PeriSCOPE March2012

PeriSCOPE

Official magazine of the Standing Committee on Professional Exchange

IFMSA

The mission of IFMSA

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

is to offer future physicians a comprehensive introduction to global health issues. Through our programs and opportunities, we develop culturally sensitive students of medicine, intent on influencing the transnational inequalities that shape the health of our planet.

Imprint Editors in Chief

Yassin Almassy, Norway MarĂ­a Aroca, Spain (Catalonia)

Design/Layout Omar H. Safa, Egypt

Proofreading

Mohamed Hussein, Sudan

Special thanks to

Marianne Koch, Austria Farhood Farid, Netherlands IFMSA Publications Team

Publisher

International Federation of Medical Students` Associations General Secretariat: IFMSA c/o WMA B.P. 63 01212 Ferney-Voltaire, France Phone: +33 450 404 759 Fax : +33 450 405 937 Email : gs@ifmsa.org Homepage : www.ifmsa.org Contacts : publications@ifmsa.org Printed in Ghana

Contents ifmsa.org

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Editorial

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This time for Africa

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African Regional Meeting

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Sub Regional Training in the Netherlands

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International medicine

Words from the Editors in Chief

or why a postcard sent from Palestine will never reach Beirut

Held from Dec. 18th to 23rd 2011 in Nairobi, Kenya

Can you SRT?

A Zambian Perspective

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Pediatrics in the Island of Spices

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Neurosurgery in Tatarstan

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Unforgettable Clerkship

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Melting pot

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With love from the Middle East

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The Health Burden of Climate Change: A Nigerian Spotlight

From Croatia to Grenada

From San Salvador to Kazan, Tatarstan Republic, Russian Federation

IN KRUNGTHEPMAHANAKHONBOWONRATTANAKOS (...): BANGKOK

@ Nephrology Department, Odense Universitet Hospital

or why a postcard sent from Palestine will never reach Beirut

Doctors for Humankind Foundation (DHF) reviews a physician’s local experience of the increased global climate change-related health burden.

PeriSCOPE - Edition 5, March 2012

ifmsa.org

This time for Africa.

Editorial

We have devoted this PeriSCOPE edition to Africa. This time we turn towards Africa to give us inputs to move forward this family and the core values to less accesible corners of the world.

IFMSA is holding its’ 61st March Meeting, and the SCOPE family is this time gathered in Ghana, the land of Gold. It’s not only a golden opportunitiy to understand Africa standing with the feet on African on soil. Nevertheless it’s a great chance to strengthen our relations to our family members in Africa. This time we all have a uniqe chance to reflect on some of the activities and love created between the huge variety of African SCOPEans. We expand each year - as a family normally does, making the family tree even more widespread. SCOPE is at the heart of the core values of IFMSA since we kicked off the IFMSA and started the project of creating the largest students’ exchange program in the world run by and for students.

Both of have, and one of is still in the NEO position, and we know what it means to be in a GA. We want to remind you all how muh efforts that are put together to organize and run these meetings.

It says something about how strong the friendships are, and what these connections mean to us. Many of us skip classes to join this extended family. We are all filled with joy and excitement when we get to the GA meetings, and get together in SCOPE mood. Why? Simply because we’re medicals without borders and we’re making history!

Looking 60 years, and thinking of how our founding fathers were able to put up an exchange program is amazing. Especially having in mind that they defied the Cold War atmosphere with strong regulations on freedom of movement. Each year we move every stone possible to overcome the boundaries and obstacles between the countries, nations and cultures. It’s amazing to see the powerful message that lies in exchanges and the outcome of what SCOPE is like today. It’s all about passion to a goal of interacting and learning from each other and broadening our horizon. So with history as background, let’s move forward with the same passion in mind. Medicine and the life as doctor doesn’t not have any boundaries - the recent pandemies and extreme weather events have shown us that. Working to give future medical students a chance to work in a

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global healthcare environment through exchanging, is what makes SCOPE fascinating.

Let’s spread the joy and the good vibes that SCOPE creates, and do not forget the fantastic unforgettable moments the SCOPE meetings gives us each year.

The African Regional Meeting took place in Dec. 2011 in Nairobi, Kenya. We’re happy that David, the RC for Africa, is sharing some of the reflections and thoughts from this meeting. There’s no doubt;new NMOs are joining the SCOPE and the our family in Africa is rising. Nyuma Mbewe, a medical student from Zambia participated the ARM and she shares an interesting African perspective on international medicine.

Our SCOPE Director gives some reflections on her amazing and unique journey to Middle East.

She attempts to understand the everyday life realities on the ground. We share with you stories written by students in search of combining traveling, applying their medical knowledge in new environments, making friends, sharing cultures and enjoying the fruitful cooperation that the exchange program creates. There’s much more fun to read. Have a look your self :) As new editors we look upon the PeriSCOPE as an important tool in promoting the SCOPE life and adventures to the broad audience of IFMSA members and externals. Nevertheless it’s important for us to bring in perspectives from related IFMSA topics and projects. In this edition we approach a Nigerian doctor at the Durban Climate Conference and gets his interesting views in: The Health Burden of Climate Change: A Nigerian Spotlight.

We hope you enjoy reading this edition and we would like to thank all the contributors that shared their wonderful stories and photos with us. Take a moment, experience SCOPE with our magazine, and don’t forget to spread the word! We are eager to hear your comments and suggestions.

Be the change you want to see.

- M. Ghandi Yassin Almassy & María Aroca Editors in Chief

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Standing Committee on Professional Exchange

This time for Africa!

Word of the Director of Professional Exchange Marianne Koch, IFMSA SCOPE Director 2011-2012

Dear SCOPEans and all medical students worldwide, I am more than happy to present you the most recent issue of our official SCOPE publication. The editorial team was investing a great amount of energy and creativity in order to provide you with a deeper insight and a virtual travel in the world of SCOPE. While reading this edition you will be able to join the authors on their journeys to different countries on almost all continents- from Grenada to Thailand, from Egypt to Tartastan, and from Sudan to Denmark.

You will get an impression of the differences of health care systems around this world and the chance to experience cultural diversity through multiple perspectives.

Moreover, this periSCOPE is crossing borders in a different way and exploring other topics despite the Exchange Program- such as climate change effects, medical missions in Sudan, a tour through Zambia and relationships in the Middle East.

more African countries to the SCOPE in the near future.

Lastly, I would like to thank the co- editors in chief, MarĂ­a Aroca and Yassin Almassy, and also Farhood Mojtahedi, Support Division Coordinator on Marketing, who made this periSCOPE possible and who did an amazing job!

Big thanks as well to all authors who contributed to this edition and of course to all of you who are making the Exchange Program run each and every day!

I wish you a pleasant reading experience,

Marianne Koch Director of the Standing Committee on Professional Exchange

In this issue we are putting the focus on the African continent- not only because the March Meeting is held in Ghana, but also because this year is dedicated to support the African region in IFMSA and in SCOPE. The African Regional Meeting in Kenya has shown that there is a lot of potential and motivation, and we hope to be able to welcome

PeriSCOPE is an IFMSA publication Š Portions of PeriSCOPE may be reproduced for non political, and non profit purposes mentioning the source provided.

Notice: Every care has been taken in the preparation of these articles. Nevertheless, errors cannot always be avoided. IFMSA cannot accept any responsibility for any liability. The opinions expressed in this PeriSCOPE are those of the authors and do not necessarily reflect the views of IFMSA. Some of the photos and graphics used are property of their authors. We have taken every consideration not to violate their rights.

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Marianne Koch is the current IFMSA Director of Professional Exchange, and living in Vienna, Austria

PeriSCOPE - Edition 5, March 2012

African Regional Meeting Held from Dec. 18th to 23rd 2011 in Nairobi, Kenya

By David Ekow Arku, Ghana

David Ekow Arku National Exchange Officer in Ghana and SCOPE Regional Assistant for Africa

In SCOPE in Africa is a rising star that will soon outshine many other regions..Currently in IFMSA, there are 11 African countries: Ghana, Sudan, Ethiopia, Nigeria, Kenya, Rwanda, Burundi, Burkina Faso, Uganda, Tanzania and Mozambique out of which 5 are SCOPE active: Ghana, Sudan, Rwanda, Ethiopia and Mozambique.

Africa is unique for its tropical diseases, friendly people and flamboyant social programs. Tropical diseases which are rare in European countries are present in abundance with patients who are easily accessible for history taking and examination and Doctors who are always ready to teach exchange students. Everywhere in Africa foreigners are welcomed with open arms and treated even far better than the indigenous people. Social programs in Africa are perhaps the best in the world, with activities differing according to the culture but across the continent they spell one word-FUN!!

Despite all these wonderful aspects of the exchange program in Africa, there have difficulties in setting up SCOPE in many NMOs due to several problems that arise. The African Regional Meeting held in Nairobi, Kenya from December 18th to 23rd,2011 was for the purpose of detecting such problems and finding solutions to them. The four outstanding problems that were discussed were: Fundraising, Apathy/Motivation, Hospital Administration and Setting up SCOPE. SWGs were formed and these problems thoroughly discussed and wonderful solutions found.

The African Regional Meeting!- what else can I say except that it was absolutely FANTASTIC!..But I’m not here to talk about the crazy parties or the exciting Safari; I’m here to talk about the amazing sessions that were held with the wonderful outcomes

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that it yielded. The SCOPE sessions were held together with SCORE sessions and facilitated by our amazing SCOPE-D, Marianne Koch, the Regional Assistant for SCORE, Delali Blood-Dzraku and yours truly, David Ekow Arku, Regional Assistant for SCOPE. There were participants from Nigeria, Kenya, Tanzania, Burundi, Zambia and Ethiopia.

For 4 days there were discussions on team building, the terminologies of SCOPE, the structure of SCOPE,exchange conditions, social program etc and the SCOPEans walked away with a wealth of information as well as many documents compiled into a digital package to help them either set up SCOPE or make their SCOPE even better.

The way forward…….The March Meeting being held in Accra, Ghana is a great opportunity for African NEOs and SCOPEans to meet once again to continue building on the progress made at the ARM. The buddy system was discussed at the ARM-A system where experienced NEOs will tutor less experienced NEOs and show them all the tips and tricks to making SCOPE excellent. At the March Meeting this system will be implemented and as NEO of Ghana I welcome all NEOs and SCOPEans from all over Africa to come and learn from our SCOPE. This is the year of Africa and I’m confident that at the August Meeting in Dubai, many more African NMOs will be at the contracts fair, starting on a road that will soon see SCOPE in Africa standing at the same level as any other region.

Watch out for AFRICA

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Standing Committee on Professional Exchange

Sub Regional Training in the Netherlands Can you SRT? Nienke van Andel

One weekend, 50 participants and 23 National Member Organizations. One weekend, 9 trainers.

One weekend, 10 trainings and 5 workshops. One weekend, SRT IFMSA-the Netherlands.

SRT stands for SubRegional Training and is a four-day regional trainings event for LEOs and LOREs. An SRT is one of the easiest accessible meetings for LEOs and LOREs and allows them to meet fellow LEOs and LOREs from outer NMOs. An SRT is the perfect opportunity to get in touch with the ‘I’ from IFMSA, it is the perfect opportunity for networking and it is a perfect opportunity to share experiences and knowledge.

The SRT in the Netherlands took place from the 24th up and till the 27th of November, in a very small place called Broek. Stereotypically the Netherlands is associated with drugs and Amsterdam’s red light

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district. This time, we decided to show you another side of our lovely country. We showed you our beautiful country side and we showed you our capacity.

Ten trainings have been organized by nine amazing trainers. We had academic quality, creativity, rhetorics, marketing, emotional intelligence, leadership development and body language, presentation skills, teambuilding, facilitation and open space trainings. The trainings were divided into two different levels, intermediate and advanced, so that everyone’s needs and expectations were met.

Next to the trainings we had three Small Working Groups focussing on evidence based SCOPE, improving SCOPE and developing SCORE. All three of the Small Working Groups provided us with extremely useful outcomes and will help us to make our Standing Committee more successful, professional and notorious.

Besides trainings and Small Working Groups there also was a lecture focussing on the developments in the Dutch health care system and hospital management.

In conclusion all I can say is that it was a fantastic SRT. I would like to take this opportunity to once again thank everyone who attended and contributed to this SRT, it has been an amazing experience!

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Nienke van Andel National Exchange Officer on incoming students IFMSA-NL SCOPE Support Division Coordinator on Capacity Building

PeriSCOPE - Edition 5, March 2012

International medicine A Zambian Perspective

By Nyuma Mbewe, participant at African Regional Meeting

I had heard of IFMSA before, but my first real taste of the organization was at the 2011 African Regional meeting in Nairobi. There, I got to participate in the SCOPE/SCORE sessions which had the primary focus of introducing more African countries to the professional exchange.

Coming from Zambia, a country still vying for membership into the IFMSA, the whole concept of Professional Exchanges was somewhat new. I guess I could liken it to the clinical elective attachments that we are allowed to do in our senior years.

A handful of students have the opportunity to go abroad to do their electives, but the vast majority does their elective at some of the rural mission hospitals and health centers across the country. There is always something new, something different to learn from the rural clinical experience. Away from the amenities of modern medicine; it’s interesting to see the interventions and “Mc-Guiver” tactics used to ensure the best patient care possible in limited health settings.

So as I sat there during the sessions, my thoughts would often drift to the possibilities that could be availed to a Zambian medical student once part of SCOPE. A clinical exchange with countries in the West would mean a chance to experience medicine where most tests are readily available and the patients could easily afford them; basically where medicine would be practiced as in the textbook.

Perusing through the 60th Anniversary edition of Periscope, I couldn’t agree more with the words of Dr. Henrick Wulff, from Denmark. According to him, “A medical doctor who has no personal experi-

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ence with medicine in other countries is simply a badly trained doctor.” To me, the allure ofSCOPE is that of the academic and clinical experience that would be gained regardless of the destination.

Moreover, the globalized world demands such experience of what I like to call ‘International Medicine.’

I smiled to myself as I thought; ‘SCOPE is almost like a student version of Doctors without BordersMedical Students without Borders.’ The cherry at the top of the ‘International Medicine’ cake is the savor of a new culture and the making of new friends.

And so, on the sessions went; each day more exciting than the last. We had a mock Contract Fair which was an absolute riot. The directors challenged us to think of what we would say to convince other NEOs to send their students our way. For one thing; if the information I gleaned from watching countless seasons of Dr. House MD is anything to go by; medicine in Zambia is more focused on the clinical diagnosis as opposed to investigations.

Emphasis is placed on the obtaining an excellent History and Examination. In the larger centers many of the modern investigations are available but too often the patients cannot afford it. So delays in diagnosis would exist as you await interventions from the social workers.

The exaggerated doctor patient ratio all over the country means that students are allowed a more hands on approach to patient care; of course under the close supervision of the watchful consultants.

Once in a while, undergraduates are even allowed to assist in theatre during major operations.

Traditionally the majority of cases seen in Zambia are those of tropical medicine and infectious diseases. The advent of HIV/AIDS has complicated many cases and put a strain on the health sector as a whole. Add to that, the improving economic status of the country, and the shift towards globalization, have led to a rise in the incidence of conditions such as Diabetes, Hypertension, Cancers and Mental illnesses. All in all, this has resulted in the double disease burden of both Communicable and NonCommunicable diseases.

However, in spite of all these challenges, medicine in Zambia is fast evolving everyday. Political will,

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on the part of the government, is working towards better health care for all Zambians with an emphasis on public health awareness and preventative measures; not to mention our First Lady is a fully trained medical doctor and our President a former Minister of Health. Donor funding has helped secure vital diagnostic tools at all the major health centers and referral hospitals. The recent introduction of two new medical schools, in addition in the well established University of Zambia School of Medicine, means the training of more medical doctors to aim at combating the health problems in the country.

The good news is that, all these efforts seem to be working. One example is the success in retarding the HIV/AIDS incidence from almost 17% in 2007 to 13.5% in 2009. Medicine in Zambia is about passion and innovation, always with the care of the patient at heart. And more than just on the academic fronts, Zambians generally are friendly people. What more proof would you need than the fact that one of the teaching hospitals is located in Ndola – also known as the Friendly City. As Zambians, we know how to have a good time, and to ensure our guests are doing likewise. And no trip to Zambia would be complete without a visit to the Victoria Falls, one of the Seven Natural Wonders of the World.

I left the sessions feeling excited at the limitless possibilities and doors that would be opened should Zambia become an active member in SCOPE. On the other hand I felt challenged by the mammoth task that lay before us to ensure that this could happen in the near future. With my graduation from med school fast approaching, in less than 18months, I know that the first Zambian exchanges will happen after I am gone. However, the prospect of being part of the team that lays the foundation for Zambian exchanges is one I do not take lightly. In fact, what better way to shout out our motto “Better Doctors for Tomorrow” than to leave my juniors with a healthy dose of ‘International Medicine’!

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PeriSCOPE - Edition 5, March 2012

Pediatrics in the Island of Spices From Croatia to Grenada Maja Ilic, Croatia

Maja Ilic, is a 5th year medical student at the Medical school in Zagreb, Croatia

Before I start writing about the most exciting adventure of my life, please allow me to introduce myself in a few words. My name is Maja Ilic, I’m fifth year student at the Medical school in Zagreb, Croatia and I’m the first student that had ever taken part in proffesional exchange program in Grenada .

Without any false modesty I can say that last summer was the best summer in my life. Why? You’ll find out when you read my article.

I have to admit that before my applaying for exchange programme I had never heard for Grenada.

After I „googled“ and found out that Grenada is one of the exotic and beautiful Caribbean islands there was no doubt I would apply for it. Before that journey I had never been out of Europe so this was a great opportunity for me to make some decisive steps in my life and to become familiar with one new, attractive and unexplored culture.

My adventure started August 5th when I took a flight from Ljubljana to London. From there the flight was continued to Barbados next 9 hours, and from Barbados with delay of 3 or 4 hours to Grenada with Caribbean airline- Liat. In my way back home I found out that frequently fliers like to call the company „Liar“ because of their annoyance with this constant problem. After landing in Grenada, tough tropical air wellcomed me together with a lot of taxi drivers. Each of them already knew where to drive me even before I told them, because St. George’s university is the only campus on the whole island. My footstep buddy placed me in a student dorm right on the one of the most beautiful beaches of the world- Grand Anse. I have to addmit that fall asleep with the sound of waves was one of the greatest privileges I had there. First days of my stay in St. Georges, the capital, was the Carnival going on–an important cultural event for both the Grenadians and the turists. It is a great parade with beautifully colored costumes, live bands,beauty contests and other competitions. Carnival also includes a middle-of-the-night juvé parade that ends at sunrise. The symbolism of this parade is cleansing the island of sins and bad luck.

I decided to spend my four weeks of exchange program at the Pediatric ward in Grenada General Hospital because I like working with children.

On my first day I asked the doctors on the ward to help me with taking Pediatric history of disease

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and physical examination so I can be sure how to do it alone because I hadn’t had classes in Paediatrics yet. All doctors on the ward were really helpful and friendly.

Difference between current practice in the hospital as a full-student and as the exchange student is that here you becoming a part of the doctors’ team, doing real work and putting your signature on something you wrote with responsibility. Every day I would come to the hospital before rounds to note the clinical progress of one of the patients from the ward. After that I would go on rounds together with all the doctors. If there was some interesting case I would read about it and discuss it the day after with the doctors. I saw patients with some diseases that are not so frequent in Croatia, such as sickle cell anemia, or Dengue fever. I also noted some epidemiological facts as a lot of children are hospitalized with asthma. I tried to compare immunization calendar in Croatia and in Grenada. I also spent some time every day on department of neonatology acquiring experience in this field of medicine. I was helping in collecting infant’s blood, writing the physical examination of newborns and was present

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know what they are doing and of all the things I learned there,what I’ll try to apply the most is their humanity, compassion, respect for patient privacy and professionalism.

at delivery.

I also noted that there are a lot of teenage pregnancies and a lot of sexually transmitted diseases at this obstetrics-neonatology ward. Comparing with hospitals that I’m accustomed to in Croatia, this one is small and diagnosis is based on basic clinical skills because there are no MRI, CT or other more complex tests on the island. All charts are handwritten and it is a little chaotic to find everything what you need especially on the ward where two different teams work and use the same charts, as in obstetricsneonatology. Doctors are very professional, they

I met two different worlds in Grenada. One world of real Grenadians who live in harmony with nature, exchange goods with each other, sell on the road. I met them in town, at the hospital, on the market. I found it funny, that all drivers are hooting, in Croatia constant hooting is a sign of a lack of culture of drivers, but hooting is like saying hello in Grenada. Everything is a bit wild and exotic, but not the way people usualy perceive it, in terms of coctails, palm trees and other features of hotel resorts, the real exotic is in the sand, dust and wildnes, in stands by the road where you can buy everything you want, and in an abundance of tropical fruits on every corner.It is cheaper to buy domestic fruits on the market then some other imported fruits- for example one bag of mango costs 1,5 Euros, and just ONE apple costs 2 Euros. The other world is a life of the students at the St.George’s University. SGU is an American university, where some of the young Americans and Canadians spend two years of their college education on preclinical subjects. The capus is beautifully decorated, all the buildings are new, with elevators, built on several hills and the rooms are mainly apartment type. In the area there are two basketball courts, large grassy area where football can be played, and two gyms which may be used by all studens. SGU is multicultural environment and the place where young people from all arond the world live together, learn and make their dreams come true regardless of what religion they belong to or what color their skin is.

This is just a small part of everything I experienced, tasted, smelled and tried to convey on paper, because some experiences such as hiking to the top of the mountain in the middle of rain season in the rain forrest, or a shower in Grenadian waterfalls surrounded by rich vegetation and colorful flowers are indescribable. This trip has opened many doors in my life because I met wonderful people who I’m still in touch with and who have treated me as their best friend since the first moment we met. Thanks to IFMSA I had an opportunity to expand my horizons and experience a different world then the one I am used to.

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PeriSCOPE - Edition 5, March 2012

Neurosurgery in Tatarstan From San Salvador to Kazan, Tatarstan Republic, Russian Federation Julio Iván Alexander Hernández Rodríguez, El Salvador

Julio I. H. Rodríguez is 5th year student in San Salvador, El Salvador

I was on my 5th year of med school when I applied for a professional exchange through IFMSA. As anyone who had been involved in this process, I was facing the decision of the country I wanted to visit. I have to say that Tatarstan-Russia immediately got my attention. I’d heard both good and bad experiences from people who had visited other places, but nothing about Russia. That unknown territory literally at the other side of the world seemed like the perfect choice to learn about a completely different culture and healthcare system. I didn’t have much hopes that someone from there would actually be considering El Salvador as a potential destination, but still I filled my AF and hoped for the best. Therefore, you can imagine how distorted my ECG might have looked when my NEO informed me that I was going to Kazan next year.

The Hospital, its staff and the University The Hospital, its Staff and the University.

I was initially accepted at my first choice department which was Ophthalmology, but a few hours before arriving to Kazan I checked my email at the airport and found a message from the NEO saying that my department was changed to Neurosurgery.

I arrived at the hospital on my first day, quite nervous for this unexpected twist, but it didn’t take me long to be thankful about it. Anticipating a very strict hierarchy and impersonal treatment, I was so surprised by how welcoming, warm and patient the staff was. Specially our tutor who treated me and another student from Catalonia more like his younger siblings rather than students. Every time he saw our confused faces when the doctors spoke in Russian, he helped us by translating and explaining the cases.

While I was there I was amazed about how different was from the Salvadoran public hospitals, I know it was not an emergency hospital, but still the level of technology used and the amenities enjoyed by patients are not available for the majority of my country fellow. Assisting a microscopic nucleoplasty was just awesome, among other interesting approaches that luckily I was able to observe and learn about. Something I noticed is that the burden imposed by the endless paperwork and bureaucracy

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are a universal headache for medical students and doctors around the world.

I wasn’t aware that in the Kazan State University were discovered many technological advances currently used in the medical field like the electron spin resonance just to mention one, and everything seems like it will continue that line. Something I really liked and I have to recognize is that they prepared a series of very interesting lectures for the exchange students, which is a good idea we can use at my LMO. The city and the poeple Kazan is a very special city, the way Tatar and Russian cultures coexist and Western and Eastern culture come together give it its unique character.

The TaMSA team had an awesome social program, a different activity every day, it could be a bar, a club, a museum or a historical place, but it was always something to do. They were definitely the best hosts possible, they tried to make us feel like home all the time and they surely did. The Khan’s mausoleum at the Kazan Kremlin is said to be a place where you throw a coin if you ever want to return to Kazan, I remember I threw a dollar dime, one cent for each

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exchange student present, now I feel I should have thrown every single dollar, euro, colón and córdoba I had in my wallet.

It was funny how my very Latin American appearance made me stand out among the local people specially when I spoke Spanish. I remember a group of youngsters staring at me and speculating where I could be from. Also I had the perception that Russian people are very quiet, completely different from my personality, for what I was sent to shut up a couple of times at the cafeteria.

Russian adventure Even though we loved Kazan, a couple of friends from the exchange group and I decided that even with our limited knowledge of Russian language we needed to explore more of the country. I mean, who knew when we would be back! That’s how we decided to go to the Ural mountains. The mission: 2040 Km in three days.

After my first train ride ever, we got a taxi from Yekaterimburg to see the line that divides Europe from Asia, it’s incredible how good a line in the pavement can make you feel, we looked like kids jumping from one continent to the other and taking tons of pictures. Next morning we took a “banya” bus to Chelyabinsk, where we had a delicious blini breakfast and I bargained the price of some Soviet Union coins I wanted for my collection.

We took another “banya” bus, this time to Zlatoust, where we met a local girl who spoke a little bit of English and once in the town, despite the fact that we’d just met her, she invited us to her place, we met her grandma and had a tasty homemade

and the sunset at the other will be in my memory until I stop breathing, It was definitely worth all the effort. After that, they invited us for dinner, I think they wanted to know what in earth could a Salvadoran, Catalan and Icelandic medical students possibly be doing over there. After that great day we retraced our steps back to Kazan next morning.

I tried to summarize what would take me many more pages if I tell you all the anecdotes and cool experiences we had. It seems to me that the universe intentionally placed all the great people we met on our way to the Urals, who gave us free food and transport, so we could make it there.

My IFMSA exchange and my life have taught me that either because you both know the origin of the name of Sonic the hedgehog gene, you both have the same views about the U.S. foreign policies or you both like Latin soap operas, when you’re with another person with a completely different origin, and you’re still able to see the way he or she is like you and not different from you, when you realize that your essences are indeed the same, that’s the best part of the human experience.

Russian lunch. She then escorted us to the bus stop, and at the end of the bus route, her friend’s sister was waiting for us to give us a ride to the National Park just because we were in need.

Finally in the park, after a few hours of hiking, we met two Russian couples who joined us climbing a cliff, where I can honestly say it was the closest I’ve been to heaven. The image of the Urals at one side

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PeriSCOPE - Edition 5, March 2012

Unforgettable Clerkship IN KRUNGTHEPMAHANAKHONBOWONRATTANAKOS (...): BANGKOK Borja Hinojal Olmedillo

Borja Hinojal Olmedillo is a medical student from Spain

My name is Borja Hinojal Olmedillo, a 22 yearold medicine student of the University of the Basque Country (located in the north of Spain, quite near the French border). About my host town, Bilbao, capital of the province of Biscay, in the autonomous community of the Basque Country (the tenth largest in Spain). Bilbao is situated in the north-central part and its main urban core is surrounded by two small mountain ranges.

About my medical education, I have been studying for six years, three of them in clinical items, period in wich I am delighted and enjoying it more and more learning real medicine, with real pacients (and not with just watching photographs in medical books). About my international experience, last year i had the great chance to open my mind and mi knowledge in Thailand, with a Ifmsa clerkship in the department of Obstetrics and Gynaecology.

I was able to see how medicine works in Thailand, and the healthcare system. I have to say that i was in Siriraj Hospital, that is one of the most modern hospital in Thailand (as i was told), so to compare about the real system (medicine in all towns, in other hospitals...) i would need another experience.

About what i saw, i found lots of patients for not too much doctors, beds,... so the waiting list was really extensive, and there were too much people in the same room. For example, where i live, every woman has it own room for delivery, with anesthesia help.

Another main difference is the participation of students in the system. In Spain, the students do nothing (just clinical history and palpation), and in Thailand i could see that are one of the most important helps in the hospital, thing that support.

About the country, culture, traditions and people can say that everything was really fantastic, one of the most importants and differents experiences in my life. The people, with no doubt, was the best.

The culture, was really kind and polite. All people liked Spain won the football world championship, great!

I didn’t like to see that there’s a big tendency to capitalism in Thailand, what it’s a big nuisance. Too much Mcdonalds, too much parties in wonderful beaches, too much shopping malls, too much bad tourists. I think Thai people should not enter in this black world of economical interests, should

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take care about it’s wonderful paradises, diffeents cultures (protect Karen people!!) take care about the contamination of the rivers and the sky, say no to international market and company speculation and don’t have the same mistake Europe made.

Actually, in this moment the Spanish society, about more items, is shouting, no more corruption!!, in the known as the Spanish revolution. Of course, i support it until the end.

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Melting pot @ Nephrology Department, Odense Universitet Hospital Sonia Lucignoli Krakamp

August 2011: Odense, Denmark.

One unforgettable experience under all aspects.

I chose to do my exchange in Denmark for pure curiosity. Here in Italy north european countries are often taken as an example of an avant-garde society.

I was curious to experience that first-hand by myself.

I was assigned to the Nephrology department of Odense University Hospital. The first morning of my internship my tutor introduced me to the whole team and the welcome was very warm. I soon learned that the department was organized in three main activities: the ward, the outpatient clinic and the consultations in other departments of the hospital. Every morning in the morning meeting I would be assigned to a doctor for one of these activities in rotation. In the whole duration of my internship I was able to discuss different clinical cases from the admission throughout the diagnosis and treatment.

I got to see the management of patients on hemodialysis vs peritoneal dialysis vs renal transplant. On one occasion, I was also able to get an insight into the pediatrical nephrology in the omonimous outpatient clinic. From a practical point of view, I was able to do physical examinations and arterial blood gas analysis mainly.

The only big problem was the language barrier.

Even though the knowledge of the English language is excellent in Denmark, obviously all hospital activities were carried out in Danish: this didn’t allow me to blend in the organization of the activites and maybe take initiative. However, the doctors were very helpful, I was always explained everything that was done and I was also able to carry out a couple of history taking with some of the less sick and youngest patients.

What I found most interesting, also compared to what I am used in Italy, was the efficient organization of all the activites at the department. Everyone had their own work and each one’s work was fitted into a system which, in the end, worked smoothly like a perfect machine.

All in all, the experience was very precious in helping me get a practical insight into the nephrological field, so much that I am seriously taking it into account as a possible future specialty.

But what is unique about an IFMSA exchange is not only the alternative professional insight into another country’s health system.

It is especially about sharing a cultural experience

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in direct contact with the local people: everything being organized by the local committee, you actually have the chance to bond with them, get to know the culture and style of living from a very close perspective and, of course, enjoy time together in a varied social program.

On top of all this, being part of a group of other incoming exchange students, coming from all over the world, I was able to share experiences, live together and bond deeply with my fellow exchangers.

What will most remain in my heart is the memories of all the rich moments we have spent together in that one month.

In conclusion, I can’t thank IFMSA enough for this wonderful opportunity. Apart from the enriching professional experience, it was the human bonding and sharing of experiences that made it all the more special. The multidirectional exchange...in one big Melting Pot.

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With love from the Middle East or why a postcard sent from Palestine will never reach Beirut Marianne Koch, Austria

“Welcome to Lebanon! Where are you going to stay?” “Ehm, I don’t know…I will stay at a friends’ place”. “You don’t know where you are going to stay? You have to put an address to the arrival form.”

Shit, why haven’t I thought of that before? After all this time traveling I obviously became ignorant of the fact that not every country just lets you in with a kiss on your hand. That’s the very nice side effect of having friends almost all over the world.

Of course this officer was not aware of my awesome situation, and kept insisting that I have to fill in an address.

“I’m sorry I don’t know the address of my friend, I didn’t ask because he’s catching me up here anyways…” and then I added the magical words, which somehow always did their duty “he’s a medical student at the AUB. You can write American University of Beirut as accommodation”.

So we agreed on filling in my friends’ name, phone number and the name of the University and left each other. Me, satisfied, with the first stamp in my new passport, he with a resigning sigh.

Later, when I told my friend about this not so comfortable situation at the immigration, he laughed and assured me that I had not been the first girl filling in his name and phone number in the form. Apparently once he had been called by the officers to check up if the information was correct and he had answered “Yes I know her. She’s not a prostitute, don’t worry”.

Awww!

Beirut- glitter glamour of Middle East. Young, hot, funky, never sleeping. Ramadan? Forget it.

Only city, which you can compare to Beirut in Middle East? Tel Aviv, it’s biggest enemy.

I spent one week in this fantastic country, jetting from one place to the next with my Lebanese friends and a bunch of incoming students. One night we were dancing on the bar of the club called BO-18.

From up there I enjoyed a nice view of the whole scenery, and well, there were things going on!

For this I should take a short break in the story and try to illustrate the relationships of Middle East and the Arab world a little bit.

Beirut is a city in the middle, not only east, but simply the middle. Traditions are balanced with a very liberate life style. It is still unthinkable that a girl would stay at a boys’ house, even if they were really only friends. But if the house is free and the parents are not there, everything could become pos-

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Photo: View from bar BO-18, Beirut/Lebanon sible. I say “could” because of course I didn’t look into every bedroom in Lebanon, it’s the conclusions I took after conversations with my Lebanese friends.

There are these questions that inevitably pop up in my mind when I experience a different culture, in which intimacy and sex are more restricted.

Why? Isn’t intimacy one of the basics of human needs? Isn’t it one of the most wonderful things in life? Of course we can debate on the provoking nudism of young generations in western style countries, and teenager pregnancies and meaningless onenight- stands which only leave a bitter taste on the next mornings’ dawn.

However, shouldn’t we be able to find a balance?

I once read an article in the Time magazine on the love life of young Saudi Arabians.

In Saudi Arabia, men and women are strictly separated during their daily life procedures. So how can young people from the opposite sex get to know each other? If you follow the rules - not so easily.

So, what do young Saudi Arabians do? Those who have the possibilities often transfer their relationships to a foreign country or they organize private parties to which the religious police doesn’t have access.

But one friend of mine who is living in Saudi Arabia also showed me that the regular choice of the vast majority of young people is to go with the tradition. And this tradition may surprise, as it is not that restricted as it might look- it’s simply that the parents influence your choice. If you are ready to

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meet somebody, you tell your parents, they arrange a first meeting. You can officially date, but are not officially engaged. And that’s the point…you can go on with this until one day you find somebody who fits you and whom you wish to marry. And to many young Saudis this is a very convenient path.

Back to Lebanon- one very good Lebanese friend of mine gave me this answer, when I asked her to explore the Lebanese approach of intimacy: ”Marianne (and she’s always rolling the “r” so delicately and completely ignoring the “e” in the end, which I adore), you see, there are the Christians, who are very western oriented. They are more open to the idea of drinking and having sex before marriage.

Then there are the Muslims, which you can divide into two groups. One is more liberal and mostly like the western oriented Christians. The other group is representing the traditional life style. But anyways, there are also those Christians who don’t believe in sex before marriage, because you know that this is also one rule of Christianity.”

So I was dancing on the bar, in the heart of Beirut, and watching young people of different backgrounds- Christians, Muslims, Lebanese, Europeans- having fun together, drinking (or not), and kissing (or not). In the end it’s everybody’s own choice, right?

Waltz with Bashir Beirut has many scars. It’s renovated, but the shiny surface of downtown confirms all suspicions that an ugly war is covered beneath. The grey, tall and sadly famous Holiday Inn hotel, which became a prime sniper position during the civil war, is still standing, bullet- riddled and empty.

That somehow felt very abstract to us, and it is difficult to describe the ambiguous feeling you get if you are staying in Beirut for a while. And I have to say that in the end, we didn’t care about the past so much, we all know about the problems in Middle East. But we are living now, and being with Lebanese friends for one week was very enriching- a mixture of serious discussions and random trivialities of our daily lives.

How Barbie Girl came to Jordan Now we were able to experience the true Ramadan, and we decided to follow it as much as possible. I was seriously wondering some hours and brainstorming why the Arabs call the dinner during Ramadan breakfast. Well.

Jordanians are very friendly towards tourists and it’s not seen as insult if you eat and drink in public during Ramadan, but still we wanted to respect the customs. Nevertheless I have to admit that Ramadan only lasted 3 more days during our stay in Jordan.

As soon as I heard that we would go to a camp in the desert I pictured it to be very romantic-

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wrapped up in a cozy sleeping bag, sitting at the fireplace drinking mint tea and telling each other stories, only surrounded by the allegiant camels and millions of stars that are enlightening the desert sky.

At least that is how my first desert experience took place two years before, in the desert of Negev, during which I was introduced to the species of camels for the first time in my life. “Never ever touch a camels’ head, you will regret it instantly”. At this very moment my arm was already fully stretched and only separating my hand three centimeters from the camels’ head. So, with this lovely scenery in my head you can imagine that I was pretty shocked when I realized that this desert camp was actually sort of a desert disco. With dozens of Jordanian families.

As soon as the sun disappeared behind the hills there was no other option than gathering around the center of the camp- a big dance floor surrounded by wooden constructions covered with nicely decorated Arabic cloth.

We cuddled on cushions around small tables, the DJ was putting on charming Arabic music, and they lit colored lights all over the small hill on whose edge the camp was built. And when a waiter placed

photo: Desert camp, Wadi Rum/Jordan a Sisha with double apple flavor in front of us I was almost reconciled.

My mood dropped only a couple of moments later- that was when I started getting hungry. No need to mention that in a desert camp, food comes slow, and we were almost dying of hunger when the buffet was finally opened two hours later. Of course I decided to eat as much as possible, because who knew how long it would take until we would receive the breakfast the next day. Why am I telling you all this- because this was the reason why I had no other chance than to watch the following ongoings from a distance because I was absolutely not able to move with all this hommos, chicken and rice in my stomach.

It was dancing time! And for us Europeans, this

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was like sitting in a cinema and watching a bizarre movie. In order to elaborate this situation I have to go back once again to the topic of interpersonal relationships of Arab people.

Women and men are still more or less interacting in a respectful- and distance guarding way, so it was only logical that women would dance in a small group on one side of the circle and a bigger crowd of enthusiastic men took over the major part of the area.

And here is the interesting thing we were able to observe located from our cushions in the tentwhenever guys would dance in Europe, as the Arab guys did this night, almost everybody I know would probably have assumed that they are gay. But things are completely different in Jordan, and men don’t shy away from taking another men’s hand and dancing with him as if they were a couple.

So whereas homosexuality is still a strict taboo in Middle East, the dancing habits of Arab men paradoxically opposite the nit- picking efforts of European men to not under any circumstances touch another guy, in order to avoid giving people the impression you might be gay.

Although homosexuality is widely integrated in most of the European societies, but forbidden in Middle East.

Our Jordanian friend was already dancing enthusiastically while I was still struggling with all the food in me, and it didn’t take him long to focus his attention on getting me to join them dancing.

Usually I am among the first people on a dance floor, but at this time the women had already left the scenery and therefore to the men. Some of them were even dressed in traditional clothes, with the veil you are usually connecting with Saudi Arabians.

I was really intimidated.

After almost one hour watching them, reluctantly tapping with my toes to the rhythm of the music and fighting with myself whether I should go dancing or not, I took a deep breath and approached the dance floor.

I was instantly greeted with cheers, they took me in their middle, smiled at me and didn’t leave a doubt that they intended to treat me as their queen for the night. One thing they really enjoyed was kneeing on the floor, clapping with their hands and just watch me dancing. Although that was slightly weird for me I couldn’t resist the general spirit and was soon dancing like crazy with all of them under the nightly desert sky- which hosted a million of stars by the way. Chilly wind ran through my hair as I turned and turned and couldn’t believe my luck of simply being there.

And then the DJ decided to switch to more western style music. I’m still bursting in tears of laughter.

I was dancing with a bunch of more or less traditional Jordanian men in the middle of the desert at

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1 a.m. to- sit down please- the song “Barbie Girl” from Aqua. And yes, we were singing the text at the top of our voices.

Without sugar, please!

During the trip to Middle East I sort of took over a Pawlow’s dog reaction. Whenever I heard the word coffee I instantly shouted “NO sugar, please!”

Everything is sweet in Middle East- coffee, boys, food, girls- and it got even sweeter in Palestine.

We took a cab from Amman to the King Hussein Bridge, which forms the cross- country border of Jordan and Israel/ Palestinian Territories. At the bridge we didn’t have to queue in line because there is a separate path for tourists to acquire the VISA for entrance. We shared a minibus with some other tourists and the Jordanian border officer tried to cheer us up by mixing up our passports. But that didn’t help, we were all damn nervous.

I wouldn’t have had to worry, absolutely nothing happened to us. They notified the Lebanese seal in our passports, but they didn’t react to it and all that happened was them keeping the backpack of my friend for a while because they found a knife in it.

“Ok, you can keep it. But put it to the bottom of your backpack”.

And off we hit the road to Jerusalem.

Territories. At the bridge we didn’t have to queue in line because there is a separate path for tourists to acquire the VISA for entrance. We shared a minibus with some other tourists and the Jordanian border officer tried to cheer us up by mixing up our passports. But that didn’t help, we were all damn nervous.

I wouldn’t have had to worry, absolutely nothing happened to us. They notified the Lebanese seal in our passports, but they didn’t react to it and all that happened was them keeping the backpack of my friend for a while because they found a knife in it.

“Ok, you can keep it. But put it to the bottom of your backpack”.

And off we hit the road to Jerusalem.

Jerusalem Syndrome Jerusalem is a very special city- on one side you see religious tourists kissing stones everywhere or even carrying a huge rented cross, imitating the last walk of Jesus. Yes, you can actually rent a one meter fifty cross.

Then you have all sorts of souvenirs all around you and security checks before you can enter both the Western Wall area and the Al Aqsa Mosque and Dome of Rock area.

In the Jewish quarter is a star of David with inscriptions that basically say “the Al-Aqsa mosque is not meant to remain at its current settings and the Holy Temple will be rebuilt at its place in the close future”.

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photo: View over Jericho from Mt. of Temptation Palestine University is inside the walls”?

It took me quite a while to understand that, if a Palestinian is talking about “inside the walls”, he means Israel, and if an Israeli is talking about “inside the walls”, he means Palestine.

However you look at it, the wall still remains where it is. For us it was relatively easy to just hop from one side to the other.

One of these days we had spent in Ramallah- after wandering around the city (discovering the Stars & Bucks café) we had Shawarma and sweet soft drinks on the corner of a street where we stopped to watch the monument of flags ofthe UN member countries, which was installed in expectation of the Palestinian application for full membership. It was fun to try to match the flags with countries.

Photo: Stars and Bucks café, Ramallah

The graveyard of Arafat in the Palestinian city of Ramallah is movable because his body is meant to be brought to Jerusalem as soon as the holy city belongs to Palestine.

Surprisingly only the Christians don’t claim anything.

Non- Muslims are not allowed to enter the Dome of Rock, whereas no Muslim will be denied entrance to the Church of the Holy Sepulchre.

There are only three mosques in Austria that are allowed to have a minaret. But I have never heard of restrictions regarding the size of a church tower in an Arab country.

It’s so complicated with the religions.

Why a postcard “Love from Jerusalem” sent from a post office in Nablus will never arrive to Beirut We kept our headquarter in Jerusalem, but went to Palestine every day. To get there we took a bus across the separation wall, got off directly after it and waited for our Palestinian friend to catch us up by car. Although he had a permission to enter Israel territories, he was still not allowed to drive a car there, so this was the most convenient to meet up.

How is life in Palestine? I was curious!

Well, on one side it is very normal. On the other side it is very abnormal. Nablus, Ramallah, Bethlehem, Jericho- all these are modern cities as you can find them anywhere else. Food is cheap and delicious, whereas the wine is not drinkable.

The people are very friendly and we were greeted with a hospitality that makes me feel ashamed as European.

In my memories I still see the brown, dry landscapes passing by the window, only now and then interrupted by some settlements. Endless roads through shiny and rocky desert.

After frequent street blocks and identity controls throughout whole Palestine we reached Jericho, which is located in area A (full Palestinian authority).

But at the entrance to the city we were asked to show our passports for the first time. That’s because Israelis are not allowed to enter zone A, and we had to proof that we don’t own the Israeli citizenship before we entered. Actually you are allowed to enter, but you might be put to jail while trying to re-enter Israeli authority.

Jericho itself was a true oasis in the surrounding desert- like landscape. It’s said to be one of the oldest continuously inhabited cities of the world and i hosts an incredible amount of biblical and archaeological sites.

Heads against the wall “My University is inside the walls, that’s why I have a permission card to enter Israel. But that only lasts until I’m graduated, afterwards I don’t know.”

“But why do you need to enter Israel if the

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to the city of Schlomos, yoghurt ice- cream and Bauhaus architecture.

We were staying with a very good Israeli friend and enjoyed the last three days mainly at the beach or with some final shopping. It was like all of a sudden being almost back to Europe again.

Additional paragraph at the end: If you think that there is missing something, you are correct. What happened with the Lebanese seal in our passports? At the airport of Tel Aviv we were separated from the rest of the queuing people because they instantly recognized the Lebanese seal in the passports. From this point on, we were constantly accompanied by some officer, until we sat in the airplane back to Europe. Our luggage was intensely checked and we had to go to a body- check in a separate room. Of course we were also interviewed about anything related to our travels through Middle East. The whole procedure took almost two hours. But after these three weeks I already felt like a professional.

Photo: IFMSA-PS on the wall/Palestine We also went to see Arafats graveyard, which is constantly guarded by military. We had to carefully watch the time because the last busses back to Jerusalem are leaving very early.

In order to get back to Jerusalem you have to pass the checkpoint by foot, it’s all long narrow corridors separated by metal bars. Only three people are allowed to pass a gate at once, afterwards you have to wait for several minutes until it opens again. After the gates we had to push our bags through a detector and had to show our passports to some guards sitting in their office.

The boys were fine, but apparently they had something to discuss with my passport. Perfect. I was asked to enter a small room, which measured about two square meters and contained only two chairs. There was a small window in one wall through which I was told (via microphone) to take a seat and wait. No more information than that.

After about 8 minutes they handed me my passport back and told me I could go. I have to say that this situation gave me a small adrenaline rush.

Apart of some occasional excitements like this, our stay in Palestine was very calm and when I think back these are the things I took with me in my memories: roads, friendly people, antique ruins, religious sites, Elias’ spring, sweet Knafeh, figs, passion fruit juice, an awesome Palestinian friend, coffee, jewelry, awful wine, pomegranates in the garden, green villages, desert, Falafel.

Tel Aviv - Where an ice cream shop becomes a club at night. After three weeks of travel we arrived

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Marianne was travelling through Middle East between August and September 2011

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The Health Burden of Climate Change: A Nigerian Spotlight Doctors for Humankind Foundation (DHF) reviews a physician’s local experience of the increased global climate change-related health burden.

Executive Summary People die from climate change. People get sick from climate change. Climate change is a matter of life and death. Let us all therefore recognize that in tackling climate change, we are essentially confronting a very challenging health issue.

Climate skeptics will always barrack whatever you say about the reality of the impact of climate change on the planet and on human health. However, those of us who grabble day after day with climate change and its health consequences are determined to forge ahead with measures both mitigating and adaptating, to tackle this challenge in hopes that the skeptics and denialists will eventually wake up.

Doctors in Nigeria have seen young adults in their early thirties, and without prior history of cardiovascular pathology, simply develop palpitations and angina, and die within minutes in the Accident and Emergency. In the same vein, we have watched some other young men, in their early 30s, rapidly worsen and die, within 6 months of diagnosis with mild hypertension and that, despite professional treatment and satisfactory hypertension control.

We have also seen unprecedented levels of flooding across the country from north to south, leaving cholera outbreaks in its wake most times. Eye diseases have worsened in prevalence and incidence.

Respiratory diseases, such as asthma, emphysema and bronchitis, have all become bigger problems despite our best efforts. Malnutrition and diarrhoeal disease amongst children continue to defy all efforts, and to chalk up ever worsening indices despite improved care, because LAKE CHAD has all but disappeared up north and the Sahara Dessert is encroaching down south at an alarming speed, foisting a shortage of everything from water to food and crowding the people more and more into townships.

Introduction We came back last month from the Durban Climate Conference to find that it was still raining: It was still raining all over southern Nigeria in December, a traditionally dry month. This trended on twitter for a bit among climate-educated people in the country. We got Blackberry messages from

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cities experiencing this ‘strange’ phenomenon. But there are still people determined to believe that all this is a normal cycle.

Climate Change in Nigeria Anthropogenic climate change has wreaked wide-ranging damage to the health of the people of Nigeria in ways that are only becoming apparent to medical practitioners and to lay people that are, otherwise, keenly observant.

But because Nigeria is the largest oil-producing nation in Africa, it is hard to separate morbidity and mortality directly from fossil fuels like petroleum and coal, both of which are in abundance in Nigeria, from indirect effects of fossil fuel exploration through climate change and its impact on health. Therefore, this paper will consider the health effects of climate change along with the health effects of the most central factor for climate change.

And when there are oil spills, which is ever so often the case in Nigeria, the health hazards multiply and deepen exponentially.

On average, there are 1 to 2 oil spills in Nigeria every single day. To contextualize, some of the have been on the ground since 1960 and have for that long remained unremediated and have continued to wreak damage to the ecosystems of the affected areas and to emit green house gases constantly. These GHGs are laden with volatile organic compounds (VOCs) such as benzene, toluene and xylene. These VOCs react with the equally heavily present oxides of nitrogen (NOx) in the sunlight to dangerously increase ground level ozone. Some of these VOCs are also CNS depressants (neurotoxins).

The Health Dimension Every organ system is affected: 1. The eyes: Anthropogenic greenhouse gases, mainly from fossil fuels like petroleum, deplete the ozone layer and allow dangerous levels of ultraviolet radiation B spectrum through.

2. Cancers: By the same damage to the ozone layer and the resultant admission of unsafe levels of UV light, damage to all human DNA now occurs in numbers and at frequencies that simply overwhelm the natural DNA repair processes

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and eventually lead to cancers of all sorts.

3. Leukaemias: Leukaemias have also been shown to be on the rise as a direct result of increased UV light penetration of our environment through a thinning ozone layer 4. Birth defects: Increased UV irradiation plus the added consequences of water and food and general environmental contamination with hydrocarbons from half a century of oil spills has served to exponentially raise the prevalence and incidence of birth defects.

Maternal, Newborn and Child Health: 1. Miscarriages/First Trimester Abortions: The unduly high prevalence and incidence of first trimester abortions in Nigeria is also not unconnected with the correspondingly high burden of prenatal teratogenic processes as has been observed.

2. Climate Change and Child Protection issues.

3. Albinos: Nigeria, being a very large population of close to 200 million people, has a correspondingly large population of albinos. Our albinos are not as in danger of ritualistic deaths as in other parts of Africa. They are at risk of climate change as they have either a quantitative or qualitative deficiency of the enzyme tyrosinase and are therefore much more vulnerable than the general population to UV and other toxin damage to the skin, eyes, and other organs.

4. Accelerated ageing: Increased UVA and UVB irradiation of our skin owing to climate change has also been demonstrated to cause damage to the skin, impairing its self-regenerating potentialities, causing accelerated wrinkling and ageing of the skin as well as delayed wound healing once it has been breached.

Noncommunicable Diseases: 1. Increased Cardiovascular Disease Morbidity and Mortality: Just less than a decade ago, NCDs were not a major problem in Nigeria; we now observe an otherwise inexplicable acceleration of the health burden due to cardiovascular diseases, ranging from anginas to arrhythmias to sudden deaths from cardiac failures amongst young men and a number of them well educated, well-to-do, and availing themselves the best healthcare in town and complying with cardiology treatment and appointments. Considering that climate change and such apparently simple things as its effect on room temperature are now beginning to be discovered to have an effect on cardiovascular health and durability, we are getting all the more suspicious that increased average temperatures are working with other factors not far from

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climate change to accelerate the progression of cardiac disease.

2. Obesity and Overweight: People stay indoors a lot more these days because of excessive outdoor temperatures. But that has begun to encourage a sedentary lifestyle which was not the case among our people before now.

Infectious diseases: 1. Insect-borne diseases: Infectious diseases are caused by microorganisms that have life cycles that tend to be tied to the seasons and weather patterns across climes. Malaria transmission, just as an example out of many, is observably more intense all year round now than used to be the case. The apparent resurgence of other infectious diseases such as yellow fever also has the same root cause.

2. Waterborne diseases: We have seen diarrhoeal diseases simply overwhelm health care services in the wake of flooding, a spate of which hit across northern and southern Nigeria in an unprecedented fashion in 2011.

3. Airborne diseases: Air borne bacterial and viral diseases such as meningitis, tuberculosis, bird flu, swine flu, etc, are all expected to get worse.

In Nigeria, bacterial meningitis is a huge health challenge up north, and gets more intense during drought.

4. Rodent-borne diseases: Floods will wash diseasebearing rodents from their hiding places into closer human cohabitation in ever increasing numbers.

5. Climate change-induced Immunosuppression and immunodeficiency: Ultraviolet radiation disrupts the immune system. This is one of the pathways by which UV radiation produces cancer. Studies are still ongoing on this in order to more fully understand the pathophysiology of this immune disruption.

6. Increased Ground Level Ozone (IGLO): Ozone is good for human health up in the stratosphere where it shields us from UVA and UVB (Good Ozone). But at ground level, O3 is formed by a chemical reaction between oxides of nitrogen (NOx) and volatile organic compounds (VOCs) in the presence of sunlight which Nigeria has a superabundance of thanks to being right at the equator and also to climate change. Ground level ozone, which we have an abundance of in Nigeria, especially in places that have suffered oil spills wherein these VOCs are superabundantly present, being major constituents of petroleum, is harmful to breathe and damages crops, trees and other vegetation. IGLO has been documented to worsen the health burden from respi-

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ratory diseases such as bronchitis, emphysema and asthma.

DHF and the Durban COP17/CMP7 Shock The most depressing experience for Doctors for Humankind at the COP17/CMP7 was the apparent lack of recognition at the UNFCCC that climate change is essentially a health challenge, the greatest health challenge of the 21st century, despite the fact that the very first article of the document setting up the UNFCCC details this recognition.

Health ought to have been at the very centre of all the events. People get sick from climate change.

People die from climate change. At the end of the day, that is the real reason we are tackling climate change. But at the COP, we saw people caught up in the economics and the politics of climate change rather than climate change and health. And we were actually struggling to be heard. This needs to change.

The 21st Century Nigerian Climate Context While the German city of Munich is gathering momentum to very soon become the first fully green-energy-powered city in the world, a truly 21st-century city, Nigeria is sinking more oil

wells, contriving to re-open abandoned oil wells in Ogoniland and elsewhere, and awarding contracts for new coal mines and coal power plants.

We now know so much about the damage that can be done to the environment and to human health by oil and coal directly and through climate change. But for pure economic reasons totally deliberately blind to the health consequences, we appear set on the fossil course for the foreseeable future.

Conclusion and Recommendations We need to set a baseline of action with all stakeholders. We need to have a clear-cut corporate social responsibility framework rolled into all MoUs with all body corporates operational in Nigeria, form the ones that have been here and have some form of such a document that obviously is not being implemented and therefore has to be reviewed, to new and intending investors. The era of investors tying themselves to politicians and escaping corporate social responsibility sacrificed on the anvils of an artfully contrived conflict of interest where the politicians are bribed and their voice mortgaged as high up the realm as possible and no one listens to the people.

Photo source: Kvåle et al. in the Journal of the Norwegian Medical Association no. 17, 2011; 131:1670-2 PeriSCOPE is the official magazine of the Standing Committee on Professional Exchange and it is printed twice a year. We would like to have your story. If you’ve been on exchange and want to share your unforgettable moments with the SCOPE family, don’t hesitate to contact us on email: María: drmarie.ar@gmail.com or Yassin: almassya@gmail.com.

Also if you have an exciting exchange project in your NMO that you want to share with other international students, email us and we will find some solutions and space for you.

The next edition is published just ahead of the August 2012, so be sure to email us your contribution in June at least. 1-2 A4 page with pictures will do fine :) We appreciate your contributions!

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