Pulse August 2012

PULSE The IFMSA Asia-Pacific Magazine August 2012

Universal Health Care

1

IFMSA

The International Federation of Medical Students’ Associations (IFMSA) is a nonprofit, non-governmental and non-partisan organization representing associations of medical students internationally. IFMSA was founded in 1951 and currently maintains 106 National Member organizations from about 100 countries across six continents with over 1,2 million students represented worldwide. IFMSA is recognized as a non-governmental organization within the United Nations’ system and the World Health Organization and as well, it is a student chapter of the World Medical Association. For more than 60 years, IFMSA has existed to bring together the global Imprint medical students community at the local, national and Editor-in-Chief international level on social and health issues.

The mission of IFMSA

Mariam Parwaiz, New Zealand

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.

Objectives:

• To expose all medical students to humanitarian and health issues, providing them with the opportunity to education themselves and their peers; • To facilitate partnerships between the physician in training community and international organization working on health, education and social issues; • To give all medical students the opportunity to take part in clinical and research exchange around the world; • To provide a network that links active medical students across the globe, including student leaders, project managers and activists, so that they can learn from and be motivated by each other; • To provide an international framework in which medical student projects can be realized; • To empower and train medical students to become advocates in leading social change.

Regional Co-ordinator Renzo Guinto, Philippines Editors Michael Valente, Australia Jim Paulo Sarsagat, Philippines Sujoy Ray, India Suranjana Basak, India Design/Layout Airin Aldiani, Indonesia Proofreading Mariam Parwaiz, New Zealand

Publisher

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

Contacts

publications@ifmsa.org

Contents Message from Regional Coordinator

4 6

Universal Health Care

Editorial

7 8

Health in Asia-Pacific Today

What’s Up Asia-Pacific?! 10 12 The Indian Scenario Thoughts from Idris Israel Oluwaseyidayo 13 14 The 1st General Assembly of Bangladesh Medical Students Society Standing Committee Updates

16 16

Write for APRM Issue

Be a Part of Us! 17

3

Message from the Regional Coordinator!

R.G. is your RC!

Universal Health Care s e l b a i t o g e n n o N e Som Today, nearly a hundred countries are embarking on a global race towards universal health coverage – a term defined by the World Health Assembly in 2005 as “access to key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost”. The array of universal coverage options is wide, ranging from tax-financed systems such as UK’s National Health Service to social health insurance models like the one in Taiwan.

However, I have a firm belief that being covered by a health financing scheme does not automatically mean receiving the care when in need. For example, my country, the Philippines, often boasts that 80% of our population is already covered by health insurance, but many of our health indicators, such as maternal and infant mortality, are among the highest in Southeast Asia. (Interestingly, an independent household survey estimated that only around 30% is actually covered by government health insurance.)

Hence, like some health policy experts and health activists, I have decided not to follow the WHO language this time and instead use the term “universal health care.” In frequently invoking this term, I help spread the message that what we need is not mere financial coverage but more care for the people. I feel glad that the organizing committee of the August Meeting 2012 in Mumbai, India chose this phrase as the theme.

But more than the term, universal health care is a social goal that we need to support, and also we need to safeguard from distortions and misinterpretations. Therefore, I am listing down five principles that should guide universal health care – and these principles should be upheld at all times, no matter what.

GOVERNMENTS SHOULD LEAD UNIVERSAL HEALTH CARE. Obviously the ongoing universal health care efforts now are initiated by governments, but it is always better to stand on the side of caution and remind governments about their obligation to their citi-

4

zens. There were even opinions that the universal health care model being globally propagated aims to increase private sector involvement in health, and even relegate some state obligations to non-state entities. I might be accused of being pro“Big Government” but this stance is not without a historical basis.

Signed by 134 countries, the 1978 Alma Ata Declaration, which reaffirmed the fundamental human right to health, reminded that “governments have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures.” At the end of the day, no matter how problematic some of our governments are these days, business enterprises satisfy their investors, NGOs depend on their donors, and governments can be held to account by the people they ought to serve.

UNIVERSAL HEALTH CARE ENTAILS ADDRESSING ALL BUILDING BLOCKS OF THE HEALTH SYSTEM. As I already previously implied, universal health care is not merely a financing issue. The money raised and earmarked for health cannot be translated into good health outcomes without the other five building blocks as enumerated by WHO – governance and leadership, human resources, medicines and technology, health information, and healthcare delivery services.

Each element is vital in ensuring that limited finances

produce the best outcomes – whether improvements in health, increased access to services, or enhancements to people’s satisfaction.

UNIVERSAL HEALTH CARE SHOULD ENCOMPASS NOT JUST CURATIVE SERVICES, BUT ALSO HEALTH PROMOTION AND DISEASE PREVENTION. The current discussions in universal health care focus on expanding the population coverage as well as the benefit coverage, especially of in-hospital services, in order to reduce catastrophic health spending and prevent impoverishment. However, what the people need the most is to learn how to avoid becoming ill and reaching the hospital, and that is through health promotion such as education and counseling, and disease prevention services like immunization and prophylaxis. Thailand, for example, included promotive and preventive services into the “essential package” that every citizen is entitled to throughout the life course. At the end of the day, the benefits of health promotion far outweigh the economic and social burden of having disease.

UNIVERSAL HEALTH CARE PROGRAMS SHOULD NOT WIDEN INEQUALITIES. The aim of universal health care is to close the gap in access to health care. Therefore, such programs must be truly universal – leaving no one in society behind. For example, a few years ago, the Philippine government set 80% of the population as a goal for “universal” coverage. The danger of setting a goal less than 100% is that the least advantaged will be excluded, no matter how rigorous the targeting system is. Furthermore, in the Philippines for example, a 2006 study revealed that well-to-do families benefit more from social health insurance than the less privileged – it is because those in the upper tiers of society are the ones that are more aware of the health services and use them more often. Today, there are concerns that those left uncovered will not be able to receive health care from public hospitals that are accredited under the insurance system. Universal health care programs should not exacerbate existing inequalities, or worse create new ones.

UNIVERSAL HEALTH CARE MUST BE COMPLEMENTED WITH ACTION ON MORE UPSTREAM DETERMINANTS OF HEALTH. What many countries are missing now is that reducing health inequalities and realizing the right to health do not depend on providing free health care to all alone. In the first place, we should be aiming to prevent disease, much of which is rooted in the social environment. Aside from lessening the disease burden, action on social determinants also reduces the vulnerability of certain groups from becoming ill –they become more educated, they live in safer environments, and they gain better access to health services. Finally, such approach also raises more money and resources for health, for example, Thai policy experts will always say that they achieved universal health care because of economic growth and internal peace, resulting in more money for paying national debts and less money for military spending and ultimately more resources allotted for the health system.

I am very excited about the upcoming general assembly in India, as we will be devoting some activities to universal health care. During our Asia-Pacific meeting, the AsiaPacific Think Tank will organize a “Global Health Session” that will enable our medical students to share their experiences and perspectives on universal health care in the region. I will also be co-directing a pre-GA workshop on universal health care, which is hosted by the newlyfounded IFMSA Global Health Equity Initiative. I am sure that universal health care will also permeate in the side discussions that will happen in the corridors. But in every conversation, let us not forget these non-negotiables.

Renzo Ramon Lorenzo Luis R. Guinto Regional Coordinator for the Asia-Pacific

International Federation of Medical Students’ Associations

5

Editorial Welcome to the third issue of Pulse for 2012!

The theme for this issue of Pulse is the same as the theme

of the editorial team, or contribute to our regular ‘What’s Up Asia-Pacific?!’ section. Check out the latest thoughts of your colleagues from around the region.

Universal

Next month is a big month in the Asia-Pacific calendar – it is

for the IFMSA August General Assembly:

Health Care.

This issue we have three articles on the topic. Idris from Nigeria, Shankar from Nepal and Sujoy from India all share their thoughts on what universal health care means.

The Asia-Pacific region is a vast and diverse region with many different countries, cultures and economies. However, there are some non-negotiables in health care. We urge you to have a read of the RC Message by our Regional Co-ordinator – Dr Renzo Guinto. In his piece, Renzo talks about some non-negotiables in universal health care. We hope you find this interesting, enlightening and thoughtprovoking.

Also in this issue, Zeba outlines some of the big issues in health affecting us right now. The Bangladesh Medical Students Society held their first General Assembly in June of this year. You can find out more about what happened in this issue of Pulse.

time for the Asia-Pacific Regional Meeting (APRM).

It’s happening in Malaysia and we are doing to be there!

We look forward to meeting all of you, sharing ideas and experiences with you, and teaching you a bit more about Publications and Communications. We are really excited and we hope you are too!

Pulse is your magazine and we love hearing from you. Email us at: da.pub.ifmsa.asiapacific@gmail.com. Our next issue will come out in September to coincide with APRM. The theme for the September issue of Pulse is Transitions

2012: Doctors-in-training changing health landscape of Asia-Pacific.

the global

Submissions for the September issue of Pulse are open now and close on 31 August. Get your articles, photos, projects and conference reports to us now! Also we will be making a call out for What’s Up Asia-Pacific?!, make sure you share your thoughts with us!

As most of you know, Pulse is the official magazine of the IFMSA Asia-Pacific region and every issue is full of articles We look forward to reading your articles! relevant to our region. We really appreciate the work that our contributors put in writing articles for us. It is easy to Until next time, be a part of Pulse – simply write an article for us, be part Mariam and Airin

Thanks to our contributors:

Mariam Parwaiz Airin Aldiani Development Asisstants for Publications & Communications

da.pub.ifmsa.asiapacific@gmail.com

Disclaimer: Pulse is the official magazine for IFMSA Asia-Pacific. Opinions shared in Pulse are not necessarily those of the Editorial Team or of IFMSA.

6

Shankar Raj Lamichhane, Nepal Zeba Unnisa, India Sujoy Ray, India Idris Oluwaseyidayo, Nigeria Zeeshan Alam, Bangladesh

Thanks to our editorial team: Michael Valente, Australia Jim Paulo Sarsagat, Philippines Suranjana Basak, India Sujoy Ray, India

Universal Health Care by: Shankar Raj Lamichhane NEO, NMSS-Nepal Universal health care, also known as universal health coverage or social health protection, is a system organised around providing a specified package of benefits to all members of a society with the end goal of providing financial risk protection, improved access to health services and improved health outcomes. Germany being the pioneer of this system has acted as the ideal prototype to be adopted by all other nations. However, there are still many nations that lag behind and don’t realise its importance. It probably is due to the insincerity of the beholder of responsibility, lack of awareness regarding the same or simply due to ignorance of the governing authorities.

The Declaration of UN supports “Right to Health”. To protect the health of the citizens is the prime job of nation. It is because of healthy citizens that the nation progresses, a diseasestricken and disabled population would merely be a burden to the nation. The economic and social status of the countries would fail to improve over the years as the manpower in the country isn’t at its best, mainly because the governing authorities haven’t looked much into health. It is all the more important that this right is emphasised and spoken about in developing and under-developed nations.

Indeed, people here are lacking modern treatment and many of them die without proper diagnosis or proper care. Sometimes, even with the diagnosis people die because of the large fee charged by private hospitals for the treatment. There are hospitals dedicated to super specialisation treatments, but it is not an affordable option for most. Looks like health care is offered only to those with money here!

It is high time that we all took action and worked towards universal health care. Governments should try and work solutions by trying to provide free modern service to the general population. There should also be provisions of affordable health plans and insurances. We understand that the nation needs basic funds for initiatives like these. However, proper planning at the governing level should make some difference. The idea of universal health care can be ignited only from the society. The rich and the educated could probably join forces and establish community and charitable hospitals instead of world class malls. I’m not saying that we shouldn’t be open to globalisation or modernisation. All I’m suggesting is that priorities must be made and be implemented accordingly. We medical students have a major role to educate people about the aspects of health and development. We, the future doctors need to realise that this noble profession is to serve the people and the nation. We may not be able to make an instant impact at the government level by putting forth our suggestions, but what we can do is spread awareness now, cure people for minimal charges in future and probably, even be one of the governing authorities. As Mahatma

In countries like Nepal, where people face difficulties in meeting with the daily needs, health care, health insurance and health services affordability are way out of reach. Though there are hospitals run by the government, these are not sufficient and the facilities provided are not adequate. That is doctors, nurses, health worker are scarce and not qualified enough, modern medical diagnostic instruments are Gandhi said, “BE THE not available. In this case, there is a compulsion to diagnose the case by clinical examination. WANT TO SEE IN

CHANGE YOU THE WORLD!”

77

Health in Asia‘The first wealth is health’ is a famous quote said by Sir Emerson. Good health is a boon. It is the real jewel of life, the most precious possession of man. If a man losses his health, the world losses all its charms for him. The simplest and most traditional definition of health is that it is the freedom of sickness and diseases. According to World Health Organization (WHO), a branch of the United Nations, health is physical, mental and social well-being and not merely the absence of disease.

Next to life itself, good health is the most precious gift and is necessary for a purposeful existence. We live in a super-fast age. The Internet has shrunk the world dramatically and people are connected 24×7. Multitasking is the order of the day as we struggle to fulfill our responsibilities to everyone in our lives. They may include employers, parents, spouses, children, clients and many others. In this melee, too often we forget to spare time for ourselves. The stress levels continue to build up until one day a major collapse may make us aware that in all this frenzied activity, we have forgotten to take care of one important thing – our health. As we spend days shuttling between hospital and home, subjecting our body to one test after another trying to find out what has gone wrong, we are forced to remember that Health is indeed Wealth.

It was recognised that in both developed and developing countries, the standard of health services the public expected was not being provided.

The services do not cover the whole population. There was a lack of services in some areas and unnecessary duplication in others. A very high proportion of the population in many developing countries, and especially in rural areas, did not have ready access to health services.

Although there was the recognition that health is a fundamental human right, there was a denial of this right to millions of people who were caught in the vicious circle of poverty and ill-health. Against the above background, the 30th World Health Assembly resolved in May 1977, that the main social target of governments and WHO in the coming decades should be the attainment by all citizens of the world a level of health that will permit the people to lead a socially and economically productive life. This culminated in the international objective of ‘HEALTH FOR ALL’ as a social goal of all governments. Health for all was a holistic concept calling for efforts in agriculture, industry, education, housing and communications, just as much as in medicine and public health.

Acute modern-day threats such as H1N1 influenza and earthquakes threaten to destabilise fragile public health advances while deepening a gnawing sense of vulnerability. Chronic threats such as tobacco addiction, obesity, environmore mental pollution, and lack of access to care In 2008, lion people than 5 mil ific region riddle the public health landscape, exac-Pac in the Asia and erbated by profound health inequities. bacco use to m o fr d die moke, With the increasing trend in lifestyle tobacco s to changes leading to sedentary habits re u s o p ex eath rage of 1 d e v coupled with addictions like smoking a n r e a b r fo um nds. This n o c and alcohol abuse, and failure to obtain e s 6 ry in eve rtunately preventive health services, for example may unfo d e k ft unchec crease if le 50. by 20

88

hypertension control, cancer detection and management of diabetes, the risk for non-communicable diseases has increased. In 2008, more than 5 million people in the Asia-Pacific region died from tobacco use and exposure to tobacco smoke, for an average of 1 death every 6 seconds. This number may unfortunately increase if left unchecked by 2050. Now the serious concern is the use of tobacco by adolescents which needs a serious attention or else the continuation of tobacco use from such an early age puts people at a much greater risk of contracting non-communicable diseases at an earlier age. If not addressed effectively, the problem will increase pressure on healthcare systems in the future and cause health expenditures to rise in those countries.

Non-Communicable Diseases Today, non-communicable diseases (NCDs), mainly cardiovascular diseases, cancers, diabetes and chronic respiratory diseases, represent a leading threat to human health and development.

These four diseases are the world’s biggest killers, causing an estimated 35 million deaths each year – 60% of all deaths globally – with 80% in low- and middle-income countries. These diseases are preventable. Up to 80% of heart disease, stroke, and type 2 diabetes and over a third of cancers could be prevented by eliminating shared risk factors, mainly tobacco use, unhealthy diet, physical inactivity and the harmful use of alcohol. Unless addressed, the mortality and disease burden from these health problems will continue to increase. WHO projects that, globally, NCD deaths will increase by 17% over the next ten years. The greatest increase will be seen in the African region (27%) and the Eastern Mediterranean region (25%).The highest absolute number of deaths will occur in the Western Pacific and South-East Asia regions. We have the right vision and knowledge to address these problems. Proven cost effective strategies exist to prevent and control this growing burden. However, high-level commitment and concrete actions are often missing at the national level. NCD prevention and control programmes remain dramatically under-funded at the national and global levels and have been left off the global development agenda. Despite impacting the poorest people in low-income parts of the world and imposing a heavy burden on socioeconomic development, NCD prevention is currently absent from the Millennium Development Goals. However, in all low- and middleincome countries, and by any measure, NCDs account for a large enough share of the disease burden of the poor to merit a serious policy response, not forgetting the deaths due to accidents and

-Pacific Today by: Zebunnisa MSAI-India injuries. Of the 5.1 million deaths from injuries globally, more than onefourth are estimated to occur in South-East Asia, these statistics may increase by 2050.

Hence a holistic approach should be taken to prevent this problem from escalating; the most important factor being life style modification, and a more accurate estimation of these burdens, their risk factors, and time trends would help to better inform policy and to monitor change in response to public health interventions. Even at the current state of knowledge, however, the magnitude of the problem is large enough to demand urgent attention and action.

Communicable Diseases Developing and least developed Asian and Pacific countries are vulnerable to both non-communicable and communicable diseases. Since most of these countries have a relatively high proportion of deaths of young people (including children) which are often caused by communicable diseases, the figures for Years of Lost Life (YLL) due to communicable diseases are higher.

Noticeably there are five Asia-Pacific countries with an YLL of 60% or more for communicable diseases (Timor- Leste, Afghanistan, Pakistan, Papua New Guinea and Tajikistan). According to WHO, low-income countries currently have a relatively higher share of deaths from: (i) HIV infection, TB and malaria, (ii) other infectious diseases, and (iii) maternal, peri-natal and nutritional causes compared with high- and middle-income countries. Although these three causes combined pose a lesser burden than non-communicable diseases, they will remain important causes of mortality in the next 25 years in low-income countries.

Hence the main motto must be improvement in health facilities coupled with prevalence of disease with complete eradication by 2050.

Others Evidence from the World Health Organization suggests that nearly half the world’s populations are affected by mental illness with an impact on their self-esteem, relationships and ability to function in everyday life. An individual’s emotional health can

also impact physical health and poor mental health can lead to problems such as substance abuse. The importance of maintaining good mental health is crucial to living a long and healthy life. Good mental health can enhance one’s life, while poor mental health can prevent someone from living a normal life. “There is growing evidence that is showing emotional abilities are associated with pro-social behaviors such as stress management and physical health” (2010). It was also concluded in their research that people who lack emotional expression lead to misfit behaviours. These behaviours are a direct reflection of their mental health. Self-destructive acts like suicide may take place to suppress emotions. The other conditions which may affect the health and well-being of people may be disasters like earthquakes, cyclones, floods, nutritional problems, volcanic eruptions, fires, severe air pollution, epidemics, toxicological accidents, nuclear accidents and warfare.

An assessment of the health status and health problems is the first requisite which may involve morbidity and mortality statistics, demographic conditions of the populations, environmental conditions, socio-economic factors, medical and health services. These may pose challenges in coming future, but these challenges also present us with rewarding opportunities to implement effective population level and policy solutions to protect the gift of health. Moreover, we envision a new cadre of informed, prepared professionals committed to solving these and other increasingly complex problems.

Our collective responsibility is to focus our vision on educating the next generation of public health leaders and ensure that they are armed for success. We can nurture them at an early age, foster a commitment to prevention, and motivate them with the promise of our field for the next decade and beyond.

The challenges ahead are great, but the world has never been in a better position to dramatically improve global health. We have the tools to prevent many of the worst diseases; we have the scientific knowledge to develop new solutions; and we have growing political commitment and resources. Working together, we can save millions of lives, and change the world’s view of what’s possible.

99

What’s Up Asia-Pacific?!

First thing that comes to your mind when you hear the phrase ‘Universal Health Care’

Sujoy Ray MSAI-India NMO Publications Director

Availability of good health and health services for all-regardless of caste,culture, religion, race and economic condition.

Does your country apply this system?

Don’t know

Do you think they should implement it?

I am not sure whether it is implemented in my country, the situation varies from place to place but yes, of course it should be implemented. since there is so much diversity in terms of cultures,races,religions and so much of a difference in living standards, healthcare sometimes does fail to reach out to everyone.

What’s the greatest benefit of using Universal Health Care in your country?

Extends care to anyone, regardless of social status or bank account

What’s the worst issue with applying Universal Health Care in your country?

Possible corruption, back-room dealing

First thing that comes to your mind when you hear the phrase ‘Universal Health Care’

A system which can cover all people’s health, poor and rich ones. It will also increase people’s awareness to do some preventions toward diseases Does your country apply this system?

Not yet, but hopefully soon they will apply this system Do you think they should implement it?

Atikah Isna Fatya CIMSA-Indonesia RA SCORE Asia-Pacific

Yes, because this system has been designed to provide healthcare which can be reached easily by people. They don’t have to think twice to go to a hospital even when they lack of money. More importantly, this system encourages people to do some prevention towards diseases. This is great because preventative medicine is way better than curing the diseases What’s the greatest benefit of using Universal Health Care in your country?

Encourages patients to practice preventative medicine What’s the worst issue with applying Universal Health Care in your country?

Possible corruption, back-room dealing

10

First thing that comes to your mind when you hear the phrase ‘Universal Health Care’

The word equity instantly comes to my mind. At its very core, I believe UHC is still anchored on the principle of health equity Does your country apply this system?

Our president has just pledged UHC

Greco Malijan AMSA-Philippines

What’s the greatest benefit of using Universal Health Care in your country?

Extends care to anyone, regardless of social status or bank account What’s the worst issue with applying Universal Health Care in your country?

Health-seeking behavior of the ordinary, middle to low income class Filipinos

First thing that comes to your mind when you hear the phrase ‘Universal Health Care’

Everyone can live a life with smile, not thinking hard about daily diet, place to sleep and death Does your country apply this system?

Yes

Shota Yamamoto IFMSA-Japan NMO President

What’s the greatest benefit of using Universal Health Care in your country?

Medical profession can concentrate on healing patients rather than any financial issues What’s the worst issue with applying Universal Health Care in your country?

Reduces doctor flexibility, poor patient care

Random Poll What is the must-have-visited-place for summer holidays in Asia-Pacific?

Bali, Indonesia

11

e r a C h t l a e Universal H

The Indian Scenario

Health is the right of all. It is perhaps the greatest asset that a human can possess, far greater than wealth. Good health is a convenience often unappreciated and one does not realise its importance until illness strikes. But is it that easy to maintain health? With the continually expanding list of agents which can cause us harm it is almost impossible for anyone to maintain their own health. That is why we need healthcare in the form of doctors, nurses, pharmacists and people who have taken up the noble profession of safeguarding and restoring health for everyone. Since everyone has a right to health, access to healthcare is an important issue, to ensure that no one is denied this right.

It is important to look into how truly “universal” health and healthcare are. The situation varies depending on the setup.

Countries in the underdeveloped and developing world (particularly those in South Asia and Africa) would cut a sorry figure in this regard. Pregnant mothers do not get the requisite antenatal care and children do not have access to simple remedies. Medicines pertinent to diseases endemic in an area are sometimes not available.

Though it is the responsibility of the government and the medical personnel to see to it that appropriate healthcare should be available to everyone, all of society can play a vital role too.

Importantly, this includes the establishment of organisations that cater to the needs of the sick. The general public can assist by supplying the much-needed workforce. There are numerous examples where unqualified people or those with a basic level of education have taken up the reins of healthcare and have done wonders. These examples need to be brought out in the limelight so that they gain their due appreciation and serve as an inspiration to others to do the same.

In India, for instance, there are several programmes/initiatives that have been taken up.

With reference to providing better antenatal/maternal care two such initiatives are relevant. One is the introduction of ASHA (Accredited Social Health Activist). The word ASHA in Hindi language aptly translates to “hope”, as indeed these people (mostly women) are a source of hope to the public.

The ASHAs have good communication skills and are selected from the community/village/district etc. Their educational qualification is up to secondary schooling. Their responsibilities include: to educate women, provide basic drugs, and provide transportation to the sick people and pregnant women to the nearest health facility. They inform about births and deaths to

12

by: Sujoy Ray

the government and promote the construction of toilets and assist with sanitation. They also provide a monetary package to pregnant women that depends upon the setting – whether it is a rural district an urban one. (1) The second initiative is in regards assistance during childbirth.

There is a provision of local dais (traditional birth attendants), who are trained for a specified period and given a stipend. After the training, they get a certificate and a delivery kit. (2) Initiatives for children are yet another example of peoples’ involvement. The involvement of schoolteachers in eye care services is worth mentioning. Teaching children to adopt proper postures, keeping track of any complaints of poor visibility etc. are some duties performed by them (3). Schoolteachers can also measure weight of children and aid in the early detection of malnutrition.

Nutrition to schoolchildren is a vital point since children spend a significant part of their day in school. There are also community nutrition programmes, one of which is the “Midday meal programme”. It aims to supply a low-cost, easily prepared meal by using locally available components, as a supplement to the diet of the children during their time at school. Appropriate guidelines for the storage, cooking methods, nutrition balancing and preservation have been provided to prepare these meals. The menu is frequently changed to avoid monotony.

Under the Integrated Child Development (ICDS), some workers are employed who provide care to adolescents, preschool children and pregnant women. They work in areas called “Anganwadis” (the word “Angan” in Hindi means courtyard). (4) It is indeed heartening to see so many initiatives giving opportunities for the wider community to make a difference. Needless to say, they have justified the trust that has been placed in them.

REFERENCES 1.K. Park, Park’s textbook of preventive and social medicine-21st edition, “Health Programmes in India” pg. 407-412 2. K. Park, Park’s textbook of preventive and social medicine-21st edition, “Health Care Systems” pg. 839 3. K. Park, Park’s textbook of preventive and social medicine-21st edition “Epidemiology of chronic non-communicable diseases and conditions-blindness” pg. 373 4. K. Park, Park’s textbook of preventive and social medicine-21st edition, “Nutrition and health” pg.611-612

Universal Health Care

Thoughts from Idris Israel Oluwaseyidayo From ancient records to recent surveys, there has been a rapid and aggravating increase in the rate of poverty and mortality. This is due to incompetent medical services, inaccessible health care centres and, most importantly, financial hardship in getting medical care. It is the vision and desire of every nation to possess an outstanding and exceptional health care system, considering the fact that “Health is the key to sustainable development.” Therefore, all World Health Organization (WHO) member countries should have it in mind and make this a priority: the vision to improve on the health conditions of their respective countries and tackle poverty by escalating the provision of Social Health Protection. The New York Times published last year that the health care cost is rising twice as fast as inflation, and health insurance is becoming increasingly unaffordable for many employers and workers. For example, in the United States, a diminutive percentage of employers are offering health insurance benefits to their employees to pay a greater percentage of the costs, and that an increasing percentage (>50%) of people have no health insurance.[1] This has detached citizens from medical care.

Universal coverage describes a health care system organised to provide health care benefits to all members of society, with the end goal of reducing financial hardship, making health care services more accessible and improving health conditions. The following critical questions come to mind when we talk about universal health care: WHO IS COVERED? The vision is beneficial to everyone.

WHAT SERVICES ARE COVERED? Provision of free health care services.

HOW MUCH OF THE COST IS COVERED? The vision is to be responsible for the health care fee. While the richer countries struggle to keep up with the rising costs of technological advances and the increasing health demand of their population, low-income countries often have insufficient resources to ensure access to even the basic health care services.

WHO IS THE ORGANISER? WHO is enforcing and monitoring its member nations to take charge of the health of its citizens by organising and conducting this system to enable the realisation of the 2015 vision.[2] HOW CAN THIS BE ACHIEVED? I believe there are 10 factors that influence Universal Health Coverage. I have based these factors on the 10 facts on universal health coverage according to the WHO [3]: 1. By developing a health financing system which ensures that everyone has access to health services without the financial hardship of having to pay for them.

2. Essential health services should be available to all those that need them. For example, in some countries, less than 20% births are attended by skilled health workers, compared with almost 100% in developed countries. So, countries should have good facilities, environment and skilful workforce for excellent output to be achieved.

3. Prepaid funds (tax and insurance) should be used instead of individual payment.

4. Sharing the costs across the population; people should make compulsory contributions through tax and insurance which amasses to a pool of funds.

5. Advise all countries to continually seek more funds for health care.

6. National government should devote more money and make health a higher priority in their budgets.

7. Innovative ways to raise revenue should be considered.

8. All countries should finance their own system with their own domestic resources by 2015. With foresight, only 8 of the world’s 49 poorest countries would not be able to. Therefore, high-income countries should commit themselves to international development assistance schemes to help low-income countries.

9. Globally, 20%-40% of resources spent on health care are wasted due to de-motivated health workers, duplication of services, and inappropriate excess use of medication and technology. WHO has an active plan to support countries in developing good health financing strategies.

10. Finally all countries should do more towards universal coverage.

These are my thoughts on universal coverage.

REFERENCES: 1. Reed Abelson-New York Times(internet);New York: Health Care Cost And Utilization Report 2010 (cited september 19,2011).

Available from http://www.nytimes.com/2011/09/20/health/ policy/20health.html?_r=3 and http://www.healthcostinstitute. org/ 2.W.H.O (internet); Geneva; W.H.O-MDG 2015(May 2012).Available from http://www.who.int/features/factfiles/universal_health_coverage/facts/en/index7.html and http://en.wikipedia.org/wiki/ Millennium_Development_Goals 3.W.H.O (internet); Geneva; 10 FACTS ON UNIVERSAL HEALTH COVERAGE (May 2012).Available from http://www.who.int/features/ factfiles/universal_health_coverage/facts/en/index.html

Idris Israel Oluwaseyidaya, CPH(Jhshp), M.D(2015,DNMU) Editor, NiMSA, 2010/2011 Editor, IFMSA Global Magazine Initiative Pioneer President, OSUMSA, Nigeria

13

The 1st General Assembly of Bangladesh Medical Students Society Medical students are always seen studying at tables, hardly getting the time to socialise or interact with people. Yes, medical life is meant to be ugly and very hectic, which is why it is considered one of the most difficult and toughest academic courses one can choose. If you compare the life you get to have as an MBBS holder to an MBA Holder, the respect and love you get even from a stranger and not just not family and friends makes it a life apart. The only requirement is that you should be willing to devote yourself completely to it!

Is Bangladesh Medical Students Society (BMSS) just a Social Service Club with a big tag line for distributing certificates in return of some hours’ work or is it something more? BMSS is an arena where all the medical students of Bangladesh can work as ‘ONE TEAM’ and help to make our country free from the deadly diseases that pose a threat to Bangladesh and the world at large. BMSS believes in building individual leadership amongst medical students, who will transform the existing problems into solutions. As much as we want to make and build a better Bangladesh, what we want more is to build a better world. To make the world a safer and better place comes under the motto of BMSS ‘Famulus Clementia’ means ‘serving humanity’. It also provides the platform of interaction between medical students from different medical colleges of the country, and also with international organisations for cultural exchanges and bridging cooperation between them.

The 1st General Assembly of BMSS was held on 8Th June at Dr Anwar Hossain Auditorium of Bangladesh Atomic Energy Commission, Agargaon. Students from more than 10 medical colleges participated in the assembly. Some students even showed up from as far as from Khulna & Chittagong.

It was quite overwhelming for us. As soon as the registration started around 9am, delegates not in their usual “White

14

Apron” poured in like giant waves!

How does the injudicious use of drugs (especially when their use is not clearly indicated) affect our health? Sometimes we start taking drugs at our own risk and that sort of misuse/ overuse of drugs can be fatal for our health. Medicines are not as friendly as we take them to be. For a better insight into this serious issue Our Heart of the Day was Prof Shubhagato Chowdhury ,Director, BIRDEM, who has been researching in this area for the last five years. Medicines are the means for a stable health; this necessarily does not remove the fact, that they are catastrophic in wrong dosage. Antibiotics save untold numbers of human lives every day. Modern medicine depends on their ability to treat and prevent infections such as pneumonia and tuberculosis. Yet drug-resistant bacteria are spreading in the nation’s communities and too often antibiotics are taken in inappropriate quantities.

Subhagato Sir said “The history of antibiotics has repeated itself: drugs are discovered, but bacterial evolution can soon render them ineffective in treating infections. Resistance is fueled by injudicious use of existing drugs and compounded by a failure to develop novel ones” Diagonal disease is self-remedial, for instance we all get panicked when there is fever but we shouldn’t worry that much and give our immune system time to defend the body. Obviously medicine has a quicker response but the amount we take matters and given the time, our body will heal itself in its own way. Prof Shubhagato shared his lifelong experiences which certainly encouraged the aspiring doctors to be more responsible and careful when it comes to professionalism. Students also got to exchange their views on the matter and what can be done to prevent overuse of medicines and to spread awareness about it!

The main weapon against drug resistance is the interruption of malaria transmission by residual spraying but in certain problem areas this is not possible. In these areas little can be done when multiple-resistant parasites are present until better drugs are available.

ee Members of the Executive Committ th wi to ga ha ub Sh f Pro the interactive session BMSS and students in

The patient should be informed about the side effects of the drugs and told to report any signs or symptoms of drug related adverse outcomes. As a routine, it is better to tell the patients that no drug is entirely safe and that sometimes drug reactions can occur. It is always preferable to record any history of drug allergy in the case papers. Just as one cannot entirely avoid the side effects of drugs, one cannot entirely avoid the side effect of litigation, although it can be minimised by following the above basic precautions. The patients have to be aware about the side effects, which will be more helpful for the doctor and awareness can be the key here.

The emergence of resistance to these drugs is a worrying phenomenon with respect to malaria; it is such a widespread and deadly disease, that the consequences of failed treatment are very high. Resistance can be caused by many factors, at the level of the drug, the human host, the mosquito host and also the malaria parasite itself. For example, poor drug compliance during treatment can lead to a failure to clear an infection completely, allowing the remaining parasites, which were less susceptible to the drug, to survive and reproduce. With successive generations, natural selection will lead to the evolution of strains of malaria parasites which are firmly resistant to that drug. The same process occurs when mass drug administration programmes, for example in areas of high malaria endemicity, give people sub-therapeutic doses of medication (in other words, doses of the drug that are too low to kill the parasite). Another problem is when people are not checked for their infection status after having been treated for malaria; if treatment fails for some reason, they will still have parasites in their blood, and should be treated again to ensure that all the malaria has been killed. If this doesn’t happen, the parasites can carry on reproducing, as in the processes described above. For these reasons, it is crucially important for people to be given accurate doses of medication, to ensure that they complete the full course of treatment, and that once treatment has been completed, they are accurately tested as negative for the malaria parasite. Finally, there are factors related to the affinity of the malaria parasite to its vector mosquito hosts which can lead to the emergence of drug resistant strains.

The four hour long interactive sessions ended in glittering smiles with a new tagline “No action today, no remedy tomorrow”. The ideas and experiences we gathered from here will pave the way for our professional development, to be better, more caring and efficient professionals when saving lives is at stake.

Coming back to the General Assembly of BMSS, the new Executive Committee Council was elected for 2012 through the plenary session which was presided by the Central Committee and the Election Commission of BMSS. Being a member of the International Federation Of Medical Students’ Association, its Bangladesh Chapter introduced its New President Mr Muhtamim Chowdhury Zubin and Secretary General Mr Shihab Arefin Chowdhury.

Mr Zubin, The New President and the Sec. Gen Mr Shihab of BMSS Council interact with the delegates The daylong session ended with the big news – BMSS Central Executive Committee is going on regional trips!Yes, outside Dhaka, so medical students around the country watch out, we are coming to your college very soon!

We are visiting nearly 40 Medical colleges throughout the country to raise awareness of the issue amongst the doctors and carry out more workshops/symposiums where medical students and doctors get to interact face to face.

For more details, please visit our facebook page: http:// www.facebook.com/groups/bmss.members/ and our website: www.bmss.org.bd A special acknowledgement to all those who worked relentlessly for the event. Without your help, it would not have been such a successful one! My utmost respect to the Respected Seniors who were always there to guide us: Mr Shihab (You will never get bored!), Mr Muinul Islam (Our 1st Alumni), Dr Khondoker Moin & Mr Tanveer .

15

Standing Committee Updates -Pacific!

from Asia

by: Briliansy Mulyanto RA SCOPH IFMSA Asia-Pacific

SCOPH is a group of dedicated students from around the world, working on developing, implementing and improving public health in their communities and societies. It brings together medical students from all over the world to learn, build skills, cooperate, explore, and share ideas when it comes to addressing all issues related to public health. Now here we are fighting diseases, improving health, saving lives - thousands at a time!

Write for APRM Pulse!

Transitions 2012: Doctors-intraining changing the global health landscape of Asia-Pacific The deadline for article submisson is August, 31th 2012. So, don’t waste your time! Start thinking and writing now!

Articles should be sent as Word (.doc or .docx) file attachment:

da.pub.ifmsa.asiapacific@gmail.com Also if you have any questions please don’t hesitate to contact us.

by: Alessandro Alfieri RA SCORA IFMSA Asia-Pacific

SCORA is a student’s organisation from around the world, for those have a strong will to take an active part in prevention interventions concerning HIV and Sexually Transmitted Infections.

We aim to support people living with HIV and AIDS, aiming to decrease stigma and discrimination. Also we work towards improving sexual and reproductive health and right through peer education and trainings, advocacy and awareness campaigns for the benefit of the communities.

16

“And by the way, everything in life is writable about if you have the outgoing guts to do it and the imagination to improvise. The worst enemy to creativity is self-doubt.” — Sylvia Plath

Be a Part of Us! Pulse is IFMSA magazine for Asia-Pacific. Pulse is a way for medical students from very different countries to connect with each other and share their stories and opinions.

Fr om Asia-Pacif ic , acif ic, t o Asia-P Asia-Pacif ic! by Join us and become one of our:

Contributors — by writing any articles relating to theme, a health issue, an NMO updates, project updates, conference report, or anything else that matches our requirements.

Editors — by helping our editorial team to edit articles that have been submitted to us.

Proofreaders — by helping our proofreading team to proofread articles that has been submitted to us.

Respondents — by simply share your ideas, thoughts, opinions, projects, photos, or anything else in an informal way (less serious and lesser words than article) on our new segment called ‘What’s Up Asia-Pacific?!’.

Designer — by helping us to design the layouts for Pulse magazine.

Author Guidelines 1. Manuscripts are to be submitted via email to da.pub.ifmsa.asiapacific@ gmail.com as an attached electronic document.

2. The email should include the full name of the author (as they would like it to appear in print), their university and their NMO/Country.

3. The subject of the email should include the words “Pulse Article”, and the author’s name. A small photo of the author may also be submitted to accompany the article in print.

4. All articles must be written in English.

5. Articles should be no longer than 700 words and use standard type fonts (eg. Times New Roman, Calibiri).

6. Articles should have spelling and grammatical checking prior to submission, however as English is a second language for many in the region we have a team of proof-readers who can check your article and provide English and editing assistance prior to writing.

7. Photos and tables are encourages. These should be submitted separate to the article with a brief description. Photos taken from external sources must be referenced appropriately, and the author should have approval to use them. Photos should be sent as a separate attached file in .JPG form and in good resolution!

8. References to external publications are not necessary however if they are used then they must be references according to the Vancouver Referencing System. References must be cited in the sequential order in which they appear in the text. All references should be cited in text with a number following the reference. At the end of the article references should be numerically listed in the order they appear in the article.

Interested?

Contact our Development Assistant for Publications and Communications (Mariam & Airin):

da.pub.ifmsa.asiapacific@gmail.com 17

Algeria (Le Souk) Argentina (IFMSA-Argentina) Armenia (AMSP) Australia (AMSA) Austria (AMSA) Azerbaijan (AzerMDS) Bahrain (IFMSA-BH) Bangladesh (BMSS) Belgium (BeMSA) Bolivia (IFMSA Bolivia) Bosnia and Herzegovina (BoHeMSA) Bosnia and Herzegovina - Rep. of Srpska (SaMSIC) Brazil (DENEM) Brazil (IFMSA Brazil) Bulgaria (AMSB) Burkina Faso (AEM) Burundi (ABEM) Canada (CFMS) Canada-Quebec (IFMSA-Quebec) Catalonia - Spain (AECS) Chile (IFMSA-Chile) China (IFMSA-China) Colombia (ASCEMCOL) Costa Rica (ACEM) Croatia (CroMSIC) Czech Republic (IFMSA CZ) Denmark (IMCC) Ecuador (IFMSA-Ecuador) Egypt (EMSA) Egypt (IFMSA-Egypt) El Salvador (IFMSA El Salvador) Estonia (EstMSA) Ethiopia (EMSA) Finland (FiMSIC) France (ANEMF) Georgia (GYMU) Germany (BVMD) Ghana (FGMSA) Greece (HelMSIC) Grenada (IFMSA-Grenada) Haiti (AHEM) Hong Kong (AMSAHK) Hungary (HuMSIRC) Iceland (IMSIC) India (MSAI) Indonesia (CIMSA-ISMKI) Iran (IFMSA-Iran) Israel (FIMS) Italy (SISM) Jamaica (JAMSA) Japan (IFMSA-Japan) Jordan (IFMSA-Jo) Kenya (MSAKE) Korea (KMSA)

Kurdistan - Iraq (IFMSA-Kurdistan/Iraq) Kuwait (KuMSA) Kyrgyzstan (MSPA Kyrgyzstan) Latvia (LaMSA Latvia) Lebanon (LeMSIC) Libya (LMSA) Lithuania (LiMSA) Luxembourg (ALEM) Malaysia (SMAMMS) Mali (APS) Malta (MMSA) Mexico (IFMSA-Mexico) Mongolia (MMLA) Montenegro (MoMSIC Montenegro) Mozambique (IFMSA-Mozambique) Nepal (NMSS) New Zealand (NZMSA) Nigeria (NiMSA) Norway (NMSA) Oman (SQU-MSG) Pakistan (IFMSA-Pakistan) Palestine (IFMSA-Palestine) Panama (IFMSA-Panama) Paraguay (IFMSA-Paraguay) Peru (APEMH) Peru (IFMSA Peru) Philippines (AMSA-Philippines) Poland (IFMSA-Poland) Portugal (PorMSIC) Romania (FASMR) Russian Federation (HCCM) Rwanda (MEDSAR) Saudi Arabia (IFMSA-Saudi Arabia) Serbia (IFMSA-Serbia) Slovakia (SloMSA) Slovenia (SloMSIC) South Africa (SAMSA) Spain (IFMSA-Spain) Sudan (MedSIN-Sudan) Sweden (IFMSA-Sweden) Switzerland (SwiMSA) Taiwan (IFMSA-Taiwan) Tanzania (TAMSAz) Tatarstan-Russia (TaMSA-Tatarstan) Thailand (IFMSA-Thailand) The former Yugoslav Republic of Macedonia (MMSA-Macedonia) The Netherlands (IFMSA-The Netherlands) Tunisia (ASSOCIA-MED) Turkey (TurkMSIC) Uganda (FUMSA) United Arab Emirates (EMSS) United Kingdom of Great Britain and Northern Ireland (Medsin-UK) United States of America (AMSA-USA) Venezuela (FEVESOCEM)

www.ifmsa.org medical students worldwide