community service. Execution: 1. Weekly Rotations in Hospital departments and private clinics. (From delivery room to autopsy table) 2. Orphanage, old age home visits

PHASE C: An Eye on the Future Focus: 1. How research creates science daily by disproving and reproving something. Execution: 1. Current medical events news, noble laureates of the field, group discussion

Advantages to the med students: Resourceful development of Communication skills, Public Speaking skills, Explanatory skills, Role Model building This will enable the curious minds to read with a fresh vision of the prospect of a fascinating life ahead and the preparation for entrance tests will become more fun rather than chaotic and stressful. We thank IFMSA for the opportunity.

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Complementary Alternative Medicine Arshiet Dhamnaskar MSAI - India

As the field of medicine reaches staggering heights, the world still looks at the other forms of medicine to cover up the fallacies in the standard system. Is this a threat to health care? A mere revolution? Or a backward step towards primitive healthcare? Before we come to a conclusion, we must take a look at what alternative medicine includes. Such other forms of medicine usually present themselves in traditional beliefs and practices originating from different parts of the world; be it Yoga and Ayurveda of India, Oriental acupuncture, or Greco-Roman herbalism. These could easily be passed off as old and worthless, but one cannot deny the possibility that the sheer existence of these practices even today could be a result of their evident efficacy. While the world has wholly embraced the benefits of some of these forms of medicines, such as yoga, the same is not included in medical curriculum. Imagine yourself as a practising doctor who realises that a particular ailment can be treated with a particular exercise or manoeuvre, but does not know the exact procedure of such a mode of treatment. Moreover, imagine having to deal with a complication the patient is facing due to the intake of a drug prescribed by another form of medicine. Wouldn’t it be better if one were to know more about this? Then why are such things not taught to us? Of course, this would certainly mean an increase in the curriculum, but notice that this is actual practical knowledge and training that we will get! 70 71

Alternative medicine may be considered superior by its practitioners, while the practitioners of standard medicine may shun the very thought of these. The debate might go on for a long time, but during its course one must not forget that medicine is, in its true essence, medicine. The ultimate goal of the doctor is to provide

optimum healthcare for the patient. Perhaps one day it will be a set requirement to resolve all set discrepancies between every form and aspect of medicine, take up an integrated approach and deliver the perfect healthcare system for all. To achieve this, we must learn. We must ask to be taught what we do not know. There is more to medicine than we can think of. And we know this! Then why not take steps into every perspective of it and fulfil our responsibilities as guardians of medicine?

References 1. 2. articles/10.1186/1472-6963-5-78 3. h t t p : / / l i b n a . m n t l . i l l i n o i s . e d u / p d f / publications/193_Chien.pdf 4. medical students worldwide | AM 2016, Mexico

August 2016

Assessing the Greek Medical Education


Katerina Dima

SCOME Regional Assistant for Europe HelMSIC - Greece

Lord Kelvin once said, “To measure is to know”. While this principle is applicable throughout science and physics, it also applies to the various aspect of life, including education. An ongoing problem in the Greek medical education system is complete lack of evaluation at all levels. Throughout six years of medical school, students and professors alike, are not given the chance to raise their voice, share their concerns and implement evidencebased change in the curriculum. It could probably be because of some cultural issue, but measuring and assessing has never been a strong feature in our education system. While this poses no issue among the academic staff (as they are the ones prolonging this situation), it inhibits student involvement and completely disregards the students’ opinions. If students,the major stakeholders of education, have no opportunity to speak and voice their opinion in the best interest of their education system , how will universities improve their curriculum? Moreover, how will the health care system improve? In 2014, HelMSIC-Hellenic Medical Students’ International Committee, and particularly, the Greek SCOME team decided it was high time someone acted upon this problem. Being the only national medical students’ representative body, we managed to secure the aid of a leading medical education expert in Greece, Dr. Yanis Dimoliatis. With his help, we took our first step towards vocalizing and externalizing what medical students really thought about their education system. Dr Dimoliatis translated and validated the DREEM (Dundee Ready Educational Environment Measure) questionnaire in the Greek language, an internationally recognized tool which HelMSIC distributed among Greek medical students between May and June 2015. Out of 9000 students in total, 804 responded, following which the results were reviewed, analyzed and prepared



into an original scientific paper. Following were our major conclusions: 1. Greek medical students perceive their schools’ Educational Environment in the cut point between poor and good, with serious problems to be addressed. Their attitudes towards learning in particular is below the limit. Positive aspects were identified in extracurricular sides, while particularly negative in the heart of intracurricular aspects, where evidence-based effective measures are needed. 2. The two worst aspects are lack of psychological support systems for stressed students and a complete lack of professors giving feedback to the students. Particularly the second aspect lies at the heart of the problem in Greek education - the lack of assessment. Both these aspects can be improved and a systematic annual measure is needed. These results came as no surprise, however, the real challenge for HelMSIC starts now, while waiting for the paper to be published. Greek SCOME & HelMSIC as a whole will be responsible for taking these results to the faculties and demanding change, but there is still more to come, as we are preparing a second questionnaire, ‘iCAN-weCAN’ to assess the clinical skills of medical students, from both, students’ the professors’ perspective. In this way, we are going to have a holistic view on the Greek medical education and be ready to back up any claims for change. Stay tuned while our second campaign comes to life in October!

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And the Advocacy Process by IFMSA Brazil Lucas Martins Teixeira & Mário Fernando Dantas Gomes & Felipe Augusto Ferreira Siquelli IFMSA - Brazil On April 1st of this year, the Brazilian government set up, based on the 2013’s brazilian “More Doctors” law: National Serial Evaluation of Medical Students (ANASEM in Portuguese), that is a text to be realized in the end of the second, fourth and sixth years of medical course, to evaluate the quality of medical education. The original law’s text preview an exam to measure the quality of Brazilian medical schools, with an aim of upgrading the education system. However, without any prior discussion, the Brazilian government established that the new evidence would have the right to retain a student’s graduation, depending on the results of their participation in the last year. The decision caused great discussion among medical students across the country, and several questions were raised in the process, on various issues like the process, frequency and situation of the student loan payment (large government stimulus policy in the last decade) like freezing the graduation, the possible repercussions of underperforming in the exam, minimum acceptable score and several other parameters. Considering that the beginning of the application process should occur early in the second half of this year, such large gaps denote the apparent lack of planning and therefore government commitment to medical education in the country. Since then, IFMSA Brazil, through its Standing Committee on Medical Education, has articulated to enable the expression of student opinion, involving the entire community of Local Coordinators and 83 affiliated educational institutions. 72 73

broad acceptance and an overwhelming response, enabling students to voice their thoughts and opinions. The online discussions also made way for contrary and favourable arguments on the topic and eventually, the issue was discussed at the 49th General Assembly by the representative of the Federal Council of Medicine, who attended the meeting to specifically address our issue. Enabling voice to numerous lines of thought and taking into account contrary and favorable arguments, including the participation of representative of the Federal Council of Medicine in 49th AG, specifically to discuss the issue. The results of this effort were outstanding. There was reform of the Policy Statement that was the subject, in addition to disclosure of a note, which was publicly issued with the position established by the community of Local Coordinators, compliance with which is that the punitive never benefit society, as transfers the student an essentially structural accountability is impossible to repair individually configured as a measure stopgap, innocuous and especially diverting attention from the only possible solution: investment, planning and dedication to improving the medium and long term graduation. The public notice of IFMSA Brazil, so far has reached 27.180 views and has gone to become one of the most important documents in the academic, medical and social development of Brazil.

A task force was set up to summon the local coordinators, decide a theme and promote online discussions based on the same, so that so that it formulated an official position to be enacted by all delegates at the 49th General Assembly, which was to occur 20 to 24 April. Within a short span of time, the mobilization received medical students worldwide | AM 2016, Mexico

August 2016

eHealth Prerna Chaudhary & Lilas Mercuriali

BeMSA - Belgium & AECS - Catalonia As defined by the World Health Organization, e-Health is the use of information and communication technologies for health [1]. Nowadays, digital technologies and solutions’ relationship with healthcare is undeniable. Yet, little has changed in medical curricula since the World Health Assembly recognized the potential of e-Health to improve healthcare and encouraged its Member States to take action in order to incorporate e-Health in the health systems and services[2]. This article aims to outline the benefits of e-Learning and e-Health integration within the medical curricula, all of which are being addressed by the IFMSA’s digital health small working group. Currently, different digital solutions are being used, next to traditional learning. Students and professionals have access to MOOCs, simulation training, webinars, interactive games and other solutions. In order to compare the outcome of these, it is possible to identify different kinds of ‘e-Learning’ and ‘blended learning’; Non-networked computer-based training, internet and local area network-based training, psychomotor skill training, virtual reality and digital game-based learning. Findings from a systematic review suggest both non-networked computer-based and network-based eLearning are not worse than traditional learning and can be equivalent to and possibly better than traditional learning, when looking at the knowledge and skills gained by healthcare students. Using eLearning tools could help reduce cost associated with delivering educational content, facilitate development and scalability of educational interventions, help improve the access to and availability of education, experts and new curricula, and help facilitate ‘immersive learning’ through augmented reality and 3-D learning environments, mobile learning and cloud learning environments[3]. Although exponential growth of data availability may be beneficial in many ways, it also carries big responsibility with it. Future healthcare professionals and researchers are expected to be able to counter the misinformation



that is being largely spread over the internet. Furthermore data visualisation techniques and information designs can improve healthcare delivery, only when healthcare professionals know how to analyse and work with these. For that sake, we believe these issues have to be tackled in the undergraduate curriculum[4]. Besides this, it may be useful to keep students updated about the new technology, which is gradually replacing old practices. For example, electronic medical records (EMR) are a novel way of storing patient data that is gradually being implemented in hospitals across the world. They provide the possibility to store an important amount of information in a way that is both real-time accessible to different types of professionals and trackable. Some EMR solutions include decision-making tools within the platforms, for instance, introducing alarms that detect erroneous prescriptions. Despite security measures, information leakage still may occur and bugs in the system may provide wrong advice to professionals[5]. As future doctors, we need to be aware of the ethical implications and limitations of these new technologies. References [1] World Health Organization [2] FIFTY-EIGHTH WORLD HEALTH ASSEMBLY. Resolutions and Decisions. WHA58.28. Geneva, Switzerland, May 2005. (Available at: http://www. [3] Atun R, Kersnik J, Švab I, Majeed A, Car J, AlShorbaji N et al. eLearning for undergraduate health professional education. London: Imperial college; 2015. [4] Weil AR. Big data in health: a new era for research and patient care. Health Affairs. 2014 Jul 1;33(7):1110. [5] ECRI institute. 2016 TOP 10 Patient Safety Concerns for Healthcare Organizations [Internet]. 2016. Available from:

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Path of Empathy Ana Cristina Assumpção Benjamin IFMSA - Brazil

During a medical student’s academic life, a topic that remains unaddressed is ‘empathy’, which is not just a term, but is the foundation of the doctor- patient relationship. It is very important to step into the other person’s shoes to understand what the opposite person is feeling or going through, which is the mere crux of our humanitarian profession. Owing to the constant pressure of performing well academically, the mere essence of our profession is slowly dying and how to establish a doctor- patient relationship on the basis of empathy and affection remains unaddressed among medical students.. Given this motivation, the students of IFMSA Brazil - Local Committee FAMEMA (Marilia’s School of Medicine) initiated a campaign, inspired by the travelling Museum of Empathy, which took place in London on September of 2015, primarily targeting the freshers of 2016 The Path of Empathy aimed to approach the topic of empathy in an impactful, yet still playful way, intending to address this matter to students entering the healthcare field. This experience report aims to display the campaign’s making off and the relevance of this approach among medical students.

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We were allotted six thematic rooms for our campaign activities. We had a turnout of about 80 fresh medical students, that were eventually divided into smaller groups, depending on which experienced the routine of patients with different conditions: cancer, positiveHIV, anorexia, obesity, depression and deafness. Each room had banners with quotes from patients that had suffered or were presently suffering from the above mentioned mentioned diseases and their thoughts on the same. The gist of the campaign was to make the medical students experience what it feels like to live with a chronic ailment, how hard it hits when you are diagnosed with one and the impediments they face, which we as doctors at the other end do not realize. At the cancer room, the news of positive diagnosis

for cancer was given to one group members, initially in a blunt and crude manner way, followed by breaking the same news in an empathic way. This was only to demonstrate to the students how hard- hitting it can be when one is given the news that they have to combat cancer and the thing that plays a crucial role in this is medical students worldwide | AM 2016, Mexico

August 2016 how you break the news to the patient. Following this a video was played that had various cancer patients talking about their fight against the disease and most importantly, their experience with the medical conduct throughout the course of their disease. In the second room, in order to reproduce the idea of the imminent danger that an HIV patient might pose, not only to himself, but also to the ones around him, one of the students was made to wear a shirt full of pins.Then, an HIV advertising video, produced by an NGO (Grupo de Incentivo à Vida - in english, Incentive of Life Group), was presented. In the anorexia room, each student was made to sit on a chair facing a cake and a mirror. They were asked to put on their headphones and listen to the thoughts of an anorexic patient. Simple daily activities, such as reaching out to objects on the floor and climbing stairs were a challenge at the obesity room, where all the students were equipped with extra weight. The next room was had dim lights and was decorated with photos that were taken from a depression exhibition, and recordings of patients suffering from depression was played in the background. In the last room, one of the students was invited to take part in a stimulation of anamnesis. However, the participant was taken by surprise when he realized that the simulated



patient was deaf, hence, challenging the ideal communication. By the end of the campaign, the students shared their experiences, and the impact of our campaign ‘Path of Empathy’ was recorded and assessed by their unanimous positive testimony. Many attested that had never felt inserted into someone else’s life in that manner. The opportunity of stepping into the patient’s shoes and being at the receiving end for a change, certainly created a very fragile environment around the medical students during the campaign, which undoubtedly reflects on the importance of ‘empathizing’ with your patients and handling delicate situations with respect to the patients, with utmost care and affection. References 1. COSTA, F. D., AZEVEDO, R. C. S.. Empatia, Relação Médico-paciente e Formação em Medicina: um Olhar Qualitativo. REVISTA BRASILEIRA DE EDUCAÇÃO MÉDICA, vol 34 (2) : p.261–269; 2010. 2. 3.

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International Medical Scientific Congress 39 Years Tradition

Jovana Prisagjanec MMSA - Macedonia

The Macedonian Medical Student Association has been organizing the ‘International Medical Scientific Congress’ for students and young doctors since 1977, and it is one of the oldest medical congresses in Europe held every year in Ohrid-Macedonia. This event has been symbolizing the strong spirit of collaboration among more than 300 medical students for 39 years. After so many years of organizing this event, the ‘International Medical Scientific Congress’ has contributed towards improving the scientific experience of the medical students and young doctors through sheer hard work on their projects and exchange experiences with each other. This unique opportunity has been taken by many students from various countries all over the world, especially by the Macedonian students, by presenting their work on their research. Also, this congress gives the opportunity to learn and see a lot of things you that one specifically does not acquire the knowledge of in everyday studies.

presents a ground for exchange of experiences and projects with the primary aim of upgrading and improving medicine. The cooperation of the medical staff can help the implementation of many novel ideas, which can further start improvement of the medical sector in the country, and by that the optimal professional potential in the country can be reached, that will bring a possibility for a brighter future for doctors in general. The Congress predominantly comprises: • Lectures held by professors from Medical Faculty from Skopje and professors from other universities on different fields of medicine and health. • Workshops from different departments of medicine, debate on a particular subject in public health and medical research. • Poster session: A discussion on selected posters from registered abstracts. • Oral sessions: Selected abstracts by registered students and young doctors who worked on their research. • Case reports: Presenting a detailed report of the symptoms, signs, diagnosis, treatment, and followup of an individual patient. • Awards: The congress jury (comprising professors from Medical Faculty in Skopje) awards the best posters and the best oral presentation during the closing ceremony of the congress.

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The Congress, with the lectures, as well as the oral sessions and workshops, has the main goal of extending the personal and professional knowledge and experience of the students. Furthermore, the quality and the tradition of the Congress fuel communication among the students, and therefore the Congress

• The social program includes boat parties, field trips, a karaoke contest and famous beach games. Apart from the educational and scientific section, the Congress offers many mutual companionships, interesting experiences out of formality, which will remain the most vivid and pleasant memories of your life.

medical students worldwide | AM 2016, Mexico

August 2016


Adrenaline Medical Conference 2016 Adit Desai & Chinmay Jani

MSAI - India

Adrenaline Medical Conference (AMCON) 2016 held at Smt. N.H.L. Municipal Medical College, Ahmedabad, was the biggest gathering of the entire medical sorority of India. With a total of over 660 delegates attending the conference from across the country AMCON went on to be the largest national medical conference of the year organized by the students, for the students. . The dictum of AMCON ’16 being exploring new horizons, it provided a platform for both, undergraduate and post-graduate students to present their research studies as either oral or poster presentations. An overwhelming response of more than 200 abstracts was received in a span of only a few weeks. Unique workshops were conducted in association with the Academy of Traumatology (A.O.T.) of India, which included six different skill stations: Spinal immobilization , Shock, FAST, Chest tube drainage, CPR, and Airway management. Another workshop included skill stations on suturing and ECG. These workshops help in enhancing a student’s skill, giving them an earlier hands-on experience, which will only help them to become better physicians in future. Avant- garde ideas like Model WHO and the National Medical Quiz were conducted for the first time ever at a medical conference, which is what helped AMCON make its mark among various other medical conferences in the country. At this one-of-its kind debating session of Model WHO, 16 participants were divided into 8 teams, each team comprising 2 delegates representing the country they were allotted. The countries of the committee were Brazil, Germany, Japan, India, Russia, Turkey, Syria and the United States of America. The topic of discussion for the session was the Syrian refugee crisis. The response received for the Model WHO was phenomenal and it was only after being premiered at AMCON that the Model WHO was eventually conducted at other



medical conferences; to name a few, EXCELSIOR 2016 at Nashik, Maharashtra and the conference conducted at Stanley Medical College, Chennai. AMCON was not only attended by medical students across the country, but was also attended by the stalwarts of Indian Medicine.The second day of the conference witnessed a gathering of over 900 students who were present to attend the lecture by our guest speakers. Dr. Jayshree Mehta, spoke on the topic of ‘Research in medicine’. This was followed by Dr. Ketan Desai addressing the topic of ‘N.E.E.T-National Eligibility Entrance Test’ and Dr. Vedprakash Mishra gave an oration on the topic ‘Competence based curriculum’. The medical students that attended this grand synod, reaped the benefits of attending the MCI panel discussion, the objective of which was to update the students on the various aspects, changes and additions in the medical curriculum, giving them an edge over the rest.Several other important discussions helped the students foresee the future of medical education in India. With the event being graced by deans of medical and dental colleges of Gujarat and other eminent doctors of the medical fraternity,AMCON shall remain an unparalleled conference organized by the medical students,in the years to come.The eminent speakers of the conference also included renowned interventional cardiologists, surgeons, general practitioners, and gynaecologists speaking on new innovations, latest technologies and diseases plaguing the medical field. AMCON got its international accreditation by the presence of Dr. Bronwyn Jones, ‘Australian of the year’, who spoke on the basic research methodologies, hence, promoting research among medical students in India. A convention of this scale with an inordinate and overwhelming response has left the medical fraternity across the nation awestruck.

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Motivating Students to Become Leaders in Education Change

Hussain M. Al-Abdulrahman KuMSA - Kuwait

The involvement of students in medical education development is very crucial, but what motivates medical students to participate in the process of curriculum development? When looking at research and evidence from around the world, we can establish that the reasons behind this are actually three main points. The first is extra- curricular interaction with faculty members, the second is engaging with highly motivated peers and the final point is student values for serving the public. While looking at the first point, it is known that the engagement of students in medical education development helps in breaking down the barriers between professors and the students at the university. In addition, it allows the students to discover the way that teachers think about the education, curriculum. These are very important due to the fact that having a good relationship and understanding the need of those who are responsible for education, helps in getting support in changing common things that we as students and them as educators see as flaws in our educational system.

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Moving on to the second point, which states that while creating student working groups, we must have motivation and drive. This is a key point when we talk about the long tiring process of changing your own curriculum. We understand the struggle and disappointment that comes when our efforts do not result in radical changes, however, this disappointment is usually offset by the opportunities that are gained by engaging with the highly motivated student colleagues working alongside.

learning experience. So, awareness regarding this point should be made to all students that they have a social responsibility in helping in the process of change of their education curriculum. They must also understand that the World Federation on Medical Education recommends student engagement in curriculum development. Finally, a lot of students out there would love to contribute to education development, but the key point is that they just don’t know how. This is why training programs and toolkits that help in the enlightenment on subjects regarding medical education are considered very important. These help in understanding concepts and enhancing skills needed to become an effective person in medical education change. Finally, being a medical student and just receiving the educational program is unfair. As a student, you should be able to give your feedback and play a leading role in asking for change in those particular aspects of your medical curriculum, which according to you are reducing the quality of medical education. Because students are so closely involved in their educational program, the yield of student involvement for the teaching institution is high. In the short-term, active student participation in providing continous feedback on their curriculum, promotes curriculum imporovement and innovation.In the long run,, active involvement of students in curriculum design and assessment is an investment in the faculty of tomorrow , which will promote a more horizontal and integrated learning experience.

Students always have a feeling that they must contribute to their education. It is very important for them to understand that they are receiving the education and it is their right to give feedback on what affects this medical students worldwide | AM 2016, Mexico


In this section, you are going to meet SCOPEople, read about their professional exchange experiences, their challenges, and meet their friends from every corner of the globe. Prepare yourself as you embark on a SCOPE journey that will take your breath away!

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from the SCOPE Director Omar Cherkaoui, Director on Professional Exchange

Dear SCOPE Family, It is such a great pleasure to be writing these words to introduce this SCOPE Section of the MSI. SCOPE is the oldest Standing Committee of the federation. Every year, we give the opportunity to more than 11.000 medical students to experience healthcare in different settings and in a different culture than theirs. Every year, thousands of medical students from more than 90 countries go back to their countries after the exchange, with plenty of memories and enriching experiences. This SCOPE section of the MSI is a great tool for students to share their experiences with other medical students around the world, hoping this would inspire them too. These articles are also being archived in a database that is available on the IFMSA website, so that anyone can easily access them in the future. It is quite sad to be writing you for the last time as SCOPE Director, as I have been serving the federation in this position for two years. This would therefore be the fourth and last time I would be introducing you this section. I truly enjoyed the time I spent serving the federation, and I would encourage you all to not miss the chance to be involved in IFMSA and especially in SCOPE. Should you have any questions, please do not hesitate to contact me.

Best, Omar Cherkaoui

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medical students worldwide | AM 2016, Mexico

August 2016

How Japan Changed My Life Maria Golebiowska

IFMSA - Poland

“When I am reborn, I will remain a neurosurgeon.� These are the words Professor Yoshiaki Shiokawa told me on the first day of my stay in Kyorin University. It made a huge impression on me. I did not expect, however, that my stay in the Land of the Rising Sun will forever change my vision of medicine. For all of my efforts in IFMSA-Poland I was awarded with a clinical exchange in Department of Neurosurgery in Kyorin University in September 2015.

in Nagoya, which enriched me with knowledge on interesting patient case reports, new techniques of surgery and diagnostics during the lectures and with the basics of microsurgical skills during the workshops chaired by Professor Akio Morita from the Nippon Medical School. During the conference, I had the honor to hear a lecture by Professor Yong-Kil Hong, Director of the Brain Tumor Center in Seoul on the psychological aspects of becoming a neurosurgeon. During my stay in Kyorin University I also had a pleasure to meet Japanese medical students, members of English Speaking Society of IFMSA-Japan, who took care of me and showed me the amazing, both new and traditional aspects of Japanese culture. Due to their hospitality I could explore the Edo Museum with the most amazing exhibition on the historical places in Tokyo, as well as the new Akihabara part - a centre of youth entertainment. Their valuable lessons on Japanese culture and language helped me in better understanding of the reality around me.

Starting from the very first day until the last day of my exchange, it was a dream come true. Not only was it my first clinical exchange, but also first neurosurgical experience in my life in one of the most wonderful countries in the world. For the first two weeks I was studying the neurovascular and trauma aspects of neurosurgery. The next two weeks I studied its oncological aspects and principles of the research in Japan. Due to the greatest hospitality of my Department and the efforts of Professor Yoshiaki Shiokawa, Doctor Kuniaki Saito and Doctor Ryuichi Yamaguchi, I had the honor to participate in Annual Meeting for Awake Surgery and 20th Annual Meeting of Japanese Congress for Brain Tumor Surgery



There are several aspects of my exchange which inspired me to become a better physician in my future career. Starting from the holistic approach to the patientneurosurgery in Japan takes into consideration not only the surgery itself, but also the internal medicine, emergency medicine, neuroradiology, neuropathology. Secondly -the amazing dedication of Japanese healthcare, which comes with great professionalism and patient-centred medicine became my moral compass which I would like to follow in the future. Thirdly - the extraordinarily precise surgical skills of Japanese neurosurgeons inspired me to the never-ending training on the way to the perfection of the surgical techniques. I will never be grateful enough for the greatest hospitality of Neurosurgery Department at Kyorin University and IFMSA-Japan, who taught me the most inspiring lesson of my life.

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Medical Experience in Portugal Anna Shestakova

HCCM - Russian Federation

My second IFMSA SCOPE exchange was in the capital city of Portugal. I was very happy when I found out that I will have my exchange in one of the most beautiful cities in the world. Lisbon is really very colorful, beautiful and historic city with distinctive features. Every year, Lisbon is visited by dozens of students from different countries to gain invaluable medical experience and to get acquainted with the history of the country. I was very pleased to meet students from Germany, Czech Republic, Mexico, Greece, Brazil, and other countries. I was very glad that I have met medical students from other states, had an opportunity to practice English and have received many invitations to visit a lot of countries from my new friends. We lived in a large student hostel, where all conditions for comfortable stay, including Wi-Fi and even computer room were organized. In the afternoon we went to museums, walked along the picturesque streets or went to the beach and in the evening we gathered in the common room and shared our impressions about working in the hospital. As for medical practice, I was lucky to work in the Central Hospital of Lisbon. It was an invaluable and

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necessary experience in the Department of General Surgery. The surgery was a big five-storey building equipped with modern equipment and appliances. I had the opportunity to scrub in on operations, participate in rounds with physicians and to gain new knowledge from experts. For the first time in my life I have seen and studied the technique of transplantation of the liver and kidneys. Working at the hospital I have met with doctors from the Department of Functional Diagnostics who taught me to diagnose and detect abnormalities of the organs of the gastrointestinal tract. In addition to the saturated working days we had social programs every weekend. During the first weekend about 40 students from Lisbon went to Porto. I never knew that Porto is the historic capital of wine. They produce about 1500 kinds of wines. In addition, Porto is an incredibly beautiful city, with great bridges, buildings and landscapes. We had a great time and met with a group of medical students who practiced in Porto. A week later we went to Sintra where I was able to walk around the castles and gardens of the Portuguese kings. It was like a fairy tale! But the most memorable journey was a trip to the Algarve. The Algarve is the end of Europe, and then across the sea begins Africa. It is impossible to imagine this beauty if you haven’t seen it with your own eyes. We stayed in the hostel and spent every day on the gorgeous beaches. I could never forget such beauty! The Algarve is the place where I would like to return again and again. In conclusion, I would like to say that Portugal is an incredible country, where you can enrich not only your medical knowledge but also to expand knowledge in history and culture. It is a country where you can enjoy beaches, swim in the ocean and relax on the rocks. Lisbon is the capital which will open up new opportunities and will give a lot of new friends. You can also be in my place, all depends on you! medical students worldwide | AM 2016, Mexico

August 2016

My SCOPE Experience in Chile

From the Caribbean Sea to the South Pole

Gabriela Guzmán Cleto

ODEM - Dominican Republic

During the month of July 2015, I had the opportunity to participate in a four-week clinical exchange in the Department of Endocrinology at the Hospital Universidad de Chile in Santiago de Chile, Chile. I will never forget my arrival day on July 4th. My host family welcomed me warmly with tea and sopaipilla, a traditional Chilean fried pastry made with pumpkin and flour. At the same time, the nation was celebrating their first “Copa América” win. In other words: Olé, Olé, Olé, Olé, Chile, Chile! Chile is the longest country in the world, with the Pacific Ocean on the western border and the Andes mountain range on the eastern border. Chilean literature is internationally recognized through the works of Nobel Prize poets Gabriela Mistral and Pablo Neruda. During my clinical exchange, I stayed in Puento Alto of Santiago, Chile’s most populated city, located in the southeast region of Santiago de Chile. Attractive for its malls, vineyard and green vegetation, long walks are inviting to the visitor. Since I am from the large metropolitan city of Santo Domingo, I was comforted with the busy city lifestyle of Santiago, ranging from rush hour traffic in the mornings and evenings to subway stations to crowded streets. However, this South American city expressed immense hospitality for international travelers to the city. I am very satisfied of my experience at the Hospital Universidad de Chile, where I was received with open arms from clinicians, other medical students and patients. Even patients were happy to know that international students would be evaluating their medical records as part of the clinical rotation. All physicians and nurses showed complete support as we completed our clinical rotation at their hospital. During our extracurricular time, IFMSA-Chile SCOPE members were enthusiastic to provide cultural and social



activities to learn about their country. We definitely were never bored! Our activities included an International dinner, where every student prepared a typical dish from their country; guided tours around Santiago; skiing excursion to Valle Nevado; visiting tours to Viña del Mar and Valparaiso; and an activity day in Cajón del Maipo. Personally, my favorite place was Valparaiso. Now I understand why Neruda loved this city because it really is a magical and colorful place where art is everywhere. In summary, my exchange month was a memorable experience, gaining knowledge and skills for my personal and professional development as a future physician. I made lifelong friendships with other IFMSA members. I encourage all IFMSA members to participate in your SCOPE clinical exchange during medical school! This exchange will provide valuable learning experiences for your future in medicine.

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The Closest Place to Space Andrea Falconí

AEMPPI - Ecuador

I have traveled the World and although I’ve been to incredible places I can say that there is no place as unique and beautiful as my country, Ecuador. The passion I have for it has pushed me this year to make our exchanges better, turning them into a perfect opportunity for people around the world to visit, discover and fall in love with Ecuador. It is unbelievable all the work we’ve done this year regarding the exchanges. Since we gained legal recognition from the Ecuadorian government, things have just kept rolling for us. From signing contracts with the most prestigious hospitals, to working vigorously to improve our Academic Quality, I can say that the exchanges from AEMPPI Ecuador are a once in a lifetime opportunity. Now, they are not only focused on fun, but are also built based on the student’s objectives and expectations. As a country, we offer unique opportunities; such as helping women during labor work, or attending surgeries with nationally recognized surgeons. Our exchanges are personalized, where each tutor works with one single student, improving the learning process and skills acquisition. Since January, we’ve made hundreds of new arrangements, expecting that our exchanges will become the best in the region, and why


not, the whole Federation. Ecuador is one of the tiniest countries in South America, but don’t be fooled, we have it all! Conformed by 4 different regions, each one with breathtaking landscapes and adventures for all type of nature lovers; that can all be visited by traveling just a few hours. We are the country with the largest biodiversity in the whole world. In our Amazon you can enjoy watching jaguars, play with monkeys and get to know the culture from our ancient tribes. The Andes, where our main cities are built, has beautiful landscapes that are enjoyable from each part of the city. Don’t passively watch nature go by, experience it: go hiking, biking, kayaking, and horseback riding through our volcanoes and mountains. If you are not a mountain person, we count with an unbelievable coastline, where you will swim in natural beaches and enjoy yourself, by learning how to surf and scuba dive. If you are lucky enough, you can even watch the spectacular humpback whale show during our summer season. The best part of it, a place that is unique in the whole world, Galapagos Islands. Heard about Darwin? Well, inspired by Galapagos, Darwin developed his Theory of Evolution and Natural Selection. This archipelago in the Pacific Ocean is filled with strangely fearless and curious animals that can’t be found anywhere else. One day you could be watching timeworn giant tortoises in the misty highlands, and the next you could be snorkeling with playful sea lions in crystal-clear water. There really is nowhere else quite like it. So, what are you waiting for? “When all you need is Ecuador” (Ministry of Tourism, 2016).


medical students worldwide | AM 2016, Mexico

August 2016

Well Begun is Half Done

the Pre-Exchange Training

Nina Gelineau

IFMSA - The Netherlands

Students who go abroad for a medical exchange receive a wide variety of impressions and come into situations from which a lot can be learned. The level of knowledge, personal approach, coping mechanism and prior preparation of the student; together with the guidance from the country of exchange determines how much a student could learn from the exchange. To keep the learning curve as high as possible, a good guidance for the outgoing students is of utmost importance. We from IFMSA-NL have played into this idea by offering the Dutch professional and research exchange students a preparation of high quality and a broad spectrum in order to prepare the students fully before going on an exchange. Not only do we want our exchange students to have academic development, but also social, cultural, and personal development. The Pre-Exchange Training (PET) of IFMSA-NL is unique in the fact that we offer our outgoings three mandatory preparation moments: two local and one national. The first moment the outgoing students come together is during the first local PET in December. Here the basics of an IFMSA exchange is explained. This way an exchangee knows more of what is expected from him/her, how the database works and when to expect information from the country of exchange. This is also



the moment we sign the outgoings’ contracts, and Terms and Conditions. The NEO-Out is present, hence she can answer all burning questions. All the outgoings from IFMSA-NL come together in a national PET in April. This day is mostly formed around Global Health and the Social Determinants of Health. By inviting two professors skilled in this theme, different aspects are highlighted. Not only does this result in more awareness on a global level, but our outgoings will also be able to tell you more about the SDHs in the Netherlands. Furthermore, a training on intercultural learning makes them prepared not only for the educational aspect of an exchange but also the cultural shock that might be experienced while abroad. Lastly, the second local PET takes part shortly before June. The main objective for this training is personal goal setting. Students who are not allowed to perform clinically invasive procedures on their exchange, because this is something they have not yet mastered back in their own curriculum, are not in any way disadvantaged. If they have a set of specific goals in advance, they can get the most out of their exchange experience. The IFMSA exchanges are unique experiences and we should stimulate the best learning outcomes for our students and send them into the world fully prepared!

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Training 4 Professional Exchange - Incomings Hakan Çirnaz & Rana Çagla Akduman TurkMSIC - Turkey

As a medical student, going to an exchange is one of the most exciting yet challenging parts of the IFMSA journey. Preparing the incomings for this new experience is a vital and imperative component of exchanges. Upon Arrival Training (UAT) plays a major role in this process by ensuring that incomings will be ready for this new experience. We aim to lay the groundwork for Upon Arrival Training for all Local Committees (LC) in Turkey by establishing T4PEI (Training 4 Professional Exchange Incomings). This way incomings in every LC could begin their exchange fully prepared. The essential part of T4PEI is definitely the survival kit. Each country has its own cultural norms and social rules. For an incoming, compliance might become a serious issue. In order to avoid culture shock, having basic tips and rules about that country/city play a fundamental role. In a country, there are certain differences even among cities and regions, thus a detailed transportation map, list of Do’s and Don’ts in Turkey, emergency contact numbers are essential components of the survival kit. In addition, workshops play a key role in T4PEI.

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Trainings such as history taking, blood pressure and pulse measurement may endow the exchange student with certain skills that are prerequisites for the professional exchange. By providing these workshops, we hope that incomings will feel more confident and competent throughout their exchanges. In countries where there are many LCs such as Turkey, workshops can be organized regionally. These regional workshops can be hosted by a different LC in each region, thus LCs that have inadequate resources or opportunities to organize the workshops or T4PEI can join other LCs from the same region. We believe that the regional workshops will reinforce the cooperation between LCs and provide each incoming with a chance to participate in T4PEI.

Moreover, brief introduction to Turkish NMO, TurkMSIC and the Local Committees is also a significant element of T4PEI. The introduction would be followed by “Global Health and Health System in Turkey”. Global health has become a major topic in our lives and as the doctors of future, where there are less borders and more interaction among individuals and societies, it is vital to have at least a basic understanding of global health. Besides, professional exchange students need to know about the healthcare system of the country that they will be working in. Professional exchange is not only about the tutorstudent relationship. In fact it comprises the patients, the hospital and the whole healthcare system of the country. Hence as the members of TurkMSIC, we strongly believe that “Global Health and Health Care System in Turkey” is an indispensable part of T4PEI. Survival kit and basic skills workshops and introduction to global health and health care system in Turkey will provide the framework of the upcoming T4PEI. Other components of this training will vary from LC to LC due to regional and cultural differences, however we hope T4PEI will be beneficial for all incomings throughout their exchange.

medical students worldwide | AM 2016, Mexico

August 2016

Exchange: A Life Changing Experience Thomas Akel Oberpaur & Constanza SepĂşlveda Gallardo IFMSA - Chile

When you decide to take part in a student exchange, you probably do it in order to learn, to get to know different health systems, protocols and perspectives in hopes of acquiring new tools for your future job performance. Is that all there is to it, though? As soon as you get off the plane, you are surrounded by new, odd sounds and gestures. Even if you speak the language, it still feels strange. They, too, can tell that you are a stranger. You are flooded by emotions; you are happy and finally there, yet you cannot help but feel nostalgia and doubts creeping in. Will they welcome me well? Will I get along with everyone? Will I be able to communicate? You feel foreign. You look around, get oriented and keep walking. One moment you are settling into your accommodation and getting told what to do, the next you are starting your first day of clerkship among the local students, pretending that you are part of the team. You listen, you observe. Am I prepared enough? The first day is the hardest, but it comes to an end. The next day goes by a little faster and by the end of the week you feel completely comfortable. You know the routine now and you are starting to enjoy it. When the weekend hits you can focus on strengthening those new friendships you just made and going all over the city that has taken you in, which allows you to get amazed, carried away and immersed in the culture. Back in the hospital, you do what you came for: you analyze and compare, you learn and you notice how many more possibilities there are that you did not know existed. During the free time you allow yourself to do things you normally overlook while being in your country: you admire the surroundings, you taste every meal as if it was the last, you get better at small talk and you even spend several moments a day getting a good rest, or more importantly, reflecting on your life.



Time flies by as you feel empowered and more alive, as you feel part of this. Each event and experience, regardless of how good or bad, teaches you something invaluable. You know yourself better. You cannot believe it is already the last day. As you approach the plane, the surrounding muttering that was once so odd now sounds familiar. You are happy to go back; however, you feel nostalgic. The plane is close to taking off. You want to go back in time and relive the memories. You were part of a world you did not know. You wonder if you are still a foreigner, a stranger. Only you know the answer.

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Exchanging Cultures JĂśrdis Rausch

bvmd - Germany

As long as I can remember I loved hearing about other cultures. As a young child every person was a unique, interesting story to me. Later in school, I made up my mind to become a psychiatrist. During my studies I found my passion for SCOPE in which I have been active for 5 years. However, I never dreamed of daring to combine these two parts of my life: exchange and psychiatry. This changed when I joined the EFPT (European Forum of Psychiatric Trainees). They told me about Kraeplin, a psychiatric scientist who made his major breakthrough while being abroad and simply observing the manners of the patients. So when a time slot after my last written exam opened up, I realized it was now or never. Since I had decided that this experience was about learning from a culture as different as possible, I wanted to go outside of Europe. Browsing through the Exchange Conditions, I settled on Taiwan, a country I had never been to before. Fortunately the SCOPE

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team was very helpful and tried their best to make this odd request of going into psychiatry, without knowing the language, work. Time lapse forward: here I was, on my first day in the psychiatric ward of a 2 million city in the south of Taiwan. My brief moment of doubt about this idea was quickly swept away when I met my tutors. What I experienced the following four weeks was one of the most treasured and valuable lessons I had during my medical education. I cannot deny that having known the language would have enabled me to gain even more insight into the structure of the mind-set and work. However, the doctors and the medical students gave their best to translate conversations for me. There was much to learn, from the concept of the medical system to the different prevalence of diseases. Seeing the behaviour of the patients and the interaction with their family members taught me the most. Before, I had absorbed the knowledge that Asian cultures often are more family centred than European cultures. Being in Taiwan showed me that I had read the knowledge, but never really understood what it meant. How family is perceived and how much people are committed to it fascinated me throughout my exchange. These observations and new ideas became very valuable to me and I hope will help me being a better doctor to patients of other cultures. I am very grateful to the dedicated students of FMS-Taiwan and the National Cheng Kung University Hospital for making this experience possible for me. I strongly encourage you to open your mind to observing the cultural behaviour during your exchanges. Exchange in psychiatry is not very common currently, therefore I hope you remember this article when you are a doctor. Don’t be afraid to take on the challenge of showing a foreign student your set of mind and give them insight into your ward, even if there is a language barrier. You will be surprised how enriching this experience can be.

medical students worldwide | AM 2016, Mexico

August 2016

An Experience of a Lifetime Yessi AlcĂĄntara Lembert

ODEM - Dominican Republic

“The world is a book, and those who do not travel read only one page.� (St. Augustine) During December 2015, I had the opportunity to participate in my first SCOPE clerkship in the Department of Urology at the Vienna General Hospital in Vienna, Austria. This amazing experience was made possible by the unconditional support by my ODEM and IFMSA families. Before my departure, I have heard many great things about Austria, which is why I selected Austria for this clinical and surgical rotation in urology. With my clinical knowledge and skills in the Dominican Republic, I knew that I would learn even more in Vienna, obtaining skill sets that were essential to every medical student. I aimed to improve my own skill sets in an international setting, yearning for this immersion to gain insight in medicine and public health in this globalized world. I was able to learn about the Austrian health system, interact with Austrian medical students, residents and attending

physicians, and gain insight on how the medical system incorporates preventive health services to the local community. Just as how the professional interactions in the clinical setting impacted me, I also noticed the intercontinental differences. I was born and raised on a tropical island, surrounded by water., However, as part of the European continent, Austria is land-locked by several countries, and has four seasons. With the cold temperatures in Austria during December, I adjusted to the cooler climate. The physicians and medical residents of the Vienna General Hospital (AKH) formed one of the best clinical teams that I have ever observed. They were courteous, friendly and patient with patients and family members during clinical rounds and medical consults. They demonstrated passion in their vocation in medicine. Upon arrival, the AMSA-Austria family organized a welcome dinner for all incoming students, where we met and talked about medical education in our countries. Later, they prepared a national food and drinks party, where AMSA and incoming students prepared typical food from their countries to add to the cultural exchange. Representing the Dominican Republic, I met four other IFMSA medical students who were participating in clerkships in different clinical or surgical departments. As we interacted during our free time, I made friends from different parts of the world! Through this SCOPE clerkship, I was able to visit the beautiful country of Austria and learn more about the Austrian culture. I will forever be appreciative for the mentorship by our professors. I had the best experience in my life during clinical rounds, surgical procedures, medical consults and ambulances. In particular, I am grateful to Professors Karen Czeloth, Harum Fajkovic and Christian Seitz; and medical residents Julian Veser and Nathalie Aktsrag.



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My Spain Exchange Ryan Shaun Sy

AMSA - Phillippines

Spending my one-month elective in Spain was one of the most amazing experience in my medical student life. One of the main reasons for taking this trip was because I was curious to know how medical practice differs in a European setting as compared to what we do here in the Philippines. I was fortunate enough to be accompanied by an excellent endocrinologist. During my stay, I tagged along on her hospital rounds in the ward and at the out-patient clinics. Patient data are placed electronically and stored in the hospital database such that any physician involved with a patient’s case can easily have access to the patient’s history and profile. Even medications dispensed in the pharmacy are logged so that physicians can check whether the patient has been compliant with his medications. I witnessed cases of patient refusal to treatment because of issues such as the patient being asymptomatic or the fear of the potential side effects. This felt ironic because in the Philippines’ case, most patients aren’t compliant mainly due to financial reasons. I was also able to witness many thyroid cases at the out-patient clinics and many uncommon diseases at the ward that all helped nourish my thirst for medical knowledge.

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In summary, the trip made me grow as a person holistically and helped me reignite my passion. It was an avenue to gain new insights regarding the world. It allowed me to see that the world is quite big yet quite small at the same time. This exchange of ideas and sharing of culture helped me acknowledge that there are a lot things I’ve yet to learn and that a medical doctor should always be curious and have the willingness to explore so as to continue expanding his knowledge and wisdom for the betterment of his patients.

What made my trip the most enjoyable journey was actually the non-medical activities. The whole atmosphere of the city was beautiful and serene ― from the ever grandiose Santiago de Compostela Cathedral to the historic and archaic city architecture. The weather wass cold and breezy which was a perfect getaway from the scorching Manila heat. With their food I can always taste the freshness and raw flavor of the food. Despite eating a lot, I didn’t gain any weight from their low fat, low sodium diet. The locals are all warm and friendly which helped alleviate my homesickness. I’ve made wonderful friends from different nationalities and we still keep in touch via Facebook up to this day.

medical students worldwide | AM 2016, Mexico

Morning SCOPHian

In this section, you are going to meet SCOPHeroes who save the day through their Orange activities. Enjoy learning about various public health initiatives. Whatever your interests, you are sure to find something that captivates you.

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from the SCOPH Director Jozo Schmuch Director on Public Health

Dearest SCOPHeroes, I always find myself amazed by the abundance of projects and their quality, when reviewing submissions of our members for the SCOPH section of the MSI. It is an outstanding proof of how much we, as the community, are capable of. That impact to our surrounding was actually a thing that inspired me the most to join the IFMSA in the first place - that opportunity to take your nose out of the book and do something that will change the health of the people around you - and I am forever grateful to be given that opportunity. SCOPHians do a lot, they work on projects ranging from advocating for better health systems to raising awareness on importance of healthy living. And while we already do a lot, health problems we encounter are still numerous. Just taking this years theme event as an example. Vaccination has always been one of the most important preventive measures we ever had. It saved many lives all around the world. It has often been singled out as one of the most important public health measures in human history. But lately, it has been failing.

With the coming of the 21th century we saw a great rise in the so called “anti-vaccine” movement, a rise that had a dire consequences on public health all around the world. It is on us, as medical students and future health professional and leaders to challenge this way of thinking and by educating and raising awareness “fight” the above mentioned movement. Students, and especially medical student always played a pivotal role in creating a social change. We need to utilize effect we have and use it to positively impact health of our own, but also global, community. And, what makes me most proud of all, is that it’s already happening and articles in this magazine are a solid proof of that. I hope you will enjoy reading through the article as much as I did and that you will get inspired to do something similar within your country. Always yours, In the name of the SCOPH IT Jozo Schmuch

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medical students worldwide | AM 2016, Mexico

August 2016

Farmacriticxs Pedro Lara Morales & Emma Pereira Arias

IFMSA - Spain

Pert Skrabanek and James McCormick made a powerful statement in 1989 regarding the attitude of most medical students1. They declared that they were vaccinated against “skepticism�, a term used to designate the questioning attitude towards unempirical knowledge or opinions and beliefs stated as facts2. As what it seems a way of denying this assertion, the project of Farmacriticxs was developed in 2009 under the premise of advocating for an ethical and non-biased pharmaceutical industry. Since it was first carried out in IFMSA-Spain, it continues to grow and increase its impact on the different Local Committees of our federation. The students involved with this project strive for a more transparent attitude from the pharmaceutical industry, which needs to take into account not only their own profit, but also the basic rights of patients. Certain reviews show that some of the industryreleased research studies are a result of fraudulent manipulation3. Pharmaceutical companies fund the vast majority of the clinical studies on new medicines, resulting in poor practice and in harming the outcome of patients. Moreover, these companies do not invest in the development of treatments that are necessary because of the high morbidity and mortality rates of the illness they seek to cure, but instead focus on the ones that ensure a higher profit for them. In order to put an end to this unethical attitude, students from different medical schools in Spain, with the collaboration of associations such as NoGracias,



have developed Farmacriticxs. This project aims to raise awareness among institutions, healthcare professionals and students with the goal of making society aware of the issue. Students that are part of this initiative organize conferences and meetings a couple times a year, while keeping in touch by using social media and email threads. By these means, they promote debate on this topic in their Local Committees, so medical students in Spain can become aware of the issue. The project was able to make IFMSA-Spain change its model of financing. Now our federation includes an agenda for the debate on this topic in all its national assemblies. Furthermore, Farmacriticxs collaborated with five different Spanish associations and medical newspapers that also support the message Farmacriticxs aims to convey. Together, students work towards improving transparency in the way research studies are conducted and financed, allowing open access to medicines to everyone who needs them and promoting a fair relationship between health professionals and pharmaceutical companies. References 1. Skrabanek P, James McCormick J. Follies and Fallacies in Medicine. Third Edition. Eastbourne (UK): Tarragon Press; 1998. p.68. ISBN 1-87078109-0 2. Merriam-Webster online dictionary ( 3. Strategies and Practices in Off-Label Marketing of Pharmaceuticals: A Retrospective Analysis of Whistleblower Complaints. Kesselheim AS, Mello MM, Studdert DM (2011) Strategies and Practices in Off-Label Marketing of Pharmaceuticals: A Retrospective Analysis of Whistleblower Complaints. PLoS Med 8(4): e1000431. doi: 10.1371/journal. pmed.1000431

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Fingers of a Palm The Fist of Development

Arshiet Dhamnaskar MSAI - India

Public Health. Whose responsibility is it? The public’s, isn’t it? Of course, awareness on the part of the public is a must; but the public also involves other professionals that can play equally important roles in nurturing healthcare systems in the community. Then why is it that it is only the doctor who can be seen grasping the reins of public health? Although it cannot be denied that there is some contribution from other fields such as bioinformatics and biomedical engineering, it might not be enough for what we wish to achieve in the healthcare system. We speak of development, we speak of health being an important factor for development, yet in many places around the world, healthcare continues to be backward. The primary reason for this being either the indifference and ignorance of the clinician in these matters or the apathy shown by other sectors towards medicine. Why should we integrate other fields into the field of medicine? The doctor might know that good sanitation and toilets are required to maintain hygiene and health, and might even possess the knowledge of specifications of the same. However, without the help of an architect, an engineer and a builder; he cannot deliver the same to the public. Likewise, while building a house, the others might not know the exact health conditions that need to be addressed, while a doctor might.

professional — each consisting of a doctor, an engineer, an administrator, a finance expert and a few chosen others — to assess the current scenario in a particular area and then formulate the development plan likewise. Individual Involvement of a Medical Student Currently, we as medical students can not only demand our respective universities to include such knowledge into our curriculum but also take a few steps from our side to aid this. For instance, we could hold regular discussions with our peers from the other sectors, and conduct activities and surveys. We could even get together and develop research studies to developing new ideas. We could even use the internet in our advantage, to explore what the other fields have in store for us. Someday, this might be a reality, and that day does not seem too far, taking into account the simplicity of the idea. We could start at our personal level, and then wait for the administrative bodies to follow up. We could all take our own efforts to add meaning to public health. Why? Because we know that all professional sectors, the fingers of the palm, are going to form a fist of development.

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There are few conferences, workshops or seminars where an integrated approach is taken towards medicine. Medical institutions should look into this; train the medical student of the same. Similarly, universities from other sectors should consider organising similar events in their institutions. Government-initiated developmental projects should involve forming teams of

References 1. 2. h t t p : / / l i b n a . m n t l . i l l i n o i s . e d u / p d f / publications/193_Chien.pdf medical students worldwide | AM 2016, Mexico

August 2016

Don’t Forget About Me Júlia Fernandes Aguiar

IFMSA - Brazil

In the last few decades, studies have shown an incessant growth in Brazil’s elderly population. Projections show that in the year 2020, 30.9 million Brazilians will be over age 60. Therefore, the increase in health issues that come along with age is becoming more notable. Among the illnesses, Alzheimer’s is a particularly worrying one, especially when combined with late diagnosis and poor care. Accordingly to the World Health Organization (WHO), Alzheimer’s disease is the most common cause of dementia, representing 60-70% of all cases.

same experienced by a patient with early Alzheimer’s.

As a public health problem, this condition does not only affect the life of the ailing, the whole family is also forced to change habits in order to give the proper care and support the Alzheimer’s patient’s needs. Although some people have heard about this disease, most of them lack understanding about the initial symptoms and can’t distinguish physiological aging from pathologic. Concerned about this scenario, IFMSA Brazil’s local committee at the Faculdades Integradas Pitágoras de Montes Claros (FIP-Moc) held the project “Não se esqueça de mim” (Don’t forget about me). It was composed by four stages: capacity building, population awareness, Alzheimer’s care and final discussion in a round table.

The last stage was a round table discussion with the presence of a geriatric and a general doctor, who debated about Alzheimer’s disease and its repercussions to patients and their families. Results and feedback received were very satisfactory. The participants were amazed at how this illness affect people’s life.

The first part capacity building was developed with the exhibition and posterior analysis of “Still Alice”. It is a movie that shows the struggle of a university teacher who recently discovered she has Alzheimer’s and the effects of this condition to her social life, especially to her closest relationships. Afterwards, the students argued about the impact of this disease on the patients and their families. The second stage population awareness was guided by a workshop where it was taught how to pretend to know a stranger and make them believe that they know you too. Later it was revealed that, in fact, you do not know each other, but the confusion that he/she felt was the



The next part Alzheimer’s care occurred in seven different days in resting homes. During each visit, we would develop several activities with the elders: play games, guitar, sing, dance and simply chat with them about anything they would like to. The experience was, somehow, life changing. Besides that, we also conferenced with the caregivers in order to give us more understanding of patients’ situations and of how difficult it is to deal with them in a daily basis.

This kind of reception evidenced the lack of knowledge about dementia in Brazil, and how simply this subject could be inserted on society. The project reinforced the commitment of the students in holistic care, learning to focus not only in the biological, but also in the psychosocial aspects of the disease. References 1. World Health Organization. Rates of demência. 2015. factsheets/fs362/en/ 2. Instituto Brasileiro de Geografia e Estatística. Síntese de Indicadores Sociais Uma Análise das Condições de Vida da População Brasileira. Rio de Janeiro: IBGE. 2012. 3. Nitrini, R; Caramelli, P; Herrera, JR, et al. Incidence of dementia in a community-dwelling brazilian population. Alzheimer Dis. Assoc. Disord., v. 18, n 4, p. 241-6, 2004.

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From Togo to the World

A Critical Perspective on the Global Health Policies Tomás Macedo Sopas de Melo Bandeira ANEM/PorMSIC - Portugal

Togo is a small country in West Africa with a size approximately similar to Croatia or Costa Rica. It was colonized by the Germans and the French and today there are around 6 million people living in this thin portion of land. Despite Togo’s small geographic size, it possesses great cultural, religious, and climatic diversity. Togo’s climate ranges from tropical to savannah. There are more than 40 different languages spoken. It is a multireligious country with a large diversity of Animistic religions - including a well-known one called Voodoo-, Christianity and Islam. The lack of cultural diversity in education does not prepare students to practice global medicine. Science is to medicine, like the human body is to the human being. Western medicine is nothing without modern science. But it is much more than the simple knowledge of the biochemical reactions or the pharmacological effects at the human receptors. Medicine needs facial expressions. It needs moods and affection. And the reason is because medicine is a human creation for a human consumption.

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When a doctor is working on the emergency service in Togo, he is usually called to care for a patient who is in coma. Frequently, this patient comes accompanied by his sister who doesn’t speak the official language of the country. After a great effort to understand what has happened, the doctor finds that the family lives far away and that the patient was unresponsive for an indefinite period of time. The patient needs ventilatory support. And then, the doctor will need to ask for some clinical analysis. However, to do it, the patient’s sister must pay before any laboratory test could be requested - from the blood collection tubes to any other supplementary investigation. Furthermore, his sister tells that before he fell into a coma, he has consulted a traditional healer

who had given him some plants that no one knows. It’s hard to be a doctor in Togo. The problem of traditional healers is not the traditional healers itself, but the fact that western medicine doesn’t know how to accommodate with them. Western medicine around the globe is taught with a very limited epidemiology and little awareness about world diversity. If theories about the human genetics are increasingly defending the inexistence of races but the similarities within our species, medical science frequently forgets about the huge multiplicity of human cultures, which necessarily have a tremendous influence on the medical approach and treatment. In Togo, or in any other country, people experience similar types of suffering while they are in the hospital. Even when cultures change the way medicine is practiced, all doctors remember their patient’s tears or their longing for relief to the end of their lives. However, we are now living in an increasingly global world, and medicine must follow its steps. If global health policy should make an international pressure in governments like the Togolese to invest more on the health system, those policies might also not forget that medicine, to be efficient and useful to the people, must be adapted and conformed with the environment where it is practiced. And the answer to that is not simply applying scientific knowledge indifferently all over the world, but mostly research all over the world. For this reason, we need a global research, we require an adapted medicine. And for this reason, even if it’s hard today to be a doctor in Togo, it is worth being a doctor in Togo!

medical students worldwide | AM 2016, Mexico

August 2016

Malaria Week

End Malaria for Good

Claude Nsabimana MEDSAR - Rwanda

The WHO reported on 9th December 2015 that Malaria is a major global public health problem and a leading cause of morbidity and mortality in many countries. It caused an estimated 198 million cases and 584000 deaths in 2013. Approximately 80% of the cases and 90% of the deaths occurred in Africa. WHO also stated that Malaria is a major killer in Africa. Cases of malaria in Rwanda have increased despite government efforts to sensitize the community on best health practices to prevent the deadly sub-Saharan disease. Reports from different hospitals indicated an increase in the number of malaria patients. Statistics from the ministry of health in Rwanda indicated that from 2013 to 2015 malaria patients increased three fold. In 2013, more than 900,000 cases of malaria were diagnosed and 409 people died of the disease, 30% of them being children under five years. In 2015, 2.7million people suffered from malaria, a 68.6% of increase. Medical Students association of Rwanda (MEDSAR) through its standing committee SCOPH organized a week, from 25th (on World Malaria day) to 30th April 2016, dedicated to efficiently fight against this global burden. The activities took place in two big cities Kigali and Huye. Throughout the whole week our strongest weapon was an online campaign. We used Official Hashtag, #InNetsWeLive, Facebook/ Twitter Events, a customized Twibbon and Posters. On April 25th, the week was started by a “SCIENTIFIC TALK ON MALARIA”. This talk had the purpose of increasing knowledge and awareness about malaria among university students. The speakers were Dr. Rulisa (lecturer and dean of College of Medicine and Health Sciences); Dr. Jeffrey and Dr. Maaike (lecturers in College of Medicine and Health Sciences).



On April 27th, around 80 medical students conducted teaching sessions at CHUB and CHUK university teaching hospitals and at Kabutare and Muhima district hospital where more than 1000 people including patients, next of kin and community health care providers were taught on how we should behave differently to fight against Malaria. From April 28th - 29th, medical students conducted radio talk shows on malaria. This was in the purpose of giving the message to whole Rwandans. The radio talk show took place on Community Radio Station of Huye and on Flash F.M. We taught Rwandans about Malaria burden, symptoms, signs and prevention strategies. In the talk we emphasized on the use of mosquito nets. The week was closed by the Umuganda community work on April 30th and took place in Huye and Gitega districts. Medical students and university authorities joined local community, local leaders, NGO representatives and senators for the community work where we cleared roads and cut bushes. After the work, all participants gathered and we taught around 800 people about malaria with emphasis on mosquito net use. • After “Scientific Talk”, more than 90% of participants joined SCOPHeroes in teaching sessions. • With teaching sessions and radio talk shows, more than a half of the Rwandan population received the message. • According to three referral hospitals, numbers of mosquito nets needs increased obviously from 12 people to 31 people in one week. • We cleared 2 km road near Gitega and Huye habitation and in one week no malaria case was reported.

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Giving Back to Those Who Deserve It Nahla Eltigani Mustafa

EMSS - United Arab Emirates

On Friday the 25th of March, SCOPH-EMSS took part in one of the most influential public events held in the UAE – a free medical camp open to the public offering free consultation and diagnosis by general practitioners and specialists. The event was arranged by Sharjah Charity international with the cooperation of the Ministry of Health and Prevention and sponsored by Malabar Gold and Diamonds. The camp was held in Al Sajja, an industrial area where the residence of hundreds of labor workers is located which was very convenient allowing many of them to attend and seek medical care. This was very important because this category of the population tends to suffer the most from injuries and illnesses but also the ones to not receive enough medical attention whether it’s due to high expenses, difficulty to make time with their busy schedules, and most importantly lack of awareness.

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A study involving 153 cement factory workers used questionnaires to assess the knowledge and practice of workers towards occupational hazards. The majority 114 (74.5 %) of the workers knew that exposure to the dust was a serious hazard to their health, but only 52.9 % of the workers knew the hazards other than the dust that were associated with their work. All the workers mentioned that they had been provided with masks to protect them from dust, however, only 28.8 % of them claimed that they used the masks all the time during working hours. Another study was conducted among 1,375 workers between 2012 and 2013. It was found that at least 75% of them were unaware of their health condition because of lack of regular health checks. These studies are further proof of how little these workers are aware of the risks threatening their health and the importance of conducting these medical camps.

The medical team taking part in this event included general practitioners, an orthopedist, a dentist, nurses and of course the SCOPHeroes. The process started by measuring the blood pressure and sugar levels of the patients. The patients were then referred to the doctors according to their complaints. Each and every patient got to sit down with the specialist they were referred to and received consultation including free medications for those who required it. An awareness booth was also set up to educate the workers about the risk factors that come with their jobs and how to deal with them since they play a major role in their health problems. They were also educated about the importance of maintaining normal blood pressure and sugar levels. Personally, I believe this event had an enormous impact on those members of the society which is what SCOPH is about, reaching out to the public and offering everything in our power to help. We got to learn a lot and got a sense of what is it like being in such a noble profession. Hopefully, there will be much more to come.

References J Egypt Public Health Assoc. 2010;85(3-4):149-67.

medical students worldwide | AM 2016, Mexico

August 2016

Global Surgery

Surgery, Anaesthesia and Obstetrics for All Dominique Vervoort & Zineb Bentounsi

BeMSA - Belgium & IFMSA - Morocco

An estimated 5 billion people in the world lack access to safe surgical care, making operable conditions with an estimated 28-32% a big part of the global burden of disease.1 Even though 234 million surgeries (less than 1 in 30 people) take place every year, only 2-3.5% of these surgeries are reserved for the poorest third in the world. Mere access to surgical care does not necessarily equal to safe and adequate care, as 7 million patients suffer from major peri- or post-operative complications annually. 1 million patients die from complications, at least half of which are preventable.2 Moreover, lack of safe anesthesia is responsible for fatal complications in up to 1 out of every 150 surgeries in Sub-Saharan Africa.3 Lastly, 530,000 women suffer from fatal complications during labor, which –together with the numerous cases of stillbirths– could have been prevented with adequate surgery and obstetrics.4 Poor countries not only lack surgical groundwork; they are also subjected to disparities in its distribution. Bigger cities monopolize healthcare and, often, only the richest can afford medical interventions. In the words of Dr. Paul Farmer, surgery has been the neglected stepchild of global health for too long, partially because of the prejudice of being too expensive. Despite this belief, safe surgical and anesthetic care are cost-effective, in many cases even more so than other interventions (e.g., HIV/AIDS campaigns). Besides the many lives (and healthy years) that could be saved, countries’ economic growth would also benefit from it in the long-term. Lack of funding is another major problem as surgery is a complex intervention, not only needing diverse staff, but anaesthetics, operating theatres, equipment, postoperative care and blood banks as well. Last but not least, a lack of surgeons due to lack of qualified training is another problem that low and middle



income countries (LMICs) are facing. For instance, there are only 565 neurosurgeons in the entire African continent compared to 4600 in the USA, whereas many countries don’t even have a neurosurgeon.5 By adopting the resolution ‘Strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage’ on May, 22nd 2015, the 68th World Health Assembly in Geneva acknowledged the need for putting Global Surgery on the agenda. The United Nations’ recent Post-2015 SDGs have also included this crucial part of global health, another important step in the right direction. Considering the crucial importance of access to safe surgical, anaesthetic and obstetric care for all, the need of pushing Global Surgery on the global agenda is ever so high. As future surgeons and doctors, we should all work together towards this goal, as that will prove to be crucial to make this happen. References 1. Mathers CD, Loncar D (2006) Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 3(11):2011–2030 2. Debas HT, Gosselin R, McCord C et al (2006) Surgery. In: Disease control priorities in developing countries, 2nd ed. Oxford University Press, New York, pp 1245–1260 3. Ouro-Bang’na Maman, AF, Tomta, K, Ahouangbevi, S, and Chobli, M. Deaths associated with anaesthesia in Togo, West Africa. Trop Doct. 2005; 35: 220–222 4. World Health Organization (2005) World health report 2005: making every mother and child count. 5. Fuller, A., Tran, T., Muhumuza, M., & Haglund, M. M. (2016). Building neurosurgical capacity in low and middle income countries. eNeurologicalSci, 3, 1-6.

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Lovely Down Omer Yaqthan Aljader & Sayf Asad Saeed IFMSA - Iraq

A cloudy sky, and torrential rain did not deter the perseverance and intensive preparations of a group of highly creative medical students in establishing the event of IFMSA Iraq which was about “Down Syndrome” during March of this year. The overall goal of the event is to treat the affected children as one would any other “able-bodied” human being, and dealing with them with some level of sensitivity and special care to preserve their lives and to reveal their true and sometimes hidden talents. The committee, focusing on Down Syndrome, formed scientific and educational groups in order to discuss the subject from several aspects. Participant students were invited to participate in this educational conference in Mosul Medical College in Kirkuk. The educational lectures began in earnest, with attendance from students of the dentistry, pharmacy and medical faculties which were more than three hundred students, in addition to several professors and faculty members. An online questionnaire was created and respondents from social media reached one thousand. The results from this questionnaire shared insights on the attitudes in the field and in particular for medical students. The knowledge level on Down syndrome was overwhelmingly disappointing. There is a distinct feeling that the curriculum in medical colleges is lacking a great level of information about Down Syndrome,

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evident in the students’ answers. The attitudes are reasonably good among students, however the community’s impact on students is obvious in their response: very little interest in Down Syndrome is shown due to the lack of campaigns and programs that raise awareness among students and others in the community. The stars of the show and highlight of the evening involve twelve Down Syndrome children who arrived with their families and members of the health management institute. They were greeted warmly with flowers, songs and flashes of cameras, causing them to enter with gleaming smiles. A lot of activities were arranged, printing colorful fingerprints on the white fabric, drawing magnificent prints and patterns as makeup on their beautiful faces. In the aisle there were sticky notes filled with positive and encouraging comments by students. The children also helped in cutting the orange cake made especially for this event. Gifts were handed to them; hence they were extremely happy and grateful. Finally a lot of photos were taken with them in the event’s photo booth. This event was done under extenuating circumstances and unusual situations, but with will-power, dedication and teamwork we were able to bring some form of happiness to the Down Syndrome children and families. Additionally, it is believed that we could in some way modify some misconceptions and wayward thoughts, furthering our understanding and removing the stigma connected to disabled members of the society. References 1. 2. h t t p : / / w w w. w h o . i n t / g e n o m i c s / p u b l i c / geneticdiseases/en/index1.html

medical students worldwide | AM 2016, Mexico

August 2016

Awareness of Brazilian Medical Students About the Autism Spectrum Disorder

Gabriela Grabowski Amorim

IFMSA - Brazil

Autism Spectrum Disorder (ASD) is a general condition for a group of complex brain disorders that is developed before, during or shortly after birth. These disorders are shown through a lack of social communication skills and repetitive behaviors. Although all people with ASD share these difficulties, their condition affect them in distinct intensities. Thus, it is necessary to recognize the disorder, their intensity levels and adversities that it brings, doing that in a humane way. The objective of the campaign was to establish the humanized contact between medical students and those who have the disorder. It was held at the Associação Amigos do Autista (AMA) – In English, Association of Friends of Autistics -, a special educational center for autistics and was based on “SensibilizARTE”, which is a project created by students from the Universidade Estadual de Londrina (Paraná, Brazil) in order to promote humanization in health care by the students.

a play; and a rendition of several children’s songs. As the activities were carried out, students realized that each child had their own way of reacting to it. Some ASD children showed interest to the activities, others were not interested in participating. Furthermore, some of them became too overwhelmed to be involved with the activities nor to interact with the students who were performing the play. The action provided personal contact with autistic youngsters, and allowed students to get a close view of the disorder’s different spectrums. It developed patience and sensitivity, virtues essential for the development of humanized care. Reflections were established regarding the children’s lifestyles, how they react to stimuli around them, the attention given by their parents, and the awareness that because of the ASD children’s exceptionality, these human beings are worthy of more attention and empathy. We could see that prior to the campaign, most students did not have a clear view of what ASD is, what its symptoms are and the way different spectrums can be expressed in a human being. Some also never had personal contact with autistic people. The project has provided not only knowledge and entertainment, but positivity for both sides as well. According to AMA’s employees, it was one of the few times the kids participated actively in campaigns. Moreover, students have reported that the action brought optimism and studying motivation.

The campaign was made in two steps: First, medical students participants of IFMSA-Brazil were trained by a psychologist who gave a lecture based on ASD symptoms and how to properly interact with autistic people, especially children, because they’re the majority of AMA’s members. Second, on the campaign’s day, participants joined in pre-established groups, and each group had a distinct activity, like drawing, painting and paper crafting workshop; storytelling; presentation of



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Overview and Combat Policies A Statement from IFMSA Brazil about Zika Virus

Andrey de Oliveira Cruz & Marcello José Ferreira Silva IFMSA - Brazil

The Zika virus was isolated in 1947 in Uganda. It was considered endemic in the east and west of the African continent. In the Americas, it was identified in the Easter Island, during the beginning of 2014. Today, it is known that the virus is transmitted by the bite of the mosquito Aedes aegypti, the same one that transmits “Dengue” and “Chikungunya”. It is believed that the high international mobility, such as during the 2014 World Cup and other major events, resulted in the introduction of Zika virus in Brazil. Despite initial knowledge about the virus, the infection cases in Brazil only obtained prominence in the second half of 2015, when the virus became associated with an epidemic 1.5 million cases of newborns having microcephaly. In spite of strong geographic, epidemiological and time association, a lot of studies are being conducted to confirm that hypothesis. The debate on epidemics and Zika virus needs a lot of attention considering the high complexity of the subject. IFMSA Brazil believes that issues like the lack of proper basic sanitation, poor garbage collection, lack of hygiene in public places, inadequate treatment of water for drinking, climate changes leading to modifications on management of water, mosquito transition to the urban area due to deforestation; lack of attention and education in public health in the most vulnerable population all act in favor of the Aedes aegypti reproduction.

abortion in case of microcephaly due to an extremely conservative agenda in the country. The epidemic prevention and the disease control can only be done in a proper way when there is an adequate structure in the national public health system (SUS). The following should be done as an investment by the government: vaccines, more studies to help disease comprehension, proper regulation about sharing genetic material; partnerships for use and supply of integrated research technology, putting global health in mind, controlling the spread of Aedes, resolution of habitat destruction and current environmental issues, and promotion of public health education. We, as medical students, should put ourselves in the front line of the epidemic combat: promote adequate medical education; create forums and discussions to the general population in order to achieve awareness about the subject; host local, regional and even national projects and activities in favor of health education; and make sure that universities develop their curricula related to basic public health, medical education and human rights.

Other issues that concern us include opportunistic media reports resulting in the desperation of many Brazilians, false information being shared about Zika and microcephaly (causing restrains on a valid 102 debate), the Brazilian government only concerned about eliminating the mosquito for a short-term (without 103 new ways of controlling the vector of the disease and solving the environmental issues in long-term), and also the absence of a platform for the discussion about safe medical students worldwide | AM 2016, Mexico

August 2016

Antimicrobial Resistance We Should “Resist” the Danger

Paraskevi Peios

HelMSIC - Greece

It is a fact, that the discovery rate of new antibiotics has decreased extremely in the past 30 years[1]. On the contrary, scientists identify the existence of antibioticresistant bacteria at a rate higher than they have originally estimated. This renders antimicrobial Resistance (AMR) threatening to Global Health, which awakes unpleasant memories from the post-antibiotic era. AMR is the term used to define the resistance of a microorganism to an antimicrobial medicine to which it was previously sensitive. It occurs naturally due to point mutations, extensive rearrangements of the bacterial DNA or acquisition of exogenous DNA through plasmids, bacteriophages, naked DNA sequences and transposed DNA from other bacteria. In addition, resistant microbes can spread through many routes, such as from person to person or by consuming products of animal origin that were not cooked properly. [2] It is important to understand that, pathogen microorganisms are those that become resistant to antibiotics - not the people that are being infected by a pathogen. The consequences of the rapid spreading of AMR have become apparent throughout the world, leading to increased healthcare costs, prolonged hospital stays, treatment failures, and sometimes death.[3] For instance, in India more than 58 thousand babies died within one year from super-resistant bacterial infections, that were in most cases passed on from their mothers.[4] In addition, more than 38 thousand deaths, due to antibiotic resistance, are being recorded in Thailand per year. According to recent data, in the United States a minimum number of 2,049,442 illnesses and approximately 23,000 deaths occur per year by antibiotic resistance while in the European Union it costs the lives of 25,000 people and an average of 2.5 extra hospital days. Greece is among the countries of the EU, that present the higher rates of AMR and also is the leading proponent of the percentage of Klebsiella pneumoniae resistant bacterial strain.[5]



The main reason AMR is spreading like wildfire is the improper way in which antibiotics are being used. Decreasing the amount of misuse of antibiotics in both people and animals alongside with implementing antibiotic stewardship programs can reduce AMR infections, treatment costs and recovery period. Moreover, governments should support the research programmes for the discovery of new antibiotics and diagnostic tests, so as to control and supervise the development of resistance. Last but not least, it is our duty to join in this fight against AMR and inform the public, by promoting the prevention of infections through vaccination, as well as compliance with hygiene rules and safe food preparation. Action needs to be taken and we - as medical students - should realize the importance of our role and the extent of our abilities since “in order to carry a positive action, we must develop first a positive vision”, just as Dalai Lama once indicated.

References 1. “Antimicrobial Resistance: Global Report On Surveillance 2014”. World Health Organization. N.p., 2016. Web. 13 May 2016. 2. Centers for Disease Control and Prevention (CDC). 3. Summary Of The Latest Data On Antibiotic Resistance In The European Union, European Antimicrobial Resistance Surveillance Network (EARS-Net), European Centre for Disease Prevention and Control (ECDC), 2015. 4. Laxminarayan, Ramanan et al. “Antibiotic Resistance-The Need For Global Solutions”. The Lancet,13.12 (2013): 1057-1098. Web. 13 May 2016. 5. Hellenic Center for Disease Control & Prevention (HCDCP).

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The Epistemological Shift

As a Stimulus to Structring Mental Health Services Mayara Secco Torres da Silva DENEM - Brazil

Democratic Psychiatry has its roots in Franco Basaglia’s ideas and the Italian experience of the mental health system reform. It aimed to break up with the traditional psychiatric paradigm, not just refurbishing asylums. The core point was closing psychiatric hospitals while creating other services which would replace this asylum logic (1). Therefore, decentralised Mental Health Centres were created, and the goal was not interning the patient again in case of a crisis, but assessing the issues related to mental health care in each territory (1). The conceptual change was deconstructing the association of madness with deviation, danger, and incapacity, operating a deinstitutionalisation which would not only replace hospitals for community-based services, but also focus on dismantling scientific, legislative and administrative devices which referred to the disease, instead of the person in psychological suffering (1). Thereafter, this epistemological approach gives back to the individual one’s citizenship by including him in the social processes. The Brazilian Anti-Asylum Movement arises in a political moment when the Brazilian society was fighting against the dictatorship, and claiming for more democracy and social rights. It started among mental health workers in 1978, and included patients and families as well, in a way that, during the 1980’s and the 1990’s, it has involved many social spheres (1). Initially, the focus was on denouncing poor conditions in psychiatric hospitals, from the understanding that people with mental illnesses were citizens and should be treated as such (1). Across time, it has started to criticise the assumptions of the asylum logic, within 104 the framework of the Democratic Psychiatry (1). This change in the conceptual foundation of Psychiatry was 105 essential to increase population’s awareness about mental health and mobilising the society towards practical achievements, such as the organisation of

services to replace the asylums and changes in the legislation (2). The movement was important to establish a new hegemonic paradigm, with roots in both a new social attitude towards “madness” (e.g. National Day of AntiAsylum Movement) and in the institutional setting, with the Psychiatric Reform’s Law, published in 2001. This law favoured the treatment in community-based services, and guaranteed the rights of people in psychological suffering (2). Afterwards, specific budgets were destined to community-based programmes, along with the encouraging of deinstitutionalisation, through legal devices and the organisation of decentralised psychosocial centres integrated to Primary Health Care and emergency services (1, 3). Currently, there are still some barriers that need to be overcome in order to consolidate Brazil’s mental health system. Some examples are training professionals within the new paradigm, expanding primary health care to support decentralised mental health services, and closing the remaining asylums (1, 3). A main challenge is the recent nomination of a doctor who was the director of a huge asylum in Brazil for the place of National’s Mental Health Coordinator. References 1. Amarante, P. Saúde Mental e Atenção Psicossocial. 4th ed. Rio de Janeiro: Editora FIOCRUZ; 2013. 2. Tenório, F. Psychiatric Reform in Brazil from the 1980’s to present days: its history and concepts. História, Ciência, Saúde – Manguinhos. 2002; 9 (1):25-59. 3. Ministério da Saúde. Reforma psiquiátrica e política de saúde mental no Brasil. Brasília: DAPE; 2005. 56 p.

medical students worldwide | AM 2016, Mexico

August 2016

Smoking is not Quiet, is Unfavorable An Experience Report

Bianca Azevedo Parreira Martins & Luna D`Angelis Barbosa de Albuquerque

IFMSA - Brazil

The cigarette have about 700 chemical additives used in its manufacture. Because of this, smoking leads to altered taste, smell, disease of the oral cavity, such as lips and tongue cancer, beyond color changes of teeth and periodontal diseases. The smoke released by the tobacco directly affects the functioning of the respiratory and cardiac system. Therefore, smoking cessation brings gains not only for the health and welfare of the smoker, but also socio-economic and environmental gains. To change this global reality with changing habits, we coordinated the action “Smoking is not quiet, is unfavorable” by Standing Committee SCOPH. Our main targets were smokers, considering unhealthy habits that can be changed for the sake of future benefits. Our aim was to report the consequences in the short and long term of tobacco on the human body, in a didactic way to stimulate its cessation. The training took place on May 6th of 2015 with a pulmonologist who taught us all the advantages that the tobacco cessation brings to the patient. We passed on all the knowledge acquired in an activity that occurred in the Shopping Pátio Belém, from 10 am to 10 pm, on the next day. After the initial presentation of the team and institution, we explained the objective of the action for every one that passed the site and was interested in the subject matter. Gifts and flyers were delivered throughout the day. We were surprised several times by pertinent questions asked by the public and even by smokers. On average we reached 100 people who returned to their homes knowing more about the subject, and were encouraged to leave the unhealthy habit of smoking. We encourage the target audience through the display of a banner on the main benefits that the tobacco abdication brings to human. In addition to pointing out all the dangers that cigarette components have to the body organs, we also explained what tools they can count



on to assist in their recovery, such as chewing gum and nicotine patches. We also encourage the demand for medical care in Basic Health Unit, mainly from the Family Health Strategy (ESF), which will forward necessary cases for the Specialized Reference Unit (URES) - Vargas Presidents where there are pulmonologists and a whole multidisciplinary team ready to help them. The population reached by the activity showed their doubts on tobacco and were encouraged to live away from tobacco. We received praise from several families, suggesting that this issue could be addressed in an open local, inciting appropriate and healthy practices in our society. After the action, many smokers obtained the desire to give up smoking and achieve all the improvements to their body. The SCOPH´s action could once again promote public health and encourage us, students, to take the knowledge gained with IFMSA and further target the community in need.

References • COMO PARAR DE FUMAR: O que você ganha parando de fumar?. Brasil: Ministério da Saúde, 2011. Disponível em: < bvs/dicas/130pararfumar.html> • PREVALÊNCIA E FATORES ASSOCIADOS AO TABAGISMO EM ESTUDANTES DE MEDICINA DE UMA UNIVERSIDADE EM PASSO FUNDO (RS). São Paulo: Jornal Brasileiro de Pneumologia, v. 35, n. 5, maio 2009. Disponível em: < arttext&pid=S1806-37132009000500009>

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Health Education

Guidelines and Training for Children on Viruses and Practises Gleison Vitor Ferreira de Castro da Silva IFMSA - Brazil Brazil is currently undergoing a critical health framework concerning the recurrence and emergence of diseases such as Dengue, Zika, Chikungunya and H1N1 influenza ďź? themes especially related to globalization and urbanization. Given the Zika epidemic, which began in October 2014, and its association with neurological disorders such as microcephaly, the Ministry of Health has decreed Public Health Emergency in November of 2015 and the World Health Organization, on February 1st of 2016. It recognized the emergency situation of international importance. To combat the mosquito Aedes aegypti, the transmitter of the main emerging diseases, and other ways of contamination, sanitary reform is necessary, as well as health education actions.

The activity, organized by members of IFMSA Brazil, was implemented in a community of Teresina, Piaui, with one of the highest rates of dengue, zika and chikungunya registered. The training of academics was made through a lecture held in college with the issue at hand. During the campaign, the students created fun activities with children in the 1st year of primary education to facilitate the assimilation of content and the learning of appropriate hygiene practices. The activities performed were: (1) storytelling with puppets to describe the public health problem and how to avoid it; (2) games of rights and wrongs, always repeating the content and checking if they were understood; (3) a walk through the school to identify possible outbreaks of the mosquito Aedes aegypti.

Knowing the importance of this theme, the objective of this campaign is to guide children to identify risky behaviors and situations that could expose themselves to emerging diseases, based on the idea that they build habits for life that can bring individual and collective protection in the health context.

Children – 29 in all – were participatory during activities and understood the content based on their appropriate responses.In addition to the applying health education knowledge acquired at the university to the community, the campaign, even in its specific local dimension, has a significant role to contribute to the control of epidemics affecting the country, encouraging changes habits that lead to individual and collective protection in health.

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medical students worldwide | AM 2016, Mexico

August 2016

Fighting Against Hydric Diseases Fellipe Carlos Corrêa Batista & José Roberto Costa Nogueira

IFMSA - Brazil Some conditions can be seen in the poor communities, e.g. rural areas in the city of Teresopolis, Rio de Janeiro. These include lack of sanitation, basic health, promotion of defense against abuse of toxic substances and others. In this context, a social intervention was created to address the issue of public health, waterborne diseases such as viral and bacterial pharyngitis, dengue, chikungunya, Zika virus, worms and infection by pesticides. These diseases are associated with environmental conditions favorable to their growth, such as animal feces in the water, walking barefoot, open sewers and vectors.. Since the intervention project was carried out in a poor community in Teresopolis, social determinants of health justify the need for action on that site. It was done in the community of Valley Alpine, countryside, through lectures, competitions, debates education on the subject, and also through the monitoring of their main diseases and their knowledge of the topic discussed. After the intervention was done, questionnaires were administered in groups to analyze the intellectual gain.

Around 43 families were educated, in order to improve their quality of life by changing their daily habits, demystifying their common misconceptions and by educating them on the causes of main community diseases. Through the answers gathered from the questionnaires, it was seen that the intervention had positive impact. In addition to that, clay filters were made and were to be to observed after 4 months. It is expected that with the intervention project, the rate of diseases caused by poor management of water resources will decrease increasingly. Lastly, yellow Ipe seedlings were planted in cooperation with Rotary Club and Applied Ecology Center of Teresopolis (CEAT). Acknowledgements : Fabio Romero Gallote de Albulquerque, Vitor de Avila Haddad, Luana Borges do Santos, Ana Cristina Camargo , Pedro Henrique Consentino Salgado and the important participation of The Rotary Club in Teresópolis. References 1. Copasa, avaliable in: http://www.copasa. doen%C3%A7as.pdf 2. Fio Cruz: chamada_home.htm



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Capacity Building

Concerning Congenital Syphilis of the Community Health Workers Leonardo Guimarães de Almeida & Katiele Mariani Cassol IFMSA - Brazil

Primary care is the essence of Brazilian National Health System, in Portuguese known as Sistema Único de Saúde (SUS). SUS provides treatment and prevention programs for many diseases free of charge. It is composed of several professionals, but one of them stands different. The Community Health Workers (CHWs) are responsible for the home visit of families and for the fortification of relations between the community and the Primary Care Unit (i.e. Family Health Care Station). The World Health Organization (WHO) proposed that in 2015 the cases of congenital syphilis (CS) would not be over 0.5 cases per 1000 inhabitants, but Brazil registered 4 cases per 1000 inhabitants and Caxias do Sul registered 7 cases per 1000 inhabitants, fourteen times higher than WHO estimative, considered as a Public Health problem. Syphilis is a sexually-transmitted disease that can also be transmitted congenitally from mother to fetus during pregnancy. It is related to a high rate of perinatal mortality or sequelae in newborns. Knowing the importance of these professionals inside the health care and aware of the great local problem, students members of IFMSA Brazil created a project with the purpose to capacitate CHWs from Caxias do Sul, aiming to increase the information level of CHWs to pass it on to visiting families. This activity occurred through the association with the Municipal Secretary of Health. The project was held in two steps: first, the students had the opportunity to learn about aspects of the disease through a lecture with a Gynecologist-Obstetrician. Then, participants of the project proposed workshops 108 to capacitate CHWs in order to deal with the problems related to CS in their residence visits, emphasizing 109 the preventive aspects, the importance of prenatal assistance and the treatment of the couple involved. This second part was made in two days because of

the high number of CHWs. During the days of capacity building, the medical students discussed with CHW cases of CS and showed them how to manage people with the disease. This work capacitated 194 CHWs, equivalent to a spectrum of 28,000 families and about 100,000 people impacted for this project. At the end of the campaign days, CHWs filled out a form with questions about the knowledge acquired and evaluated the quality of the workshops. The results showed that CHWs have understood the importance of their role in disseminating information about CS and how to manage people with the disease. With these results, we can say that we fully reached our goals. Therefore, capacity building of CHWs has been shown as a way to inform and educate thousands of people effectively. In addition, this action enables the interaction of medical students to public. Finally, work such as this should be encouraged because it helps the personal and professional development of society and the medical students. References • DE LORENZI, Dino Roberto Soares; MADI, José Mauro. Sífilis Congênita como Indicador de Assistência Pré-natal. Rev. Bras. Ginecol. Obstet., Rio de Janeiro , v. 23, n. 10, p. 647-652, Dec. 2001. • FILIPPINI, F.B.; Krapf, M.O.; Carli, M.; Liz, F.M.; Zenil, A.P.D.; “Casos Tratados De Sífilis Congênita No Hospital Geral De Caxias Do Sul Entre 2010 E 2013”, p. 26 . In: . São Paulo: Blucher, 2014. • MINISTÉRIO DA SAÚDE DO BRASIL. Diretrizes Para o Controle Da Sífilis Congênita – Manual De Bolso. Brasília-DF, MS, 2006. 73p.

medical students worldwide | AM 2016, Mexico

August 2016

Communicable Disease Outbreaks in Post Disaster Setting

Dhiya Khoirunnisa

CIMSA-ISMKI - Indonesia

Refugee is a common terminology used for people affected by a disaster (natural or mankind) which force them to stay outside their home either because of their home is broken or for safety reasons. UNHCR defines refugee as someone who owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality, and is unable to, or owing to such fear, is unwilling to avail himself of the protection of that country (Refugee Convention, 1951). The survivors who are affected by disaster are commonly called as Internally Displaced Persons (IDP). Unlike refugee, IDPs have not crossed an international border to find sanctuary but have remained inside their home countries. In this article, refugee means IDPs. Refugees are considered as vulnerable group because their rights tend to be violated. Indonesia is a supermarket of natural disaster. Every month, 200 disasters hit Indonesia. Having ability to handle refugee is crucial for SCORPions, as ambassadors of human rights. What can medical students do? Outbreaks of disease commonly occur following a disaster. In many post-disaster settings, 60 to 90 percents of death of the refugees are due to communicable diseases. Thus in doing humanitarian action, refugees’ health are some of the main concerns. The risk of outbreaks following natural disasters is closely related to the health status and living conditions of the displaced population. The refugee’s camp are often crowded, has poor sanitation, inadequate health services and worsen by insufficient food supply. These factors contribute to the quick and rapid spreading of communicable diseases. There are a few activities to prevent communicable diseases: 1. Safe water, sanitation, site planning. It should be based on standard. This will ensure that the refugees are given good living condition. This may



prevent diseases such as diarrhea, leptospirosis and hepatitis A and E. 2. Primary health-care services. It is used to provide early diagnosis and treatment for diseases. Primary health care also has a role for vector and environment control. Aside from that, they need to give health education to the refugees in order to promote refugees’ health. 3. Surveillance/early warning system. It should be quickly established to detect outbreaks and monitor priority endemic diseases. 4. Immunization. Measles immunization is the most common vaccine given in post-disaster setting. This program is combined with vitamin A supplementation 100,000 IU for children 6-11 months and 200,000 IU for children above 1 year. To conclude, the post-disaster disease outbreaks must be considered as risks. Immunization program during the disaster must be put as an important plan for preparedness. Provision of vaccine, ensuring the cold chain and having skilled health providers are needed to be calculated and budgeted. SCORPions can play important roles on this by working together with the ministry of health to contribute “Build Back Better”.

References • Refugee convention, 1951 • Communicable Diseases Control in Emergency: A field Manual, World Health Organization 2005 • Communicable Disease following Natural Disasters, World Health Organization, 2006

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Popular Pharmacies Tamara Bustos & Jorge González IFMSA - Chile

This story is an example of the roots of the public health problems of our country, Americas region and maybe the world. Its protagonists are common people like us, tired of injustice, but as nonconformist as dreamers. It is a story that has just begun to be written, and maybe was started in a small place by anonymous persons. This inspiration they gave us, left us thinking on how many changes we could achieve to improve the health system and the quality of life of those who need it the most. Where there’s a will there’s a way. The struggle for equitable and universal access to health has been present in Chile since the early twentieth century, because although progress has allowed to reach an important part of the population that was previously excluded, many problems are patent and remain in the public system. One of the main concerns we always have is access; to medical attention, to exams and even more devoid of dignity, access to medication; because it does not matter how much effort you did to find a diagnosis and propose of treatment, you will never know if your patient will be healed (or know they will not) of something easily treated with drugs, but they cannot achieve secondary to its unaffordable commercial value driven by market logic and not by the social interest or need. This concept, completely legal, means to make a scale will between need and business and allows pharmacies to decide a price to priceless goods, such as health

and life. Having this deficient laws permitted the major pharmacies of the country collide to raise drug prices altogether, a situation in which they were found guilty in January 2012, creating a stir nationwide, and even there was an economic punishment, it did not create a change, and we are still seeing this problem anyway, everyday. In response to these facts, desperate neighbours and municipality workers decided to take the other hand of law: it is the responsibility of the municipality to safeguard the community’s health and welfare, but they cannot if they are not able to afford those drugs neither. And they started to create non-profit pharmacies called “popular pharmacies”; popular because it comes from and to population. This project manages direct purchase of medicines to national laboratories and also imports from abroad, obtaining drugs at much less cost than buying them to the colluded pharmacies and makes a kind of municipal delivery service of medication. Of course they are having problems: a lot of lawsuits, economical pressure and barriers; but these will not make them stop. This system has been implemented in 4 communes in only a few months and it is not planning to stop. In this system of huge social inequities and a gigantic historical debt in the matter of public health, this type of actions funnels public policies towards the people, and gives back the hope to continue building a better society.

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Welcome to the world of SCORAngels! This section will provide you with much insight into the life of the delightful Standing Committee On Sexual & Reproductive Health including HIV/AIDS.

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from the SCORA Director Carles Pericas Escalé Director on Sexual & Reproductive Health including HIV/AIDS

Dear SCORA Family, The past six months have been an amazing time for SCORA and its members and with this term coming to an end, I cannot help but look back at all the amazing activities that have been held. From the SCORA IT, we’ve been involved in a lot of campaigns, but the true magic though, happens when you take a look at each National Member Organization and at each Local Committee. SCORA is well known for its passionate members and the activities they create, which are always well planned, outcome-oriented, and thought provoking. During the events happening during this past months, SCORAngels from all over the globe have been proving they can create the best interventions and that they are willing to share them with the rest of the members. In this new edition of the Medical Students International, you’ll find a selection of articles that showcase what SCORA has been up to in a national and local level. Read, enjoy and get inspired with what SCORA has to offer. Warm Hugs, On behalf of the SCORA International Team Carles Pericas

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medical students worldwide | AM 2016, Mexico

August 2016

And What About You?

How Many Children Do You Want to Have?

Marina Vegas Romero

IFMSA - Spain

I can’t remember the first time someone asked me that question, but I’m sure I was really young, probably just a child. For the next years, that situation repeated itself in many family meetings and other social events, with the difference that my answers turned into an “I don’t know” that didn’t wrap up the conversation until someone said that I was still too young to think about it. I have to admit that sometimes I’ve subtlety hinted that I may not have any and I immediately got some inquiring glances looking for a reasonable explanation and I… I feel pressured to justify my decision. It goes without saying that my brother was barely ever bothered with the same question. Since the first moment we are able to distinguish the



external genitals in an echography, we tend to impose a gender identity and roles that will definitely mark the following years of the fetus. In the case of women, understood as a social construct associated to specific anatomic and physiological characters and behaviors considered female because of the heritage we receive; society believes they have the right to interfere in many aspects of our daily life, including our sexual freedom, reducing the person to a reproductive function. One more time, our uterus becomes a matter of state to the point where it takes over our body’s autonomy. This is because we live in a culture with deeply rooted a gender stereotypes that make us believe that the woman who is not a mother, is not ultimately a woman.

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Shiu for ‘’Psiu’’

Stopping Daily Harassment With Women Fernanda Acatauassú Beckmann & Giovanna Gomes e Silva IFMSA - Brazil

The violence and sexual harassment against women are an old problem to the society that stills an issue in nowadays. For that reason, we think it is very important to talk about daily harassment like ‘pick up like’ and whistle, which most people see as a normal attitude with no consequences. And it isn’t true. Women that suffer this kind of violence are susceptible to have psychological damage which may change their social behavior and daily life. From avoiding certain places and type of clothes to avoid getting out at all women in the actual society live with constant fear. To show the local population how serious this subjective is, the students of IFMSA-BRAZIL CESUPA realized the campaign “Shiu for Psiu!”(Stop the Psiu. - Psiu: a way of getting someone’s attention, commonly used in Brazil to call women on the streets). The main aim of the campaign was to raise awareness between the local population about how offensive sexual harassment may be and the psychologic consequences that may develop within the victims. To be able to talk with people the students were qualified by a psychologist who is a specialist in violence against women. She exposed some researches results confirming the expected consequences of sexual harassment and prepared the participants to be able to have a good and improved conversation with the locals.

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The campaign happened in two different moments. The first one was the qualification already describe and at a second moment the students went to a public space call “Portal da Amazônia” where they were able to tell and surprisingly listen a lot of histories. At this moment the students were split in smaller groups to turn the approach easier and each group choose how they were going to initiate contact. We gave them some choices and one example is that they could simulate a Harassment with each other or with someone who was passing by and ask them how did they feel and explain what was the reason. That kind of approach allowed us to show how inconvenient that can be. And we also explain the consequences that this kind of harassment can bring on and a lot of people were surprised to see and realize how serious that really is. At total 70 locals were interview by the students, mostly men, which had a lot of reactions. Some of them confessed that they used to do these actions with women, they thought that was normal and didn’t realize how that has a negative impact on that women’s life. Others at first seem to think like the most part of population but overlooked the conversation they start to fell and think different. The campaign helped people to think about this matter like a social problem and no longer like a daily attitude. And that made locals see that women have their rights broken in many ways that may seem like only small attitudes and moments, but that that just can’t keep happening. References SOUZA, Terezinha Martins dos Santos. Assédio Moral e Assédio Sexual: Interfaces. Revista Interfacehs. São Paulo, 2006.

medical students worldwide | AM 2016, Mexico

August 2016

Medical Updates on Maternal Health Care Miranda Mutia

CIMSA-ISMKI - Indonesia

Indonesia is one of the top countries with highest maternal mortality rate in south-east Asia. According to the Indonesian Demographic and Health Survey, the maternal mortality rate in Indonesia reaches 220 deaths per 100,000 live births while MDGs target towards it was 102 per 100,000 live births by the end of 2015. The main cause of maternal death in Indonesia is eclampsia, followed by bleeding, infection, and other disease (such as TB, HIV, etc). Most of these deaths occur because of lack access to health services during pregnancy and childbirth. Those complications were not treated properly as most of them had not received quality care from competent health care provider. To improve the quality of maternal health care services in Indonesia, WHO Indonesia in collaboration with Center for Indonesian Medical Students’ Activities (CIMSA) held a series of one-day workshop across 15 medical schools in Indonesia. It aimed to introduce the Pocket Book of Maternal Health Care for Primary and Referral Facilities (also known as the Maternal Health Pocket Book), EDUKIA website (, and the iOS app of the pocket book. We chose MADRE as name of this workshop. MADRE, which means ‘mother’ in Spanish, is an abbreviation for “Medical Updates on Maternal Health Care”. The objective of MADRE was to integrate the Maternal Health Pocket Book into the medical curricula as a highly recommended and referenced guideline for maternal health care. The workshops lasting from April 2016 until June 2016 were open for final year medical students (in clinical rotation). One-day workshop of MADRE consisted of three lectures, group discussion, and plenary session. The lectures were conducted by WHO Indonesia as well as Obstetrician and Gynecologist. The first lecture was about the importance of improving the quality of maternal health care services to reduce maternal mortality. In this



section, participants learned that maternal mortality is a very challenging health problem arises from the complex interplay of multiple factors and determinants, such as poor family planning, gender inequality, and lack of access to quality health services. In second lecture, participants were trained how to use the pocket book properly. After that, the last lecture was introducing EDUKIA website and the iOS app of the pocket book to the participants as online learning resource they can use to gain more information related to maternal and child care. The lectures followed by a group discussion, in which the participants were given opportunity to demonstrate their skills in using the pocket book to solve clinical cases. In plenary session, a representation of each group came forward to present clinical case they were discussed before. All participants discussed it together afterwards. Finally, the workshop was closed with a post test. The pretest and posttest analysis was used to measure workshop output. References • • Pusat Data dan Informasi Kementrian Kesehatan RI • h t t p : / / w w w . d e p k e s . g o . i d / d o w n l o a d . php?file=download/pusdatin/infodatin/infodatinibu.pdf • id=1087

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Access to Safe Abortion A Medical Students’ Perspective

Alan Ricardo Patlán Hernández IFMSA - Mexico

Over the past two decades, the health evidence, technologies and human rights rationale for providing safe, comprehensive abortion care have evolved greatly. Despite these advances, an estimated 22 million abortions continue to be performed unsafely each year, resulting in the death of an estimated 47 000 women and disabilities for an additional 5 million women. This is particularly disturbing because unsafe abortion is the only cause of maternal mortality that is entirely preventable. Almost every one of these deaths and disabilities could have been prevented through sexuality education, family planning, and the provision of safe, legal induced abortion and care for complications of abortion. In 2015, acknowledging the importance of abortion worldwide, we designed a survey in order to know the current situation and the stand of medical students in México regarding this issue, with the ultimate goal of proposing viable solutions through activities of our National Member Organization and its Standing Committees.

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Of the 132 medical students belonging to 64 different universities member of IFMSA Mexico who responded to the survey, half of them women; 28.1% consider that the main cause of unintended pregnancy in Mexico is the low educational level and the 20.8% consider that it is caused by the lack of information about sexual and reproductive health among the society; furthermore 59% believe that the main cause of abortion in Mexico is due to the young age of women who become pregnant and 50% believe it is due to pregnancy resulting from sexual abuse.

abortion; 24.2% consider it is due to the unfavorable economic conditions of many women, and 17.9% consider it is due to the lack of information. In conclusion, 35.9% believe that access to safe abortion can be guaranteed by ensuring access to health services for all women and 27.2% believe can be done by generating government policies and reliable information available to the entire population. According to the results, the majority of medical students involved is this work think that the main causes of unsafe abortion practices are conditions and problems concerning the socio-cultural and economic contexts in Mexico. Furthermore, most of the students believe that some of the pillars of the solution remain incomplete or uncovered since information about abortion and sexual and reproductive health still has poor distribution and scope, and much of the current information has few filters of quality and reliability. tAcknowledging the current situation regarding abortion in Mexico, medical students recognizes that actions to improve and solve the problems concerning this issue should be proposed, urged and done wisely and promptly. All of this taking action in different areas, with the ultimate goal of ensure access to information and health services of high quality, thus guaranteeing access to safe abortion or preventing some of the causes that lead to require the practice of abortion.

Regarding unsafe and clandestine abortion, 33.7% of the students consider it is practiced due to the lack of legislations that allow and ensure the access to safe medical students worldwide | AM 2016, Mexico

August 2016

Teen Pregnancy

A Major Health Problem in Mexico

Ismael Tapia Castro

IFMSA - Mexico

Since 2007, Mexico set up public policies that aimed on prioritizing access to maternal health services, one of the most important ones was on May 28 of 2009 when the General Convention of Interagency Collaboration for the Care of Obstetric Emergency was signed by the Mexican Social Security Institute, the Institute of Social Security on Service for the State Workers and the Health Department , which provides that all women who develop obstetric complications must be entered in any of the health units in these institutions, regardless of their membership status. Between 2012 and 2013, the number of maternal deaths has decreased from 960 to 861, this resulted in a reduction in maternal death rate from 42.3 to 38.2 per 100,000 live births, but among teenagers aged 15 to 19 years, the maternal mortality ratio increased from 32.0 to 37.3 deaths per 100,000 live births, higher than the figure recorded among women aged 20 to 24 years representing one of the target groups of population to intervene within pregnancy prevention. Within the pregnancy control according to the results of the National Survey of Demographic Dynamics (ENADID, 2009), between 2004 and 2009 more than 97% pregnant women had prenatal screening,

the average number of revisions was seven and 95% of these cases were performed by medical staff. However, it has not been able to consistently reduce the maternal mortality, reflecting that the primary health care priority is not the quality of care delivery or obstetric emergency. It is important to point that bleeding and Hypertensive disease (mainly eclampsia) are the leading causes of death but the abortion as a cause of maternal death in Mexico is about 6% according to statistics from INEGI data for 2009. This represents that only 74 of 1207 women died from this cause during that year. Nevertheless, according to estimates by the World Health Organization, that percentage is 13% maternal mortality overall and 24% in the Latin America. It is estimated that in Mexico, approximately 4,200,000 pregnancies happen per year, and that only 60% reaches the end of gestation and the other pregnancies end with spontaneous abortions or induced abortions. Nevertheless, the criminalization of abortion does not prevent its practice; it is estimated that 9.2% of the pregnancies in women aged 15 to 19 years occurred between 2004 and 2009 ended in abortion despite the legal restrictions on 31 of the 32 states and the annual rate of hospitalizations for abortion in teenagers aged 15 to 19 years has increased in the country from 6.1 per thousand in 2000 to 9.5 in 2010. In terms of comprehensive sexual education, this area is one of the biggest challenges for our intervention as medical students being a main point to include sexual and reproductive education as a curricular component of the basic education preparing teenagers to adopt a healthy sexuality.



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Antenatal Depression in Pakistan Samia Rauf Butt IFMSA - Pakistan

In the more competitive environment there has been a widespread increase in stress related mental disorders. Social attitudes and norms along with cultural practices have contributed to a large female population suffering from depression especially pregnant women in developing countries like Pakistan. 1 Anxiety or mood swings during pregnancy is usually expected but about 19-25% women experience depression in economically poor countries. Antenatal period and mothers’ health is a critical issue which still remains neglected. The key obstacle lies in women’s unawareness and lack of skilled quality care at perinatal period. Prenatal depression has drawn more attention in recent years due to break down of social, physical and emotional support. Pregnancy brings a huge difference in psychological and physiological

state of mind and body. A woman may find difficulty to cope with additional demand of pregnancy, living in poverty and many dependent children. Other face issues regarding domestic violence or relationship conflict. Maternal depression is linked to psychoneuroendocrine disorders causing stunted growth, poor cognitive development, low birth weight and incomplete immunization during first year of infancy2. Antenatal depression is found to be associated with maternal age, socioeconomic, nutritional status, and gender based violence, partner lacking empathy during child birth, history of miscarriage, pregnancy termination or unwanted/unintended pregnancy.3Its occurrence is high in women. Intervention of antenatal depression is mostly in third trimester (28-36 weeks).According to a perspective

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August 2016 cohort study done in Rawalpindi, 25% of women in antenatal period and 28% in postnatal period were depressed, being a victim of socioeconomic crisis4. Another study strongly supports its prevalence due to physical, sexual and verbal abuse, which further is a prediction of low birth weight infants, increasing their risk of morbidity and mortality5.UNICEF released “The state of world’s children 2014” reporting that Pakistan is among the countries with highest infant mortality rate. However, this problem can be controlled by proper screening and diagnosing the signs and symptoms as early as possible. Now taking into account above facts and its epidemiology maternal health policies should incorporate programs that deal with management of nonpsychotic common perinatal mental disorders (CPMDs) among women in low income states. A randomized control trial was used by intervening cognitive behavior therapy among married women (age16-45) in rural areas of Pakistan. The intervention group was assessed by Diagnostic and Statistical Manual of Mental Disorders and then trained by Lady Health Workers in Thinking Healthy Program during third trimester which showed a positive result in antenatal as well as preceding postnatal depression. Infants had better health and enhanced routine care6.

Depression Week for parents to help them understand their feelings and to support them and instill that their problems are uncommon and treatable. Mortality and morbidity due to such complications is preventable and treatable conditions. Such counseling should be practiced in Pakistan either through lady health workers or online to integrate better health in mother and baby and postnatal period. References 1. Ali Shah, Syed Mahboob et al. ‘Prevalence Of Antenatal Depression: Comparison Between Pakistani And Canadian Women’. JPMA 61.242 (2011): n. pag. Print. 2. Rahman, Atif et al. ‘Interventions For Common Perinatal Mental Disorders In Women In Low- And Middle-Income Countries: A Systematic Review And Meta-Analysis’. N.p., 2013. Web. 9 Nov. 2015. 3. Leigh, Bronwyn, and Jeannette Milgrom. ‘Risk Factors For Antenatal Depression, Postnatal Depression And Parenting Stress’. BMC 8.24 (2008): n. pag. Web. 9 Nov. 2015. 4. Rehman, atif. ‘Life Events, Social Support And Depression In Childbirth: Perspectives From A Rural Community In The Developing World’. Psychological Medicine 7 (2003): 1161-1167. Web. 9 Nov. 2015. 5. Karmaliani, Rozina, and NargisAsad. ‘Prevalence Of Anxiety, Depression And Associated Factors Among Pregnant Women Of Hyderabad, Pakistan’. International Journal Of Social Psychiatry 55.5 (2009): 414-424. Web. 10 Nov. 2015.

However, untreated depression increases risk of preterm delivery and other obstetric complications. Use of antidepressants is inadvisable as it causes toxicity in neonates in mild conditions. It is associated with 68% increase in spontaneous abortions. 7The Gynecologist should discuss risks and benefits of pharmacological treatment with the pregnant lady. Early detection of depression and its adequate treatment are critical to avoid its consequence on the child. Australia organizes Perinatal Anxiety and



6. Rahman, Atif, and Abid Malik. ‘Cognitive Behaviour Therapy-Based Intervention By Community Health Workers For Mothers With Depression And Their Infants In Rural Pakistan: A Cluster-Randomised Controlled Trial’. lancet 372.902-09 (2008): 863. Print. 7. Einarson RN, Adrienne. ‘Antidepressants And Pregnancy: Complexities Of Producing EvidenceBased Information’. CMAJ 182.10 (2010): 10171018. Web. 10 Nov. 2015.

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Seville LGTB Week Pablo Nieto-Tocino IFMSA - Spain Physiology, Neurology, Psychiatry, Pediatrics, they’re all fields related to Sexology and Sexuality, but in college all these subjects tend to tiptoe around Sexuality itself– not to mention LGTB sexuality. Hundreds of social taboos may be the most likely explanation to this, but the consequences of this massive ignorance in our curricula will be suffered in the future by our patients, and specially LGTB patients. I thought this wasn’t something we should just accept and go on, but instead we should do something about it, at least a small contribution: LGTB Week became that small contribution – a week full of activities where Sevillian med students could learn more about this. When I first came up with this idea, it seemed to go nowhere, since we were only a few people in

AJIEMS (our Local Committee here in Seville), not really motivated and with many difficulties to reach our fellow students – moreover, AJIEMS was way less involved in a national level than it is now. Even so, I was decided to make LGTB Week a reality, so I kept going... But given this context, it’s no surprise that during our first editions, everything started to look like our negative prediction: we had just two or three students attending to the LGTB Week’s activities. We were almost considering not to do it this year, but in the end I thought that, even if no one came, it was an event I felt the moral duty to organize. And now I’m glad I did it, because this year it really changed: I convinced some friends to help me advertising it, so we could reach more students, and our effort was worth it when more than 30 people came to each of our activities – and not only Medicine students, but also from other colleges: future engineers, future teachers, future psychologists, future lawyers, etc. Over these years, some of the lectures have been about trans people (by Spanish historic trans activist Mar Cambrollé), the different ‘therapies’ that have been said to ‘cure’ homosexuality (by Dr. García Arroyo, psychiatrist), lesbian visibility (by NGO “DeFrente”), trans kids (by NGO “Chrysallis”) or about bullying (by NGO “Triángulo”), along with the clinical training “LGTB Patients & Prejudices” (by myself, since I was given a similar training from our former NORSA Adri) and several movie+debate activities.

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And what about the future? Well, in our last RI (one of IFMSA Spain’s two national meetings) we had a Project Fair where other LCs became interested in our idea, and some of them even asked us to help them prepare it, and wondered if I could give the clinical training in their cities – you can imagine my both-blushed-and-proud face in that moment! That encouraged us to spread this project all over the country through trainings in a national event that we’d host next year... step by step, this is happening guys! medical students worldwide | AM 2016, Mexico

August 2016

The Rainbow Project 2016

International Day Against Homophobia, Transphobia and Biphobia Campaign

Cristel Andrea Quiñones Palacios

IFMSA - Peru Homophobia is a term used to describe the fear, discomfort, intolerance, or hatred of homosexuality or same-sex attraction in others and in oneself (internalized homophobia). The group of persons belonging to sexual minorities continues to remain invisible and to live in fear and under conditions of discrimination and no access to healthcare. Homophobia among healthcare professionals and medical students are well documented, studies of homophobia in medical students show that more than 10% of medical students have a significant level of homophobia. Hence, our prime objective with ‘The Rainbow project’ is to reduce the level of homophobia in Peruvian medical students and also enlighten them with more knowledge about sexual diversity. The Rainbow Project team made a schedule and a Powerpoint presentation, where was included all the necessary material for the campaign. Then this information was sent to the local officers on sexual and reproductive health include VIH/SIDA (LORAs). A helping hand was offered by some NGOs, like Epicentro and Cepesex, they trained the LORAs in sensitization techniques and sexual diversity in order to empower them with knowledge and skills so they can develop the campaign in their Local Associations. The campaign took place at five universities in different cities (Lima, Huacho and Cuzco); medical students from different parts of Peru had the opportunity to learn about



LGBT population (concepts and history) and differences between gender identity, sexual orientation and sexual identity. Besides, they improved their knowledge on homophobia consequences such as stress, depression, anxiety, and many others. The main importance of providing all this knowledge is to reduce the level of homophobia in medical students. I dream that some day homophobia will be eradicated; this should happen all over the world and not only in medical students, but starting with them is a big step. We can make the world a better place. References 1. Lemuel M. Arnold. Promoting culturally competent care for the lesbian, gay, bisexual, and transgender population. American Journal of Public Health 2011; 91(11): 1731-1734. 2. Campo Arias, Herazo Edwin. Homofobia en estudiantes de medicina: Una revisión de los diez últimos años. MedUNAB. 2008; 11(1): 120-123. 3. Díaz Rafael, Ayala George et al. The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: Finding from 3 US cities. American Journal Public Health. 2001; 91:927-932. 4. Cáceres CF, Talavera VA, Mazín Reynoso R. Diversidad sexual, salud y ciudadanía. Revista Peruana de Medicina Experimental y Salud Publica. 2013;30(4):698-704.

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Sexperts Montréal Our Style of Sex Ed

Brittney Elliott

IFMSA - Quebec

Sexperts is a sexual education project for youth run by IFMSA’s Standing Committee on Reproductive Health including AIDS. Sex ed is a controversial subject to teach, especially given that it can be approached from so many differing values and viewpoints. The overall solution that Sexperts Montréal believes in is to make sex ed as person-centered (or patient-centered) as possible, and to simply educate youth about their many options rather than making suggestions as to what they ought to do. The goal with this empowerment is to allow individuals to take responsibility for their own decisions, and to allow patients to work in partnerships with their physicians towards common goals of wellbeing. Besides focusing on patient autonomy from the start, Sexperts also stresses, throughout every module, the importance of empowering and obtaining consent from one’s partner. We explain why consent can be confusing and encourage explicit consent before any sexual activity so that partners can avoid ambiguity.

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When approaching risk reduction, Sexperts does not tell youth that they must use barriers (e.g. condoms) if they choose to be sexually active, nor do we tell youth that it is best to be abstinent. Instead, we teach that every sexual activity comes with a certain level of risk but that some activities are riskier than others, and we inform youth about different options they have for lowering their level of risk if they choose to have sex. Also crucial to our Sexperts style is that we do not use fear tactics to illustrate the seriousness of certain sexually transmissible infections. While we do explain some of the potentially grave complications of STI’s, we do so in as neutral a manner as possible, as we believe that fear might contribute to stigma and/or discourage patients from being screened (out of concern of a positive test result). Instead, we teach that many STI’s

are highly treatable or curable, but that many cases may be asymptomatic, which is why it’s a great idea to talk to one’s physician about being screened. Importantly, we also strive to teach these aforementioned lessons in a way that is relevant to and inclusive of everyone, and that normalizes sexual and gender diversity. Ultimately, our goal is not to transform youth into experts; it’s simply to make talking about sex less frightening. The impression that I have received from the secondary students I have taught is that many of them have not yet spoken to a physician about their sexual health, because divulging personal information can be scary, being judged or criticized can be scary, and sexually transmissible infections can be scary. Given this, I hope that healthcare providers might consider using the philosophies of Sexperts when they educate patients about sexual health. I think the most important factor is to simply make an individual aware that they have a right to a safe space to learn about sex. My hope is that, if we can accomplish this, patients will be more willing to let their physicians in and to seek care.

medical students worldwide | AM 2016, Mexico

August 2016

Sexuality Education in Lithuania Egle Janusonyte

LiMSA - Lithuania

Every SCORAngel surely knows the importance of sexuality education for dispelling common myths regarding gender or sexuality and understanding relationships better. LiMSA (Lithuanian Medical Students’ Association) is currently participating in a government discussion about a new project that will decide the future of sexuality education in Lithuania. As various points of the project are still being considered by authorities, LiMSA has undertaken the task to additionally provide sexuality education for the children and teenagers of Lithuania. If you want to teach someone, it is crucial to be competent in the subject. In order to educate Lithuania’s SCORAngels our NORA (who is a certified Peer Educator) has organized two sessions of National peer education trainings regarding sexuality education in Vilnius University and Lithuanian University of Health Sciences. The sessions were intended for the members of LiMSA and their primary goal was to improve their qualifications and to provide them with information how to communicate with youngsters effectively. They included mainly interactive activities such as learning how to deal with younger audience, understanding AIDS, and looking into the concept of gender based violence. There were

also guests from Lithuanian Gay League who presented us with the issues queer people face in everyday life and most common stereotypes regarding their sexuality and gender identity. The rape question was also discussed by analyzing magazines intended for a male audience and rapists’ statements. These sessions were carried out very successfully, unfortunately, there were too many students who wanted to participate and not enough resources, due to this another session is currently being planned to take place in September. After the sessions forms were prepared and sent to state schools with an invitation to participate in the LiMSA sexuality education project, offering lessons in topics such as HIV and other STIs, sexuality and gender identity, family planning, pornography and gender based violence. Some schools have already accepted the offer and we are planning to start the project in autumn. However, in May LiMSA has received an invitation from parents of a class of fourth-graders that asked us to conduct a lesson for their children because they were often engaged in watching pornography during the breaks and lessons. We undertook the challenge and met the class. Puberty changes were discussed and the problems with depiction of sexual intercourse in pornography were examined. Relay races and various games were included as well. The meeting turned out to be very rewarding for the children as well as for members of LiMSA. The current outlook of sexuality education in Lithuania seems to be uncertain, but we are moving in a right direction, and the members of LiMSA are doing their best to improve it. LiMSA has so much potential and a lot of members are truly devoted to the idea that providing good education equals a better future, so I believe that our project will prove to be beneficial in creating a better, more educated society.



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Youth Education on Sexual Health Samuel Niyonkuru MEDSAR - Rwanda

In Rwanda, 3% of the total population is infected with HIV/AIDS and 2.9% of them are the youths (National Institutional Statistical Rwanda (NISR) 2010). The youth in Rwanda are more susceptible to HIV/AIDS due to ignorance, lack of information, lack of adult guidance and risky activities like prostitution. This has led to many school dropouts, early death, unwanted pregnancies, unsafe abortion, social discrimination, hindrance of potential and contribution towards the development of their society. Many organizations have been involved in campaign against HIV/AIDS using different approaches but not knowing that sports is one of the best way to mobilize and pass on information to as many youths as possible. This is why SCORA MEDSAR deliberately targets the youth within its beneficiaries to address the issues of HIV/AIDS among the youth and their communities through sports in Project known as YES (Youth Educational Activities on Sexual Health) Project from 23rd April till 19th June, 2016.

Outcomes • Platform to share the best practices in fight and prevention against HIV/AIDS.

The vision of the project is to provide the youth with essential knowledge and skills, on how they can fight against HIV/AIDS.

• Lead to sustainable ways/methods to share information.

High school students: The project is targeting 12 high schools approximately 1,800 youth students aged 1419 years.


To make our session successful, we divided ourselves into different groups according to the participants, one group transmit message through cricket game another conduct teaching session. With focus on the meaning of HIV/AIDS because mostly of participants are high school students who are not really aware of the meaning HIV/AIDS, possible transmission of HIV, complications and all possible ways to prevent HIV/AIDS. Highly we focus on the A, B, C and T with A: Abstain, B: Be faithful, C: Condoms and T: Testing, we have seen that those four letters if applicable, can play a big role in prevention each can help us to prevent HIV/AIDS.

The mission of the project is to create HIV/AIDs and other STIs awareness among the youths.



Refugees: Youth in Camps are most susceptible HIV/ AIDS, and have limited access to information make them the least aware of cause and remedies against HIV/AIDS. The Project works with Mugombwa refugee camp in Gisagara district and Kigeme Refugee camp in Nyamagabe district. Approximately 800 refugees are targeted.

University students: The project works with two universities; UR Huye campus and IPRC south. The majority of the youth in the universities are targeted to be reached through campaigns On HIV/AIDS awareness. Approximately 200 university students are targeted.

• Participants understood the role of knowing their HIV/AIDS status and take appropriate measures towards the test outcome. • Cleared some myths on HIV/AIDS • 4,000 Youths understood the danger of HIV/AIDS, causes and prevention measures to take.

medical students worldwide | AM 2016, Mexico

August 2016

Pre-Exposure Prophylaxis (PrEP) Adrián Carrasco Munera

IFMSA - Spain

The use of Post-Exposure Prophylaxis (PEP) is wide extended when mechanical barriers such as condoms are not used or do not work properly and an exposure to HIV happens. The combination of tenofovir and emtricitabine is currently use for both antiretroviral treatment and PEP. The usage of tenofovir + emtricitabine as Pre-Exposure Prophylaxis (PrEP) was and authorised in 2012 in the United States of America by the FDA (US Food and Drug Administration) according to the CDC (Centre for Disease Control and prevention), which claimed than its use as PrEP was 92% effective at preventing HIV when taken daily. PrEP has not been authorised in most of the European countries yet. PrEP is mainly recommended for 4 social groups: men who have sex with other men (MSM), women who have sex with men, injection drug users and sex workers. Other groups such as health workers and researchers may also be target groups for PrEP. I would like to remind that “risk groups” don’t exist, but “risk practices” like not using mechanical barriers as preventive method. Despite this fact, CDC infographics about PrEP are specially focused on MSM. Organizations of people living with HIV and those working on HIV prevention advocate for the authorization of tenofovir + emtricitabine as PrEP in Europe. Meanwhile, European specialist on HIV debate about the real convenience of PrEP approval. We must take into account that most of patients and medical organizations which advocate for PrEP are directly sponsored by Gilead Sciences, the pharma-industry which commercializes PrEP drugs. But, is PrEP as positive as advocating organizations stand up for? When the European Medicines Agency approved tenofovir + emtricitabine as antiretroviral treatment in 2005, several serious side effects were notified: hypophosphatemia, dizziness, diarrhea,



vomiting, elevation of CK (>1/10); insomnia, nightmares, elevation of glycaemia, triglycerides, bilirubin, transaminases (>1/100 - <1/10); and renal pathologies such as acute renal failure (> 1/10.000 - < 1/1.000). Just one year later, acute renal failure showed a higher incidence, so several national agencies informed their doctors about this issue. In 2014, the Spanish Medicines and Health Products Agency advised that this risk of acute renal failure increases even more when tenofovir + emtricitabine is used together with NSAIDs. Thus we can imagine how much this risk rises since the use of NSAIDs is pretty spread for mild and severe medical conditions. The usage of tenofovir + emtricitabine is not free of risk. When it is used as either antiretroviral treatment or PEP, these risks are permissible due to its risk/benefit profile. When it is used as PrEP, it is used on healthy individuals meaning another example of medicalization of healthy people, exposing them to severe side effects, and medicalization of sexuality. We should defend an evidence based medicine, clean of conflicts of interest (specially related to the pharmaceutical companies) and in favor of the public health. As medical students and future healthcare providers we should stand up for these values and keep a critical attitude toward our education and the information that reach us.

( M S I 34 )

Diferential Diagnosis Child Abuse and Neglect

Erva Nur Çinar TurkMSIC - Turkey

Child abuse and neglect is physical, sexual, or psychological mistreatment or neglect of children, especially by a parent or other caregiver. The World Health Organization (WHO) defines child abuse and neglect as “all forms of physical and/or emotional illtreatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power’’.

proportion drops to about 20% of murders of children aged 10 to 14, and 5% of murders of children aged 15 to 19. A substantial proportion of homicides of children under 10 years of age are committed by a stepparent, by a parent’s boyfriend or girl-friend, or by other people known to the victim. The WHO estimates that 150 million girls and 73 million boys under 18 have experienced forced sexual intercourse or other forms of sexual violence involving physical contact, 48 though this is certainly an underestimate.

There are 4 types of child abuse and neglect: Physical abuse, Emotional abuse, Sexual abuse, Neglect.

Violence and neglect against children harms to child’s development and physical health. Therefore, growing is educated parents and doctors is so important for children’s future.

Physical abuse of a child is defined as those acts of commission by a caregiver that cause actual physical harm or have the potential for harm. Sexual abuse is defined as those acts where a caregiver uses a child for sexual gratification. Emotional abuse includes the failure of a caregiver to provide an appropriate and supportive environment and includes acts that have an adverse effect on the emotional health and development of a child. Neglect refers to the failure of a parent to provide for the development of the child – where the parent is in a position to do so – in one or more of the following areas: health, education, emotional development, nutrition, shelter and safe living conditions.

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In general, children under 10 are at significantly greater risk than children aged 10 to 19 of severe violence perpetrated by family members and people closely associated with the family. Age and sex are important risk factors. The majority of murders of children under the age of one are perpetrated by one or both of the child’s parents, frequently the mother. While approximately 50% to 75% of murders of children aged under 10 are by family members, this

As Cerrahpasa Local Committee we asked our professors to train us on this subject supplementary to our academic program. We see that academic program is not enough to have the sufficient knowledge on “Child Abuse and Neglect”. So we started to plan our trainings in response to the request of the students. We planned our trainings as multidisciplinary. Our professors from the departments of Forensic Medicine, Gynecology, Neurosurgery, Pediatrics, Pediatric Surgery and Child and Adolescent Psychiatry approved and joined us. Trainings are planned for the 1st, 2nd and 3rd grade students of the medical faculty. And we were approximately with 85 eager students! The best motivation is to sustain the attention. Furthermore, we want to inform the children and their families about Child Abuse and Neglect by the trainings which we are having now. One of our aim is also providing to create an awareness among them. Furthermore, we desire to start this project in other medical faculties in Turkey by Cerrahpasa Local Committee. Everybody should do something to stop the “Child Abuse and Neglect” and create an awareness for it. If we could make a little bit contribution about it, it is great for us. medical students worldwide | AM 2016, Mexico

August 2016

The Pursuit of Positive Carles Diaz Boada & Carlos Acosta

AECS - Catalonia, DENEM - Brazil,

Bugchasing has been described as a new subculture practice, usually present amongst men who have sex with men (MSM) that consists on the desire of acquiring the Human Immunodeficiency Virus (HIV) voluntarily. 1 This practice has alarmed many public health scholars as in a first line it is a counteraction towards many public health efforts towards eliminating HIV infection. Furthermore, it raised curiosity of many mental health professionals with the combination of “misbehavior”, disease and social development. 2 Even though there is not too much data about it, experts believe tendencies are this practice to rise, not necessarily because there are more chasers, but because it is now a stronger social practice as well as medical advances on HIV therapeutics increase global survival. The actual concern to public health and sociology experts is not intercourse between people living with HIV and individuals who don’t. The core of the discussion is a common practice among bug chasers that is called “barebacking” which stands for unprotected anal sex. Barebacking in this case functions as a main vector for HIV acquisition3. It is important to note that not all bug chasers perform barebacking and that this practice is not only seen among the bugchasing community, therefore barebacking is not a solid link to explain the reasons why people become bug chasers. Another point to discuss is that most bugchasing occurs in collective practices. People generally gather in bareback parties and conversion ceremonies (event to convert someone from HIV negative status to positive) to practice bugchasing, which can be seen as a controlled space of acquisition of HIV or, epidemiologically, as a promoting factor of prevalence of new sexually transmitted infections (STIs). On the other hand, another topic to focus on is that this practice can be related, and usually overlapped, with “chemsex” which stands for the intake of recreational drugs to aim self-inhibition and have sex with multiple



partners for hours, or even days. At this point, while public health agencies are studying and developing measures to confront this issue, medical practitioners have to face its consequences. Whereas some of them think of a mental health approach, others try to handle it by educating their patients about the risks of this practice, independently of their HIV status. The fact is that the reasons why people bugchase are multifactorial. Therefore, there is more than one possible intervention to comprehensively address this matter. Some of the reasons we know are sexual arousal to riskful situations, group affiliation, stigma visibility or avoidance of condom use in future intercourses4. As we can see, some of these people lack of information about STIs, but others have made a thoughtful choice. Even though we have to care about everyone’s health, we still have to respect individuals’ freedom to choose the sexual practices they want to take part in. So at the moment, the most attainable intervention as medical students is to raise awareness and deliver proper sexual education amongst vulnerable groups. References 1. Moskowitz DA, Roloff ME. The existence of a Bug Chasing Subculture. Culture, Health and Sexyality. 2007;9:347-57. 2. Berkman LF, Kawachi I. “A Historical Framework for Social Epidemiology,” in Social Epidemiology, ed. L.F. Berkman and I. Kawachi (New York: Oxford University Press, 2000). 3. Tomso G. Bugchasing, barebacking and the risks of care. Lit Med. 2004 Spring;23(1):88-111 4. Hogarth L. The gift [documentary]. Dream out loud; 2003.


Have you ever wondered what SCORE Exchanges are all about? Which countries you could go to? Or what research projects are offered? Find out more here in SCOREview, the publication that has everyone talking about research exchange

( M S I 34 )


from the SCORE Director Koen Demaegd Director on Research Exchange

Dear Dark Blue Family around the globe, It is with deep honor and great pleasure that we introduce you to this 34th edition of MSI and with it, to the most engaging and sophisticated pages, SCOREview! Without the shadow of a doubt, as members of the largest medical student’s organization, and part of the Standing Committee on Research Exchange, we are genuinely convinced that exchanges represent an amazing opportunity to develop academic capacities, intercultural skills and acquiring knowledge which would allow medical students to become qualified physicians ready to face international health issues and with the motivation to advocate for a better health practice. Scientific improvement is one of driven passions behind SCORE. Our daily duty is to create a network of active students who facilitate access to research projects, to work on the achievement of academic quality, to provide great experiences to our exchange students, and to seek for recognition. Why do we do this? Why does this mean so much for each one of us? Is our federation taking the right steps on the achievement of the aforementioned? Well, there could not be better explanation than what you are about to read in the next pages. Currently, 69 National Member Organizations are SCORE Active, but our Standing Committee means much more than that. SCORE represents each and every of the 2,500 students who annually take part of a life changing experience called “research 130

Blue Hugs,


Koen Demaegd

exchange” where they learn the basic principles of medical research; it represents every tutor who decide to share their time and knowledge with medical students through more than 3000 research projects all over the world; it represents all of the different cultures that we manage to bring together and all of the enrichment and personal growth that this signifies; and last but not least, it represents every NORE and LORE working so incredibly hard on the organization of Professional and Research Exchange Training, Pre-Exchange Trainings, Upon Arrival Trainings, Scientific and Educational Activities and Social Programs, all with the aim of reaching an authentic impact over the medical education worldwide. Finally, I would like to extend to each of you beloved readers a very sincere invitation to actually pay attention to following stories of people who have, in many ways, contributed to our goals and objectives. If you are an author of any of the following articles, I truly congratulate and thank you because without your help this would not have become as big as it is now. If you have participated in a SCORE exchange or done something in your NMO regarding our Standing Committee, we call you to be part of this important magazine; lastly and most important I think, if you have never experienced what SCORE is, I encourage you to set aside your fears and take the chance to live what has moved us all. Once you experience the dark side of the blue, I promise… you will not regret it.

medical students worldwide | AM 2016, Mexico

August 2016

The Diversity in This World Su Ching Huang

FMS - Taiwan

The center I visited during my research exchange with SCORE was Endocrine Genetics Laboratory at the McGill University Health Centre. McGill University in Quebec is a ranked top 50 University in the world, and the McGill University Health Centre is the hospital accompanied with the University. The laboratory I stayed in during my visit had about six people, and only two were official researchers while the rest were students. However, it felt like the entire United Nations was in this laboratory: my professor was Greek, my tutor was Irish, there were other exchange students from China, and one student from Aman. It was a very great opportunity for me to interact with the other countries’ cultures. I felt like the research environment was very pleasant in this country, there did not seem to be any tension or conflict between research partners, and whenever someone had a problem everyone was there to help. My professor was a very good teacher; although he was a doctor and was often busy with clinical work, he did thoroughly know the job of each person in his laboratory,



even if he was not able to come to the laboratory every day. The professor also came into the lab every Friday morning for a meeting to understand everyone’s weekly progress. My lab was a mainly students-lab and beside the official researchers who need to clock in and clock out on time, each student was free to leave the lab after finishing the day’s progress. Furthermore, the research progression here is not too forced and not pressured at all. My research topic was about Type-I Diabetes and looking at mutated genes within patients with the disease, mainly using PCR. Before leaving for the exchange, the professor sent me a paper to read so I

( M S I 34 ) could understand gene-testing as well as related technology and research. Since I have only learned the theory behind PCR, the month’s learning objective was to understand PCR operating and learning the procedures in setting a research goal. The tutor who led me was a resident doctor from Ireland, and he was very patient with me. He took me step by step from the start, and would occasionally share research papers with me as well. I feel like my research was very closely correlated with molecular biology which I had a course in during my second year of college, and it was necessary for me to understand the basics of DNA and genes to be able to easily get started on the research. However my main difficulty was on communication. I thought my English was on the mediocre level, but because I had very little experience going to foreign countries, it was hard for me to get used to the foreigners speaking fluent English. Sometimes I could only understand some key words. Besides, for those who did not have English as a first language, there were deemed to be some accents and that just added to the difficulty in communication. Thankfully the people in the laboratory were all very nice to me and were willing to speak again when I was not able to understand them.

The biggest thing I learned in this month of exchange was not the technicality and theory in research, but the challenges not related to the research. These included communication, lifestyle, the culture of the laboratory, the mindset, etc. The culture of the laboratory here was to be very active in asking questions, and if the students did not ask any questions, the teachers would not teach. This was very different from the education I received in Taiwan. Furthermore, I thought that it was important for me to be open-hearted, and to be willing to make friends with the foreigners. From doing so, I realized my stupidity in being stubborn with the stereotypes I had about the other cultures. When I threw those stereotypes away, I found that the world out there is very big, and everyone had their own diverse way of being different. At the end of the exchange my teacher wanted me to give a presentation of my learning throughout the entire month. The result was very successful. I was even able to keep in contact with the teacher after I came back to Taiwan. I feel like I have met many different people in the one month, and this was a very important experience for me. Montreal, Canada is no longer just another name on the map for me, but a place which I have bounded to by its culture and the local lifestyle. This is not what a normal vacation trip can offer, and is why this research exchange trip was definitely worth it.

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medical students worldwide | AM 2016, Mexico

August 2016

SCORE Congress

Discover The Scientist Inside You! Basak Sezgin

TurkMSIC - Turkey

As TurkMSIC, we are a very large NMO and we offer many of our students the chance to have “a life in a month”. What makes us a family this big is that we are very strong in numbers. There are a lot of medical schools from all over Turkey and they are all eager to be a part of IFMSA exchanges. However, every year a new generation of medical students join us and there are many medical students who are yet not familiar with this experience. So, we wanted to bring this astonishing experience to our students and we would encourage the students to participate in research exchange. This made the very foundation of “SCORE Congress”. Since 2011, we arrange SCORE Congress to introduce

research exchange to willing students and keep up the motivation of SCORE volunteers. Every year we develop our congress program to continue spreading the exchange spirit. The latest SCORE Congress happened in October 2015. Students who have been on a research exchange told the participants about their exchange period and this inspired curious students and encouraged them to participate. Academicians talked about what is a research exchange program in their point of view so the students would know better what is expected from them and be more qualified to participate in a scientific research. Training sessions were arranged to prepare the students for a smooth, productive and beneficial exchange period. Social programs related to an exchange period were held such as “National Foods and Drinks Party” where exchange participants presented their hosting country’s culture. I am the coordinator of SCORE Congress 2016 and this year we plan to add a panel with popular science magazines’ editors to our congress with the purpose of making our participants interiorize science and research spirit. With what we do, every year more and more curious students want to be a part of this unforgettable experience. They get motivated to join TurkMSIC SCORE and they contribute to improve research exchange in our country. That makes us a stronger and more motivated dark blue family and we keep making ourselves better and better. We are a group of people who don’t want to be just physicians, we want to become also the best scientists and SCORE Congress is where we gather to start following the path of science.



( M S I 34 )

My Experience in SCORE Erwin Barboza

IFMSA - Paraguay

Lao-Tzu once said that “the journey of a thousand miles begins with a single step.” Regarding my growth in and through IFMSA, I couldn’t agree any more: These are the steps of my journey. It hasn’t been more than 1 and a half years since I began working within my NMO (IFMSA-Paraguay), when we were just a handful of crazy medical students with a crazy dream: Let’s consolidate IFMSA in our country. Let’s be part of the solution, not part of the problem. It wasn’t until last year that I decided I wanted more than just to be around: I felt committed to cause an impact wherever I could. I went for the LORE position and I couldn’t be more grateful for getting the spot! I felt SCORE was all I ever dreamed of: The thrill of both the exchange and the research, the idea of giving students the opportunity to travel to so many countries, breaking cultural barriers, making students more aware of what’s in this world to know, see and do. Interestingly, it was the same year that our NMO became SCORE-active, so guess what: There were tons of work to do! I tried my best to accomplish as much as I could, but I have to be honest: It hit me like a truck. I found myself knocking every door just to be given the cold shoulder by department heads, academic directors, finding a million problems, telling me the program was possible but it needed way more than what they could offer. Bottomline: we had an established structure in our LC, but we lacked cooperation from the faculty.

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like no one wanted to take. They had reasons to, though. This term we receive our first bunch of incomings and we are sending our first group of Paraguayan students that will take part in the Research Exchange program. The work left undone was huge so it took some guts to get involved. But by the time I thought of all this I had already taken the leap of faith. Here I am now, a little under two months of our handover, writing this because I feel like my experiences will probably help and/or motivate someone who’s going through these hardships as an officer at any level, and from any Standing Committee. Some people in Paraguay keep saying that our idea of doing Research was too far-fetched, let alone a Research Exchange. But we are slowly shutting mouths. We keep having issues here and there but we are definitely going in the right direction. We won’t stop working, for all the med students who are to come.

With self-doubt about my capacity and leading skills, after such a horrible term as a LORE, I was pushed and motivated by many friends and fellow IFMSAians and SCOREans not to give up and not to just settle for the Local Officer spot once again. They thought I could go for the Co-NORE spot this term that seemed

medical students worldwide | AM 2016, Mexico

August 2016

Pre-Exchange Training 101 Xiya Ma


Congratulations! You just got selected for an IFMSA exchange! An amazing experience which promises to open your mind to scientific advancements and cultural diversity! You just need to hop in a plane and go... ... after your PET. A Pre-Exchange Training (or PET for short) is a training that is given in many National Member Organisations (NMOs) to their outgoing students before they leave for their exchange. While the format varies from a country to another, the purpose of this training is to properly prepare their students to the numerous cultural and logistical matters that they could encounter during their time abroad. Often given simultaneously to SCORE and SCOPE outgoings, it is also an important method by which SCORE (and SCOPE) ensures the quality of their exchanges by sending well-informed, culturally-sensitive students to enjoy their experience to the fullest. As an example, in my home NMO IFMSA-QuÊbec, the Pre-Exchange training gathers more than a hundred students from all medical faculties on a one-day training specially designed over the years to fit the students’ needs. We start with a brief introduction on IFMSA,

an explanation on how communication works and the contact information of our officers. We walk through the application process and remind them of how to send their card of confirmation (CC) or the documents they need before their departures. We also address the (very) complicated matters concerning visa or insurances and equip them with the resources they need to complete the formalities. This is all done in an interactive setting where we encourage them to share their experience to the rest of the participants. Then the fun part starts: discussing cultural differences and the importance of ethics abroad. Presentations get very heavy after a while, so here is when we decide to spark things up with energizers and interactive smallgroup discussions on their previous travel experiences, their expectations and their worries. We elaborate the topics of cultural iceberg, Hofstede cultural dimensions and cultural shock, a term to express the process of how one experiences the cultural differences of a foreign country, and how to manage it as it arises. Students will also share their motivations to go on an exchange and learn about the impact they could have on the host country. Finally, we wrap it up with the essential knowledge that they should know to ensure their health and security when travelling abroad. Of course, we cannot forget to ask their feedback about their day with us as it all comes to an end. While Pre-Departure trainings may be difficult to establish at first, we strongly believe it is of utmost importance for our students. For many of them, this will be their first experience beyond the country or their first integration within a foreign community, and we want them to be as prepared as possible. With that, we hope that all NMOs can implement this training in their programs and improve the quality of exchanges worldwide.



( M S I 34 )

New Experiences with SCORE Fernanda Bifano Soares IFMSA - Brazil

Since I first learned about IFMSA during my first semester in medicine, I was thrilled with the idea of the exchange program, of being able to get to know other countries through medicine. The main reason for that was the fact that I come from a developing country. Since my university does not have a promising research division where students can participate, I saw SCORE as the opportunity I could have to get in touch with that area. My first experience with SCORE was in September 2013, when I had just finished my first year in medical school. I took four planes and, after more than 24 hours of travelling, I arrived to Tromso, Norway.

It was a small city, but with a great medical school, a promising research department and a tutor that was very attentive. There, I could learn the basics on lab work. I experienced what it was like to work with sectioning, the basic staining process and immunohistochemistry, something I had only heard about but never actually seen it. In addition to the academic learning, I also got to know an entire different culture. I come from a country where everyone is very expansive and intense. There, I met people who were calm and extremely polite. I also got to see the polar environment and achieved my dream of seeing the northern lights. My second experience happened in February 2016, almost three years later, as I was starting my fourth year. This time, I went to Amsterdam in the Netherlands. It was a whole different experience than the first one. There, I learned every bit of how an Immuno-pulmonology Research Department worked. I did not work only in one project, but I followed how the whole process work, since how the material was collected, passing through lab work, finishing with trials with real patients. It was very productive because I could fill the gaps I had in the idea about how a research department and process worked. During my last week, we initiated a new research work, so I could go through that experience and help with that too. Amsterdam was also a beautiful city and I also had the chance of travelling to other cities and meet members of other Local Committees. SCORE actually changed my way of seeing medicine and the theoretical part of it. I can’t wait to travel again!

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medical students worldwide | AM 2016, Mexico

August 2016

SCORE & SCOPE Teamwork Larissa Lanzaro & Vítor Macedo

ANEM/PorMSIC - Portugal

Being PorMSIC’s NORE and NEO, we are the first ones to admit that the Standing Committee on Research Exchange (SCORE) and the Standing Committee on Professional Exchange (SCOPE) may have different visions, regulations or international teams. It’s a fact! However, it’s also true that they share the same object of work: exchanges! We all work on exchanges, love exchanges and live with exchanges. It’s our passion! So why not work together to achieve the same goals? A lot of times teamwork may not be the easiest, since constant communication and trust are essential. However, when the perfect symbiosis is achieved, you may conquer goals that you once found to be unreachable. In Portugal, we have one NEO and one NORE. Everything related to IFMSA exchanges programs is coordinated between the two of us. As of that, we managed to find a perfect balance between teamwork and professionalism. This collaboration was born since we have a lot of activities that must be organized by both committees! We will try to expose our experience on teamwork, by showing everything we’ve done, together, so far. First, we organize Pre-Exchange Trainings all over the country for our Outgoings. These trainings are

coordinated on a national level and then applied by Local Officers (LOs). By having these trainings on all of our medical schools, we guarantee that all of our students get the opportunity to develop their skills and get prepared for the month of their lives! We also don’t forget Incomings! Regarding Social Program, we offer three types. The first one is organized by us, National Coordinators, and consists in two weekends in July and two weekends in August on which incomings from all LCs come to Lisbon and Porto, so they can meet not only a new city, but also a huge amount of people. Next, we have local social programs, organized between LEOs and LOREs. Last but not least, the Couch Exchange, where Incomings from one LC can apply to be hosted by a Contact Person from a city other than the one he is doing his exchange. Besides social program, we also give our Incomings the opportunity to participate on the Upon Arrival Training (UAT) which is organized in all LCs, after a training session given to LOs by us. Since the beginning, we’ve already had some training sessions for our LOs, so they can work as one in order to give both programs’ students the best possible experience. Also, the promotion and enrollment process on exchanges work together - we have a common period, on which both departments work on publicize the IFMSA exchanges and on catching people’s attention to how amazing can an exchange be. We tried to show you how two different committees can work together in order to make the best out of their goals! In Portugal, we have different SCORE and SCOPE teams. However, we share one bigger team, one love, one goal. Exchanges bring us all together!



( M S I 34 )

Our Part in “Global Action” Basak Sinem Sezgin & Sibel Huet TurkMSIC - Turkey

When you think of an endemic disease, people tend to think of sub-equatorial countries where those types of diseases are thought to be preponderant, since in most people’s mind endemic is a synonym for tropical disease. They tend to limit those diseases to the ones caused for example by Zika virus or Chagas disease in South America, and also Malaria or African sleeping sickness in Africa. What most of us seem to ignore is that Europe is also a cradle of endemic diseases. We can cite Leishmaniasis with 3750 autochthonous cases reported in all southern countries of Europe.

Thalassemia. It is specifically seen in the Mediterranean Region in which the cities of Mersin and Adana are located. This year Turkey became the first country from European Region to send a GAP project to IFMSA SCORE. Our project “A new genetic biosensor design for detection of thalassemia” is given to us by Çukurova University in Adana. Incomings will have the opportunity to gain a lot of knowledge about thalassemia in theoretical lectures, collect patient blood samples on the field and help develop a new biosensor that would detect thalassemia in laboratory.

If we take the example of Turkey, it is a mine of endemic diseases. It is a country that groups a lot of them that are spread throughout Europe and Asia, due to its geographical position as a bridge between those two continents. Its history of being home to so many empires and civilizations thus making it a melting pot of nationalities, leads to people having very heterogeneous gene profiles.

It will be particularly interesting for those who probably didn’t or never will have the chance to study that disease in depth as the definition of endemic indicates the necessity of its regional specificity. It could provide the opportunity to learn something new, but also the opportunity to test and diagnose it on the field.

Apart from Leishmaniasis, Malaria, Goitre, one of the most known endemic diseases in Turkey is beta-

As TurkMSIC SCORE keeps working on new GAP projects, we invite you to learn a very wide range of endemic diseases in a country that will change your perspective to medicine, history and culture.

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medical students worldwide | AM 2016, Mexico

August 2016

Exchange Sessions

at EuRegMe Thessaloniki 2016

Alzbeta Tylová

IFMSA - Czech Republic

In April 2016 delegates from many European NMOs gathered in Greece, Thessaloniki for the XIII. European Regional Meeting, with the theme of Preventive Medicine. The exchange sessions were held together for both SCOPE and SCORE, prepared by our marvelous Regional Assistants with the support of a great session team. Around 50 participants consisting of NEOs, NOREs, LEOs, LOREs and exchange members met for 3 days to gain and exchange some knowledge, share their ideas and work on current issues over the exchanges standing committees. The agenda contained many parallel sessions including both beginners and advanced topics to mirror the different level of knowledge of the participants. We had the chance to take part in interesting workshops on Exchange Management, PDT/PET, UAT and Incomings, Academic Quality, Ethics within Exchanges, “Why we do what we do?” and SCOPE & SCORE collaboration. In the Small Working Groups we had the opportunity to talk about different aspects of exchange management like how to motivate and involve local officers, how to manage contact persons, how to set up NGA sessions, how European NMOs can collaborate in exchanges and more.

We also had two Standing Committee specific trainings delivered by the recently certified TNET trainers, Promotion of Exchanges and Sponsorship and Fundraising in Exchanges, as well as joint sessions with other SCs covering the trending topics of Global Health and Recognition.

The most interesting part of the sessions for me was “Sharing best practices”, an activity that started in the NEO/NORE weekend in Madrid earlier this year. The attending NMOs had a chance to introduce some of the practices they feel they are best at. We heard some interesting ideas about how to avoid late CAs, national language exam for outgoing selection, LEO/LORE weekend, online database for management of CPs and social program and others. During this time the NMOs also had a space to introduce their exchange program and give out some promotional goodies. Finally, I would like to thank the RAs Maud, Ester, Mery and all the session team members for their great work both before and during the meeting. They managed to deliver fruitful sessions to a broad audience of differently experienced people and cover all the topics in an interesting and interactive way.



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My Exchange in Germany Jang-Jier Tseng FMS - Taiwan

Thinking of the participation in the SCORE exchange project, I’ve received a lot of help from people around me, which made me grow step by step. Nearly two months overseas on my own gave me lots of chances to learn how to be independent and to take good care of myself. Furthermore, it provided me time to think about my life planning. Now, I finally have time to sit down and recall this memory, the memory full of gratitude. On the train to Bonn, the Cologne Bridge and the dark steeple made me think of the industrial revolution time in Europe. As the buildings went through, what came next was Rhine River and wind from the wheat field. As I stepped out of train, I saw my contact person, Stefan raising a board with my Chinese name on it. It was really surprising to me, and what surprised me more was the apartment that I was going to lodge in August. The first social program was held in the second night after my arrival, it was a celebration party in the Limo (a bar). The social program here in Germany is really different from that in Taiwan. In my opinion, I think that social program is like holding BBQ parties, going to bars on weekday; however the social program in Germany is a very flexible activity.

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The Unikilinikum of Bonn is on the top of a small hill. On my first day to work, I took the bus from city center to there. The bus went through half of Bonn. Though it is the capital of West Germany, it is still pretty different from the big cities. I think Bonn is more like a small town with leisure and casual atmosphere. Germans are really different from Taiwanese: they don’t work overtime. What’s more, they think of it rude to disturb people after work time. They grab every second during work time to finish their job and get off work on time. I’ve participated in two experiments in this month, Rubber Hand Illusion and TMS Coil Navigated By

fMRI. In Rubber Hand, we asked the volunteers to do a questionnaire about their self-sensitivity. Then we asked them to count seconds in their mind. By recording it, we got a comparison of reality and their self-sensitivity. Here comes the main point for this experiment. The volunteers were asked to put their left hand in the black box on their left side, putting on black long-sleeves t-shirt with a rubberhand and their right hand beneath the table pointing out where they think their middle finger is. The conductor used two brushes to brush the left hand and the rubber hand simultaneously or at different time for five minutes. What we wanted to observe was that the first time the volunteer thought that the conductor was brushing their left hand instead of the rubber hand. Volunteers were divided into two groups, one sniffing oxytocin and the other group sniffing raspberry or the sweat smell of men. Many paper that we collected pointed out that oxytocin have influence with intimation and some other positive emotions. Thus we want to know if oxytocin can affect self-sensitivity. TMS Coil is a therapy that psychiatry department use to treat depression. By giving a magnetic field to cerebral cortex, the brain will generate electric current and give electric shock. In our experiment, we use TMS Coil shock to control the cortex of right hand finger, thus giving out snapping action. In the previous experiment, the locating of the cortex was by trial and error. By using fMRI to build up a three-dimensional model of the brains of the volunteers we can make the experiment more accurate and more efficient. In both experiments, I’ve acted as the conductor and the volunteer. I also did the measuring, recording, and the analyzing of the data. Though I finally didn’t get the result of these two experiments, I still consider this a special experience. Thank you for those who provided me a lot of help during the exchange period.

medical students worldwide | AM 2016, Mexico

August 2016

How to be a LEO and a LORE Jahir David Parra del Ángel

IFMSA - Mexico

Here I am. I’m a 3rd year student in the Univesidad Veracruzana Campus Xalapa, and my name is David. I’m a Local Exchange Officer of my Local Committee: AMEXA, and the question you have is why am I writing about SCORE while being part of another Standing Committee? This is the story, it will be long but I’ll start. I joined the federation when I was a 1st year student and I joined DSP (Supportive Project Division for the acronym in Spanish) and then SCOPH but in the last year I became interested in International Exchanges, especially in SCOPE. In November last year I’ve been elected as a LEO, in that time I didn’t even know that SCORE exists, actually I was surprised when I noticed that SCORE exists and I started to have plans and projects with them. But there was a problem. We didn’t have a LORE, and as the second elections passed, SCORE was going to be closed in my Local Committee. So my LC president, the NORE, the LONE (Local Officer of National Exchange) of my LC and I decided to absorb the SCORE functions. I’ll act as LORE assistant until we find a permanent LORE.

In my case I had the advantage that I already knew how to use the database of SCORE (similar to the SCOPE one), and I started to get involved in SCORE. To tell you the truth I didn’t expect much about the job, for me it was like “SCOPE number 2”, but now I know that



I was wrong. SCORE and SCOPE are similar but not the same, for me it was hard to come to SCORE and have the LEO mentality, a lot of things were different. Only the database looked familiar for me, the other things were so new and it was difficult to learn them. As a LEO I have 19 places for medical students and I add also 8 new places from SCORE, so in the year we could receive 28 students. To be honest I expected only about two SCORE places. I panicked. But now I realize that being a LEO and a LORE is not so different and I enjoy them both. The experience I have working with SCOPE and SCORE is hard, and to separate the work between them was not easy at all. But I realized that SCOPE and SCORE can work together to get better results and to improve. I’m planning “Training for New Contact Persons”, an idea I had for SCOPE but I involved SCORE as well and this training will happen in the next days. To finish my story, I would like to say that even if I’m a LEO working with SCORE team, it has been a great experience. Now I know that their work sometimes is underappreciated but they deserved credit. In my LC, we will have new SCOPE/SCORE projects. Now I realize that I’m not a sky blue blood or a dark blue blood, I’m just a Blueblood ;) .

The SCORPion

The SCORPion will take you into the world of Human Rights and Peace, where you will find out about the numerous activities that everday SCORPions conduct on the local, national and international levels.

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from the SCORP Director Hana Awil Director on Human Rights & Peace

Dearest SCORP Family, Despite all human beings having RIGHTS that are inalienable, their rights are trampled on and disregarded on a daily basis. We are constantly observing a blatant disregard for human life with increasing inequality, political extremism and more forcibly displaced persons than ever before. HUMAN RIGHTS & PEACE are closely connected, intertwined into a net that allows us to take a leap forward to a brighter future, knowing that this safety net will catch us if we fall. To achieve PEACE, we must remind ourselves that our loyalties must transcend our ethnicity, religion, class and nationality. We need to develop a feeling of unity and belonging, we need a global perspective. IFMSA gives its members a possibility to create this global perspective. You and the rest of our members use your skills and knowledge to tackle issues that you encounter in the world, some of which you will be able to read about in the articles of this section. With that, I would like to welcome you to the section on Human Rights and Peace of MSI34! In addition, I would like to express my deepest appreciation to the individuals that have submitted articles, for the SCORP section of the MSI34. Always remember, we must never stay silent, while injustice surrounds us, slowly suffocating the very being that makes us human. Now, more than ever before, it is important that we stand up, speak up and take action. Yours, Hana Awil On behalf of the SCORP International Team

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medical students worldwide | AM 2016, Mexico

August 2016

Health: An Orphan Right Gusmaria Araujo

FEVESOCEM - Venezuela

Over the years we have been taught that the right to health is essential and basic, however in our changing world there are still countries or populations where this ‘RIGHT’ becomes PRIVILEGE. In countries such as where I live (VENEZUELA) health is in a corner, hidden in what we might call ‘Orphanage of Rights’, to be victims of violations and failure to observe people and entities around like an orphan more in this world.

drugs. 68% clinics have closed. 6 out of 10 hospitals are running in a state collapse. Public hospitals with 75% failure input, almost a total lack of medicines for cancer patients and cardiovascular diseases, which is the most common cause of deaths in our country have only added to the crisis. The scenario, on the whole, in Venezuela is extremely downcast. However, as responsible citizens of the country and most importantly, being SCORPions, we shall leave no stone unturned to reverse the health , just like adopting an orphan child to give it a better life. In this sense, SCORP-Venezuela will carry out activities or campaigns for Human Rights and Health like ‘Medical Care Days’, because although we have the ability to address the shortcomings of our health sector, we wish to provide knowledge and support to the population, medical students and health professionals, teaching them how to assert their rights and also assure them that they are not alone in this struggle. I am strongly of the opinion that the only battle lost is the one not fought. Finally, I would like to thank IFMSA, not only for being the muchneeded platform to voice our opinions and situation, but for also helping us in our endeavour through SCORP. As SCORPios, we believe that ‘a small act can make a big difference’ and we shall strive to the best of our abilities to achieve our goals and reverse the health sector scenario in our country.

According to the World Health Organization, “The enjoyment of the highest attainable standard of health that can be achieved is one of the fundamental rights of every human being”, but what is the right to health are we talking about? Is the appropriate, acceptable and affordable access to health care services of sufficient quality available to all? At least in Venezuela, we are scraping through the roughest patch in the health- sector area and are experiencing ‘humanitarian crisis in health’. There has been an absence of 65% of the essential



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Sharing is Caring Saad Chaibi & Yahya Boussebaa IFMSA - Morocco

The right to education has always been one of our priorities at IFMSA-Morocco, as we try to advocate for it the most we can. In fact, education is the pillar of every country and by promoting it, we promote the growth of the nation. Hence, it is our duty to help children get access to information and help them face academic problems that can lead to their failure. Sharing is caring is a mathematic teaching program for children between 9 to 12 years of age, from the orphanage of Dar El Moubdioun. The program is organized by the local committee of Rabat “Méd’Ociation” and would take place at local orphanages every Saturday. The idea flourished from one of our SCORP activities. It was a visit to the orphanage ‘Dar el Moubdioun’, where we organized multiple activities: sports, games, DIY and arts workshop, etc. The children were incredibly responsive and their joy knew no bounds. At the end of the day, we distributed cookies and chocolates, followed by a group photograph with the enthusiastic bunch of children. Overwhelmed with the response we got from the children, we decided to pay them weekly visits, which would also help them grow on an educational and personal level. At first, we got in touch with the

supervisors of the orphanage and requested them to give us a couple of hours every week to continue our activities and also allow us to use their material for the same. Five SCORPians volunteered to manage the first course. The hesitation stemming from inadequate formal training was overcome soon after we started. Their eagerness to learn and zealous inquisitiveness facilitated our efforts, eventually it came naturally to us. The joy we could observe on their faces on being able to resolve an operation, calculate the diameter of a circle, or simply nominate a geometric form was the most content we could have felt. But it couldn’t compare with our joy, to see those children getting more and more comfortable with us, and maybe take a step closer towards achieving their dreams.Their rising comfort, their inclination towards achieving their dreams gave us immense gratification. This endeavour of SCORPions is proof enough that Moroccan medical students are capable of activities that can improve the world bit by bit. We look forward to many such events in the future. All the achievement of our SCORPions show that Moroccan medical student can have extracurricular activities that help create a better world. It was one of the most satisfying projects we have ever done and we can not help but feel excited to repeat it next year.

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medical students worldwide | AM 2016, Mexico

August 2016

1% Sharing Project

A Step for Health Equality

Tae-Young Kim & Chiajan Wang KMSA - Korea

‘The 1% Sharing Project’, beginning in 2012 and is now celebrating its 5th year, is a project based on a belief that our 1% can be someone else’s 100%. Every year, a person who is in need of help is selected and is provided with a bit of donation by each medical school’s student council fee, by individual students, and also from different charity events held by KMSA-Korea. By these different donations, we are trying to promote our project.

do we help them economically so that they can receive the right treatment at the right time, but we also establish a mentor-mentee relationship so that they can have a positive attitude towards their treatment. This type of effort, starting in the medical community, must spread throughout different communities so that the equality of people’s right of health can be discussed as an important issue of the society.

The economic inequality of today’s society is harming many people’s right of health. The aim of ‘the 1% Sharing Project’ is to contribute to the world by claiming the right of health of the underprivileged ones. Not only

‘The 1% Sharing Project’ may be a motivation for medical students to share, donate, and serve. For medical students, it may be nothing more than just 1% but to someone else’s life, it may be a full 100%. This catch phrase establishes that sharing is something that anyone can do, and that my small effort may completely change someone else’s life. When medical students fulfill active sharing and if their sharing spreads to others, this ‘1% Sharing Project’ will be an efficacious project. There is a Korean Proverb, “Average doctors fix disease of body, skillful doctors fix the disease of minds, and the best doctors fix the society and the country.” Obviously, the primary standards of an excellent medical doctor is how well the doctor diagnoses and treats a disease. However, doctors also have the responsibility and is capable to make a healthier society, hence a better world. Therefore, as preliminary medical personnel, medical students must confront the issues of the society. ‘The 1% Sharing Project’ not only allows medical students to have an opportunity to help patients, but also to have a wider perspective on the society and its issues. Although ‘the 1% Sharing Project’ is leading many medical students to make contribution to the society, in order to motivate even more people, and to have a bigger impact on the society, it must be promoted by bigger and various different communities. To this day, we will work hard for ‘the 1% Sharing Project’ to be a project that not only medical students know, but a project that normal citizens are aware of.



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The Dangerous Route to Safety Jessica Zhang & Marián Sedlák

IFMSA-Sweden & SloMSA-Slovakia

“Migration is an expression of the human aspiration for dignity, safety and a better future. It is part of the social fabric, part of our very make-up as a human family,” said the Secretary-General of the United Nations, Ban Ki-Moon. Most people who migrate leave their country voluntarily. However, the number of persons displaced by war and conflict have been steadily increasing during the past few years, and has reached approximately 60 million during 2015. This is the highest level of displacement ever measured by the United Nations High Commissioner for Refugees . Being forcibly displaced is difficult. A majority of these people move to other parts of their home country, as internally displaced persons (IDPs). Out of those who do cross an international border, most stay in neighbouring countries. Turkey, Pakistan and Lebanon host the highest number of refugees in the world , and displaced populations face challenges such as lack of access to health care, security, education and career opportunities, both in camps and in urban areas. Furthermore, displaced persons seldom have the legal permission to travel between countries. Subsequently, the journey is often irregular and dangerous. According to the International Organization of Migration, around 5400 migrants lost their lives in 2015 , while searching for a safer future.

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IFMSA believes in international, intercultural as well as interpersonal solidarity. We believe that human rights apply to all humans regardless of where they live, their nationality, their religious belief, or any other factor, and that dignity, safety and the chance for a better future must be protected for one and all, regardless of their legal or migration status. With our Policy Statement on Asylum seekers and Refugees adopted earlier this year, we recognize the challenges existing within the current system, calling governments

as well as students to take action in order to improve the health and wellbeing of refugees. We often speak about vulnerable populations, raising awareness about the problems that they might face. Words can sometimes save lives, no doubt about that, but in these times, only words are not enough. We can ask ourselves: are we students able to do anything? Are we able to implement solutions? Are we able to make a change? As future healthcare workers, we have chosen a profession with the aim to help people and alleviate suffering. But also as students, we can take action. Through capacity building, advocacy and projects, IFMSA contributes to shaping the future of healthcare as well as humanitarian actions. We can affect healthcare professionals’ and students’ approach to migration and health, and contribute to their ability to appropriately address the health consequences of forced displacement. We work towards decision making and the general population to change policies, regulations and public opinion, and last but not least, we interact with concerned people, directly targeting their needs and talking with them – not only about them. We strongly encourage you to take part in these activities, or maybe even start your own because we all have the same rights, and we must protect them together. References 1. International Migration Organization (2016) 2. United Nations High Commissioner for Refugees, Mid-Year Trends 2015 http://www.unhcr. org/56701b969.html 3. United Nations High Commissioner for Refugees (2015)

medical students worldwide | AM 2016, Mexico

August 2016

Health as a Human Right

IFMSA Brazil’s Exchange Experience in Amazon Daniela Esteves Temporim & Marcello José Ferreira Silva

IFMSA - Brazil

In 1988 was promulgated the National Constitution which established health as a citizen’s right and State devoir. This legal commitment thrived with the creation of the Public healthcare system as it is today- the ‘S.U.S.’, structured by Universality, Equity and Integrality as principles, therefore, aiming to grant massive population, access to services and assets that should guarantee health in a whole and equitable way. However, concretion of the three virtues that substructure the SUS has proven itself at least challenging when taking into consideration State’s broad territorial dimensions and vast natural scenarios. How do we, thereby, enable SUS extension covering to Ribeirinho – riverside- families and to those who reside isolated by hundreds of kilometers from the closest family healthcare unit (E.S.F.) or city center? Intending to know the reality of the riverside inhabitants better, IFMSA Brazil, through its NMO national exchange programme, provided students the opportunity to take part in a Primary Healthcare Unit in a Ribeirinho community, responsible for 1300 families, in the sweeping Ponta de Pedras’ county, situated in Marajo’s archipelago- belonging to Pará’s province. According to researchers, the Ribeirinhos contribute demographically to Pará’s province with an amount of 40 thousand families- spread kilometers throughout rivers, igarapés- living, therefore, riverside, adjacent to streams and in thickets. Lacking company/piped water, there is disseminated fluvial dependency for simple daily activities such as cooking, taking showers, dish and clothes washing. The intimate relationship of this population with the water presents itself as an important direct and indirect cause for the most common diseases found in their scope. Recurrent amongst these women, bacterial vaginal discharge is consensually- for local health



result of the habit of wearing wet clothes for hours, whilst children are frequently bothered by parasitosis - Entamoeba histolytica, Giardia lamblia e Ascarides lumbricoides. Another fundamental concept when trying to understand the Ribeirinho’s picture is perceiving the extreme importance of unusual means of transportation. Canoes and boats are mandatory when it comes to moving alongside the streams, from their houses to the healthcare unit, school, market, church, neighbors, city center, other cities, and are, hence, essential for their living. Confronted with watercourse logistics and the economic condition, one should rapidly notice the impairment of Universality for the population living there. The gas/oil price comes into account as a major factor for these low income families which need to confront the long distance between their houses and the basic healthcare unit. The Family itinerant basically faces the waiting strategy with either recovery of the ill, spread of the disease to other members or until aggravation of the condition –betaking the river only in the last two outcomes- all justified for gas saving. Comprehend public health as a fundamental human right is to prosper in the concepts of health in its integral form, building up the human being in consonance with his peculiar way of life. For this reason, the experience with the ribeirinho community corroborates with the active quest commitment for the medical formation in agreement with the different people’s necessities.

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Invisible Ones

The Vulnerable Social Groups Hellen Meira Gois & Ana Elisa Carvalho IFMSA - Brazil

Vulnerable social groups are a minority who do not have equal access to universal goods and services, they suffer social, material and psychological exclusion. Social exclusion is constructed through a cycle of poverty which includes unemployment, violence, social injustice, social disqualification, educational inequality and precarious health maintenance. These groups are excluded from public policies, even the health related ones. Their health is worsened when we pair their difficult access to the health system with their miserable life style. The local committee IFMSA Brazil UFMT, through Atenção Integral a Grupos Sociais Vulneráveis project, intervened on two vulnerable social groups, due to local demand: street people, through clinical care and health promotion, and young offenders in fulfillment of socio-educational measures, through lectures on sexuality education, in Cuiabá. To intervene and track the main diseases prevalent among homeless people, such as hypertension, STDs, tuberculosis, leprosy, etc,the project members had two months for theoretical preparation. After 6 months, we gauged 6 intervention measures that could be taken with the street people. We educated them on the sexually transmitted diseases, the preventive measures, providing clinical care and mental health evaluation.

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Concerning to the teenagers, complementing their social educative measures, we discussed sexuality education. Such program intended to provide adequate knowledge about sexuality, allowing them to reintegrate society with a healthier sexual life. To evaluate their previous knowledge and the effectiveness of our action, it was applied a questionnaire before and after the activity.

As results of our project, we observed an academic integration among medical, nursing, psychology, public health and nutrition graduation students, besides health professionals, totalizing 46 members. The participants gained lots of knowledge through theoretical capacitation, but primarily health care was provided to the homeless. A total of 79 people were attended. It was observed, through a partial analysis of our data, the prevalence of: infectious diseases (16%), ophthalmologic problems (10%), dermatologic affections (10%), neuropsychiatric diseases (8%), chronic disease (7%), nutritional alterations (6%), allergy (5%), back pain (5%), physical trauma (5%), gastrointestinal disturbance (5%), headache (3%) and others (19%). During the intervention, 51% of the problems were solved. 25 young offenders participated of our action. Only 20% participants had adequate knowledge about sexual organs anatomy and physiology, presenting an improvement of 11.25% after the intervention. Regarding the knowledge about sexual acts and fecundation, there was an increase from 34% to 50%. Only 38% knew how to make an adequate intimal hygiene. Also, a better understanding of the social dimension in the lives of those who are homeless is needed.Our intervention was an ancillary measure, that did not answer all of its group’s demands. We expect that our data collection could help in the construction of specific health policies. Through lectures on sexual health, adolescents had the opportunity to solve their doubts on the same, however, to obtain a better impact on their consciousness about safe sex and others sexuality aspects, a longer intervention is necessary.

medical students worldwide | AM 2016, Mexico

August 2016

Read With Me

Literacy for a Better World Ricardo Regis & Sérgio da Cruz & Gilvaldo Silva Jr

IFMSA - Brazil

The International Literacy Day, date created by the UN and UNESCO, is celebrated on September 08 and aims to foster literacy in several countries. The importance of this date is remarkable, because there are 781 million adults who cannot read or write in the world, according to the latest UNESCO monitoring report 2013-2014. Unfortunately, Brazil is the eighth country in the world with the highest concentration of illiterates. Literacy is not just the process of learning to read and write. It is also one of the elements responsible for the development of a country. The right to have access to education and, consequently, to be literate, it is of all Brazilian citizens and should be required and stimulated. Thinking about it, members of IFMSA BRAZIL - Local Committee CESUPA, developed the campaign called “Leia Comigo”. The main objective of the campaign was to reinforce the importance of valorize the literacy, encouraging awareness and habit of reading of children and teachers from a public school in Belém (PA), in order to change the current reality. The campaign was divided into two stages: first, on September 17th 2015, was realized a setup meeting, with goals to explain how should be the approach on the campaign day and a brief explanation of child psychosocial development. On September 29th 2015, the campaign took place and was held on literacy and its needs in the current situation. The group had a little talk about learning techniques and which one is the most indicated for them. Finally, we performed a play for the kids. As a result, about 200 people were directly affected, including students from different age groups and school professionals such as teachers and the principal. During the event all involved have proved extremely attentive and interested into our exposition. We were also able



to create a propitious environment for the completion of the activities. That moment happened motivated not only by our group activities, but also by our individual conversation with the kids in order to hear their stories and encourage them, even more, to grub the world of imagination and reading. It is noteworthy, thought, the reality shock that was imposed on students who promoted the campaign. We were aware of the precarious situation of education in our country and specially in the state of Pará. However, we did not expect such a delicate level in literacy of students who, in theory, should have mastered certain skills. That view created in the group a strong feeling of making a project that can keep monitoring this segment of the population. Therefore, the campaign not only was helpful to children and education professionals to stimulate awareness of the importance of literacy and encourage reading, but also brought to the medical students greater knowledge about citizenship, social responsibility, and helped them to be humanistic health care professionals, as made them realized that, even with difficulties, it is possible to contribute to the stimulation of an inalienable right of society, the right to education. References • on_international_literacy_day/#.Vy5UCYQrLIV • h t t p : / / b r a s i l e s c o l a . u o l . c o m . b r / d a t a s comemorativas/dia-da-alfabetizacao.htm

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Women’s Health

Accomplishing Gender Equity Luiza Minussi DENEM - Brazil

During the 40s, a new conception of “being a woman” was brought to discussion by feminist thinkers such as Joan Scott and Simone de Beauvoir. This deeper conception of gender definition detaches the biological part (male and female) of the social constructions featuring a man and a woman. We start from the principle that a woman is a woman not only because of its genotype or because of phenotype; it is rather a complex interaction between biological, cultural factors, attitudes, interpersonal relationships, religion, attributes and roles. With the formation and development of this concept, the feminist movement view to the organization of society begins to change and we can then see the importance of specific social policies towards gender. Considering the performance of our social environment in a woman’s life and the concept of health, we can perceive during the 60s and 70s that attention to their health was always directed towards their biological and reproductive functions. This reductionist view has created a system where there is lack of a comprehensive approach to women’s health. We find the need to look into the health policies pertaining to the concept of gender equity. It aims to reduce unjust inequalities and have the ability to change. The intention is to reduce the inequality in the access to health, to make specific public policies created for each difference with specific preventive actions, seeking materials and medicines that meet this differentiated part of the population, causing women to have access to consistent services with their real needs. 152 153

In the 90s, most of the discussions worldwide on women’s health were boosted by the WHO, the high point being in 1993 at the International Conference on Human Rights, when the organisation declared that any practice violating women’s rights would

be considered as as violation of human rights.. In this concept, we include, for example, domestic and sexual violence. The following year, at the Cairo Conference (ICPD 1994), it was decided that all countries should commit to promote actions to guarantee sexual and reproductive rights of women. In this scenario, unsafe abortion was a major cause for increasing mortality rates and maternal morbidity worldwide. Banned or poorly regulated abortion led women to commit abortions in a clandestine scenario, often putting their lives at risk due to poor conditions. Therefore, in 1995 at the Beijing Conference, there was recommendation to review legal penalties for those women that proceeded with having an abortion. Neglecting the issue of abortion for a moment, even though this was an agenda topic relevant worldwide, Brazil, in 2003 during its 12th National Conference on Health recommended the offer to the health of the woman should begin to consider the specific needs of black women, lesbian, urban, rural, gender and indigenous professionals. Complementing the health care of women, though still limited to their reproductive rights, the conference said natural birth should be stimulated with access to analgesia and that access to caesarean section, when necessary, be guaranteed. All of this through the public health system (SUS), the program was called PNAISM (National Plan for Integral Attention to Women’s Health). Since all these advances in the development of the concept of gender and its role in the social determinants of health and disease for the women, we can highlight some key issues in health care pertaining to this group: First, women must be met at all levels of specificity, sheltered age and social environment (rural, urban, indigenous, prisoners, sex worker, hard to reach areas). Second, the reduction of maternal mortality should receive serious attention. Some social determinants medical students worldwide | AM 2016, Mexico

August 2016 affect this statistic such as rich woman, poor, black, and white, residing in rural or urban area. Third, differences in access to health and should be reduced, regardless of these factors, they should all get access to quality health services. Emphasizing that, in Brazil, the maternal mortality rate in black women is about 6 times higher than in white women. The decrease in these numbers involves providing access to prenatal care, ensure access to abortion in cases of unsafe pregnancy, childbirth care, puerperium, and risk pregnancies. Fourth, female specific illnesses should also receive attention. The prevention and control and cancers such as the cervical and breast should be encouraged. Fifth, attention to women in menopause. We know it is a period of many bodily changes for women, so medical care in this period is important for it to maintain its quality of life. Sixth, the working woman assistance. Last but not least, assistance to victims of domestic or sexual violence should receive attention towards their physical and mental health.

4. Brasil. Ministério da Saúde, Secretaria de políticas para as mulheres (Outubro 2014). PNAISM, monitoramento e acompanhamento da política nacional de atenção integral à saúde da mulher e do plano nacional de políticas para as mulheres PNPM. 5. Equity in law: a Brazilian health system’s principle? 1 Departamento de Saúde Coletiva, Faculdade de Medicina de Petrópolis e Curso de Nutrição da Faculdade Arthur Sá Earp Neto, rua Machado Fagundes 326, Cascatinha, 25716-000, Petrópolis, RJ. rabelais@ Cristina Maria Rabelais Duarte 1


6. AVILA, Rebeca Contrera; PORTES, Écio Antônio. A tríplice jornada de mulheres pobres na universidade pública: trabalho doméstico, trabalho remunerado e estudos. Rev. Estud. Fem., Florianópolis , v. 20, n. 3, p. 809-832, Dec. 2012 . Available from < scielo.php?script=sci_arttext&pid=S0104-026X20 12000300011&lng=en&nrm=iso>. access on 31 Mar. 2016.

1. Brasil. Ministério da Saúde, Secretaria de Gestão Estratégica e Participativa, Departamento de Apoio à Gestão Participativa e ao Controle Social. (2010a ). Saúde da mulher: um diálogo aberto e participativo. Brasília: Editora do Ministério da Saúde Recuperado em 04 de maio de 2011, de saude_da_mulher_um_dialogo_aber to_part.pdf.

7. CYFER, Ingrid. Afinal, o que é uma mulher? Simone de Beauvoir e “a questão do sujeito” na teoria crítica feminista. Lua Nova, São Paulo , n. 94, p. 41-77, Apr. 2015 . Available from <http://www.scielo. br/scielo.php?script=sci_arttext&pid=S010264452015000100003&lng=en&nrm=iso>. access on 31 Mar. 2016. http://dx.doi. org/10.1590/0102-64452015009400003.

2. TAMANINI, Marlene. 0 processo saúde/ doença das empregadas domesticas: gênero, trabalho e sofrimento. Revista de Ciências Humanas, Florianópolis, p. 49-69, jan. 2000. ISSN 2178-4582. Disponível em: <https:// view/25761/22560>. Acesso em: 31 mar. 2016. doi:

8. COSTA, Ana Maria. Participação social na conquista das políticas de saúde para mulheres no Brasil. Ciênc. saúde coletiva, Rio de Janeiro , v. 14, n. 4, p. 1073-1083, Aug. 2009 . Available from < arttext&pid=S1413-81232009000400014&ln g=en&nrm=iso>. access on 31 Mar. 2016.

Therefore, health policies related to women must be formulated, and renewed every time, according to the context of women’s needs and the historical period in which they live. Social movements must go refining their claims , which could help in the construction of attention to women’s health and, more than that, in improving their quality of life appropriate to their gender.

3. Organizacion Mundial de la Salud. Estudio multipais de la OMS sobre salud de la mujer y violência domestica – Primeros resultados sobre prevalência, eventos relativos a la salud y respuestas de las mujeres a ditcha violencia.



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Ethics’ Awareness Among Medical Students José Chen Xu

ANEM/PorMSIC - Portugal

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As future physicians we are driven by Global Health matters, such as economical issues, climate change and refugees. These affect deeply the Healthcare we are going to provide and the rights of our future patients. When addressing these matters, discussions tend to focus on the problems of the Healthcare system itself, the interventions made to tackle diseases and the impact on the quality of Healthcare services rather than the ethical concerns. And the latter are more important than it may seem at first.

This document is integrated in our +humanos project. It was built because we believe that Medical Education should not only be directed to the technical and scientific components but also to the development of humanistic features in healthcare professionals, in a patient centered healthcare. It intends to be a set of recommendations for students to consult before starting and even during their journey in the clinical setting.

An ethical approach may provide a broader idea, regarding cost-effectiveness issues, epidemiologic risks and even logistic concerns. However, it goes further as it also considers the equity of the distribution of resources, either a Procedural or Distributive Justice, as well as the impact of the intervention on minorities and vulnerable groups, affecting their access to healthcare and consequently the basic rights as well.

• Raising awareness for a more humane clinical practice, fully respectful of Human Rights;

So, in order to understand the values underlying the decisions and actions in health, we should get acquainted to Ethics, by implementing a seed in a familiar context and then extrapolate and make it grow outside its borders, creating a well structured background. That is why IFMSA’s motto “Think Globally, Act Locally” is still very current. Medical Students play a key role in these matters by improving themselves and developing critical thinking on Medical Ethics, whilst learning to be doctors. Therefore, we should be given tools to advocate for ethical issues and against violations of Human Rights.

• Providing and disseminating a document recognized by competent external entities and used in White Coat Ceremonies of each Portuguese Medical School;

Those were the thoughts that led to the development of PorMSIC’s National Ethical Code for Medical Students, with the purpose of creating a common code of conduct for all Portuguese Medical Schools, without prejudice to the existing Ethical Codes and bylaws previously implemented in these Educational Institutions.

This document was officially presented in 2015. It aims at:

• Informing students of patients’ rights and their duties towards them; • Raising awareness for the students’ sense of responsibility and knowledge of their limitations in the clinical practice;

• Developing critical thinking on Medical Ethics and Ethical Issues. This Ethical Code has been revised twice by Medical Students, the Bioethics Portuguese Association and also by the Portuguese Medical Council, leading to an improved and updated version. Thus, this document represents a precious tool to tackle the need for Ethics and Human Rights in our Medical curricula. We urge you to join us and develop Medical Ethics in your NMO as well, since there is always something we can do locally, to become caregivers aware of these issues and able to advocate for a more holistic Medicine. medical students worldwide | AM 2016, Mexico

August 2016

Celebrate Humanity Rujvee Pareshkumar Patel

MSAI - India

In today’s highly modernised world, the basic need of the hour seems to be humanity. Where we have ample of technology on one hand in the form of machines and gadgets, we seem be distanced from our roots- humanity. And this is the scenario almost everywhere in the world and not just limited within any geographical boundaries, but a global issue. In the race for money and success, we beings have remained less of humans now. The tapering humanity among humans has become an issue of concern these days.

The elderly age- group are taught about the ageing and the various diseases that are most common in the old age group. Also, awareness about human rights is given, depending on the age- group, such as child rights, women’s rights, rights of the elderly, etc. They share their grief, problems, and hardships they face, with us. We too provide them with medical assistance of any sort and personal counselling on a one on one basis. It is very aptly said that all we need is love, and we are more than happy to spread a smile and quintals of love.

I am extremely proud stating that SCORP-India has initiated a campaign called ‘Make the world smile’ campaign. Just as the name suggests, we make an effort to make the world smile; the teams of medical students go to orphanages, juvenile homes, shelter homes, old age homes and similar such places and talk to the people staying there, distribute appropriate gifts according to their needs, help them in every way we can and also educate the people regarding smaller medical based topics relevant to their age group. Personal hygiene, environmental cleanliness, food and nutrition is usually addressed for the younger age group. Adolescents are educated on reproductive health and hygiene, menstrual hygiene, common problems and disorders in puberty.

In our medical world, we have the Hippocratic oath, where we, the doctors of tomorrow, at the beginning of our medical careers, have to pledge to serve humanity, in all circumstances, without any kind of discrimination. We must abide by this pledge and serve humanity to the best of our abilities. Afterall, there is nothing more humanitarian than curing a person of his/her suffering.



Let’s make this world more human! Lets spread smiles, happiness, love and peace, And this world a better to live in!

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TRANSforming Medicine Kayo Silva Gustavo & Henrique Otavio Coutinho Sanches IFMSA - Brazil

According to the NGO Transgender Europe, Brazil is a leader in transgender homicides representing about 40% of hate crimes to these groups between 2008 and 2011. Moreover, according to the Brazilian Ministry of Health, sexual orientation and gender identity are factors recognized as constraints and determinants of health status for exposing GLBTT population (Gays, Lesbians, Bisexuals, Transvestites and Transsexuals) to injuries resulting from stigma, discrimination and social exclusion, making them vulnerable to drug addiction and STDs/HIV contraction. Therefore, it is essential to teach medical students (and other health professionals) to promote more humane and respectful host of Transvestites and Transsexuals on hospitals and other places of health care to achieve the permanence of these groups in the health system. Knowing the importance of this issue, local members of SCORP set up an intervention in the Institute of Health Sciences (ICS) in Belém, Brazil, between 4th and 7th of May, 2016, called “TRANSforming Medicine”. The purpose was to promote awareness of health professionals on the reality of public health for Transsexual and Transvestites through real testimonials group of patients, explaining the reasons that keep them from equal treatment and fair human rights. Over the days, several activities were carried out in the campaign. Transgender activists and health professionals with experience in the subject reported

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their personal experiences to sensitize students about the reality of Brazilian LGBTT Health. There were discussions on the subject and testimonials about the problems faced by transgender people in society and in health places, such as hospitals and clinics. Both men and transsexual women emphasized the importance of discussing this issue among medical students for the future, stop transphobia problems to the point where they are able to have access to health care in a dignified way and a quality of life that is rightfully theirs. Moreover, it was taught the concepts of gender, sexual orientation, biological sex and gender expression. On the second day, the students were able to answer their own doubts while watching instructional videos and discussing in groups about the action. Finally, a questionnaire was applied to 22 (of 45) medical students to measure the campaign’s effectiveness and the application in their academic life. Starting from the principle that knowledge is an important weapon against prejudice, “TRANSforming Medicine” was a campaign that aimed to promote the inclusion and the deconstruction of taboos, and ensures a fairer future care for a socially marginalized group in the health segment. After the campaign, we came to conclusion that the absences of medical/social education corroborate the maintenance of state neglect of the human right to health of non-binary populations. Actions such as “transforming medicine” are extremely necessary because of its immense potential to combat prejudice and discrimination by promoting a healthy and constructive debate. It is important to note that there is a hard way towards humanizing and medical awareness when it comes to culturally stigmatized populations, however, dialogue, compression, empowerment and compassion can facilitate this process, this fact engenders hope regarding future of medical services offered to this population. medical students worldwide | AM 2016, Mexico

August 2016

The Street Seller Bingsian Lin

FMS - Taiwan

Who are “street sellers”? The street sellers are social vulnerable groups who might’ve fallen down the social class ladder due to different kinds of reasons, selling simple items (usually tissue packs, bubble gums, or flowers ) on the street for a living. Rejected by the job market, they work hard over a long period of time under the scorching sun for merely a mouthful of bread. With an eye to know more about these street vendors and their lives at the bottom, students from four medical schools started up a mini-social experiment named “life on the street”, in which they experienced a day of such neglected people. Medical students are dressed as the street sellers and peddle on the street in order to find out how would the



society interact with them. We think that this in-person experience is critical to a better understanding of the street sellers. And it makes us think of what else we could do in order to improve their income or to help them. Those who might never draw our attention.

( M S I 34 )

Meet the Team of Officials 2015 - 2016

The Executive Board

Karim M. Abuzied President

Petar Kr. Velikov Vice-President for Activities

Kornelija Maceviciute Vice-President for External Affairs

Joakim Bergman Vice-President for Finance

Gustavo Fitas Manaia Vice-President for Capacity Building

Meggie Mwoka Vice-President for Members

Mustafa Ozan Alpay Vice-President for PR & Communication

The Regional Directors

Edward Appiah-Kubi Africa

Ignacia Alvarez Argaluza Americas

Farhan Mari Isa Asia Pacific

158 159 Ahmed Reda EMR

Diogo Silva Europe medical students worldwide | AM 2016, Mexico

August 2016

The Standing Committee Directors

Ying-Cing Chen SCOME-D

Omar Cherkaoui, SCOPE-D

Jozo Schmuch SCOPH-D

Carles Pericas Escalé SCORA-D

Koen Demaegd SCORE-D

Hana Awil SCORP-D

The Liaison Officers


Stijntje Dijk Medical Education issues

Skander Essafi Public Health issues

Michalina Drejza Sexual & Reproductive Health issues incl. HIV/AIDS

Karim M. Abdeltawab Human Rights & Peace issues

Marwa Daly Student Organizations

Marie Hauerslev World Health Organization


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Meet the Supervising Council 2015 - 2016

Camille Pelletier Vernooy

Diogo Martins

Salma M. H. Abdalla

Jonathan SchĂźtze

Steen Kare Fagerberg

Mike Kalmus-Eliasz

Wael Nasri


medical students worldwide | AM 2016, Mexico

August 2016

WHO Conference on Health & Climate

Visual Identity Photo Contest Results

Benjamin Magyar - swimsa Switzerland

Safya Danneni - Medsin UK

The picture shows a small family of four on a simple cheap motorbike on the island Phu Quoc in Vietnam. The mother is wearing a mask to protect herself against the present airpollution. Where as the husband and the children are not wearing any masks. The children, as a vulnerable group are exposed. A Family as smallest member of a community was representing my impressions of Vietnam: Young people trying to make a living.

Women carrying out their daily routine collecting water in a rural village in Jamkhed, India during one of the worst droughts in decades. (February 2016)

Location: Phu Quoc, Vietnam

In the background you can see the ocean and a boat. The situation was absurd, because the machines of one boat were not working and the other boat was trying to help. Also the boat and the motorbike had no catalysator and both were severly smoking black air. This is currently not in the picture.

Madhurima Maity - MSA India Location: Delhi, India

The CNG(Compressed Natural Gas) run auto rickshaws in Delhi (the most polluted Indian city) were introduced by the Delhi government as a measure to reduce air pollution.



Location: India

In the face of one of one the worst droughts in the state of Maharashtra India, female village health workers in Jamkhed, who act as health advocates for their respective villages, have worked with The Comprehensive Rural Health Project to secure water management tools such as hand pumps in their own villages as well as innovative practice for agricultural irrigation. Not only is water a basic necessity in a domestic context for drinking, sanitation and cooking but also an essential part of income generation in this agricultural community. The drought, and the subsequent failing crops have also taken a particular toll on the mental health of farmers who are often deep in a cycle debt after buying genetically modified seeds from large corporations such as Monsanto. Farmer suicide represents a mental health crisis in India with staggering estimates of one farmer committing suicide every thirty minutes according to researchers from the Center for Human Rights and Global Justice at New York University. In light of this the Comprehensive Rural Health Project is not only supporting farmers by implementing water management techniques such as watershed management and drip irrigation but also a Farmer’s Club which is an inclusive community that also address the mental health needs of farmers.

Algeria (Le Souk)

Georgia (GMSA)

Oman (SQU-MSG)

Argentina (IFMSA-Argentina)

Germany (BVMD)

Pakistan (IFMSA-Pakistan)

Armenia (AMSP)

Ghana (FGMSA)

Palestine (IFMSA-Palestine)

Australia (AMSA)

Greece (HelMSIC)

Panama (IFMSA-Panama)

Austria (AMSA)

Grenada (IFMSA-Grenada)

Paraguay (IFMSA-Paraguay)

Azerbaijan (AzerMDS)

Guatemala (ASOCEM)

Peru (APEMH)

Bangladesh (BMSS)

Guinea (AEM)

Peru (IFMSA-Peru)

Belgium (BeMSA)

Guyana (GuMSA)

Philippines (AMSA-Philippines)

Benin (AEMB)

Haiti (AHEM)

Poland (IFMSA-Poland)

Bolivia (IFMSA-Bolivia)

Honduras (ASEM)

Portugal (PorMSIC)

Bosnia and Herzegovina (BoHeMSA)

Hungary (HuMSIRC)

Romania (FASMR)

Bosnia and Herzegovina - Rep.

Iceland (IMSIC)

Russian Federation (HCCM)

of Srpska (SaMSIC)

India (MSAI)

Rwanda (MEDSAR)

Brazil (DENEM)

Indonesia (CIMSA-ISMKI)

Serbia (IFMSA-Serbia)

Brazil (IFMSA-Brazil)

Iran (IMSA)

Sierra Leone (SLEMSA)

Bulgaria (AMSB)

Iraq (IFMSA-Iraq)

Singapore (AMSA-Singapore)

Burkina Faso (AEM)

Ireland (AMSI)

Slovakia (SloMSA)

Burundi (ABEM)

Israel (FIMS)

Slovenia (SloMSIC)

Canada (CFMS)

Italy (SISM)

South Africa (SAMSA)

Canada-Quebec (IFMSA-Quebec)

Jamaica (JAMSA)

Spain (IFMSA-Spain)

Catalonia - Spain (AECS)

Japan (IFMSA-Japan)

Sudan (MedSIN-Sudan)

Chile (IFMSA-Chile)

Jordan (IFMSA-Jo)

Sweden (IFMSA-Sweden)

China (IFMSA-China)

Kazakhstan (KazMSA)

Switzerland (SwiMSA)

China-Hong Kong (AMSAHK)

Kenya (MSAKE)

Taiwan (FMS-Taiwan)

Colombia (ASCEMCOL)

Korea (KMSA)

Tatarstan-Russia (TaMSA-Tatarstan)

Congo, Democratic Republic

Kuwait (KuMSA)

Tanzania (TAMSA)

of (MSA-DRC)

Kurdistan - Iraq (IFMSA-Kurdistan/Iraq)

Thailand (IFMSA-Thailand)

Costa Rica (ACEM)

Latvia (LaMSA-Latvia)

The Former Yoguslav Republic

Croatia (CroMSIC)

Lebanon (LeMSIC)

of Macedonia (MMSA-Macedonia)

Cyprus (CyMSA)

Libya (LMSA)

The Netherlands (IFMSA-NL)

Czech Republica (IFMSA-CZ)

Lithuania (LiMSA)


Denmark (IMCC)

Luxembourg (ALEM)

Turkey (TurkMSIC)

Dominican Republic (ODEM)

Mali (APS)

Uganda (FUMSA)

Ecuador (AEMPPI)

Malta (MMSA)

Ukraine (UMSA)

Egypt (IFMSA-Egypt)

Mexico (IFMSA-Mexico)

United Arab Emirates (EMSS)

El Salvador (IFMSA-El Salvador)

Moldova (ASRM)

United Kingdom of Great Britain

Estonia (EstMSA)

Mongolia (MMLA)

& Northern Ireland (Medsin-UK)

Ethiopia (EMSA)

Montenegro (MoMSIC-Montenegro)

United States of America (AMSA-USA)

Fiji (FJMSA)

Morocco (IFMSA-Morocco)

Uruguay (IFMSA-Uruguay)

Finland (FiMSIC)

Namibia (MESANA)

Venezuela (FEVESOCEM)

France (ANEMF)

Nepal (NMSS)

Zambia (ZAMSA)

Gambia (UniGaMSA)

New Zealand (NZMSA)

Zimbabwe (ZIMSA)

Nigeria (NiMSA) Norway (NMSA)

medical students worldwide