Issuu

PULSE

The IFMSA Asia Pacific Magazine March 2012

Youth and Social Determinants of Health

IFMSA

Imprint

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.

Publisher

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 Nationsâ€™ 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.

Editor in Chief Mariam Parwaiz, New Zealand Regional Co-ordinator Renzo Guinto, Philippines Editors Airin Aldiani, Indonesia Design/Layout Airin Aldiani, Indonesia Proofreading Mariam Parwaiz, New Zealand Airin Aldiani, Indonesia Theo Dapamede, Indonesia

International Federation of Medical Studentsâ€™ 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 A Message from the Regional Coordinator

Editorials

Theme Article: Act on Social Determinant of Health

6-7

Conference Report IFMSA Asia Pacific Region and AMSA-Philippines 8-9 hold Confab towards Transformative Medical Education 10 11

Putting Patientâ€™s Safety First

International Conference: 2nd Health Professional Education Quality

NMO Updates! 12

NZMSA Conference 2012 15

India

Role of Future Healthcare Professional in Advocacy and Policy

13-14

Social Determinant of Health

Write for our May Issue!

Be A Part of Us!

a message from the regional coordinator

Medical Students as

R.G. is your RC!

Social Determinants of Health Good day IFMSA Asia-Pacific family! I am deeply elated to open this issue of the Pulse that focuses on social determinants of health, as our region’s contribution to this year’s March General Assembly in Accra, Ghana, which will revolve around the theme

“Youth and Social Determinants of Health”

I am sure that most of our readers are aware that your Regional Coordinator has been involved in IFMSA’s work on social determinants since the very beginning. It was AMSA-Philippines, in partnership with the Norwegian Medical Students’ Association, that proposed the policy statement on social determinants of health and health inequity during the 2011 March General Assembly in Jakarta. Before I became Regional Coordinator, I was appointed facilitator of the Small Working Group on Health Inequities which led activities pertaining to social determinants, from the forum with Professor Sir Michael Marmot, the head of the WHO Commission on Social Determinants of Health, during our 60th anniversary General Assembly in Copenhagen, to the online educational campaign “Root Out, Reach Out.” These efforts culminated in our stellar presence at the World Conference on Social Determinants of Health in Rio de Janeiro last October. Now, after trying to tackle the many social determinants that affect people’s health, let me digress a bit and discuss us – medical students – as important social determinants of health. For months, we have been involved in campaigning for a social determinants approach to health, but we have not yet discussed ourselves as social determinants. Below I list three initial tips on how medical students can become powerful social determinants towards better health for all.

Reflect on what we think and do as medical students. We don’t notice it, but the things we do as medical students, from the way we study to the opportunities we use to apply theoretical skills, determine the health of our patients and the shape of the health care system. We will certainly carry the ideas that we cultivate as early as now, from our understanding of health and our beliefs on certain health issues such as the financing of health or the education of physicians, as we mature in the health system. Our attitudes towards patients even during internship may make or break their physical and even emotional well-being.One of WHO Commission’s recommendations is to start interventions early in life, and the same can be said for medical students – positive changes in mindset and attitudes should also begin ear-

ly in the medical career ladder; in short – in medical school.

Address the determinants that shape us. The “determinants view of health” recognizes that some determinants are affected by other determinants as well. Medical students are influenced by other factors, most of them seem large and difficult to tackle, such as the curriculum design in medical schools or state policies that govern deployment of medical students after graduation. Medical students must work hand in hand and become deeply involved in efforts that aim to transform policies in health care, from the way we produce our health workers to the way we deliver health services. Join the worldwide movement for action on social determinants. Oftentimes, we think that there are other chances in life for us to positively contribute to the world, and student life is not one of them. This time, you may feel discouraged because of a sense of inadequacy or burned out because of the voluminous reading materials, but you should never underestimate the capacity of young people to change communities and transform the world. Medical students should not miss this exciting opportunity to change the world for the better at such a grand scale. Today, more and more organizations from government, private sector, and academia are rising up to the challenge of closing the health gap in our generation, and IFMSA should also step into the ring. Some say that action on social determinants of health is beyond the confines of medicine. I always tell my fellow medical students that I am not asking all of them to become public health practitioners, but I am asking all of them not to partake in the further widening of health inequities.

We physicians are the “natural attorneys of the poor,” according to the great German physician Rudolf Virchow. It is unacceptable for us young doctors to surrender this noble responsibility and instead become accomplice in spreading health injustice.

Renzo Ramon Lorenzo Luis R. Guinto Regional Coordinator for the Asia-Pacific International Federation of Medical Students’ Associations

Editorial

Greetings, Kia ora, Salaam, Namaste, Ni Hao, Selamat, Konnichiwa, Sà-wàt-dee and Kumusta!

Welcome to the first issue of Pulse for 2012! Pulse is the official magazine of the IFMSA Asia-Pacific region. It comes out every two months and as always this issue is jam-packed with articles that will be of interest to our readers – the medical students from around Asia-Pacific! The theme for this issue is Youth and Social Determinants of Health, the same as the theme for IFMSA’s March Meeting in Ghana happening right now. The social determinants of health have been known for a long time. But the recent publications from the World Health Organization’s Commission on Social Determinants of Health have added new life into the cause and it is now gaining further momentum. As the youth of today, and future physicians of tomorrow, we have an important part of play in ensuring health equity for all. We have an excellent issue in store for you. Shela Putri Sundawa from Indonesia shares her thoughts on what we can do to act on the social determinants of health on page 6. Rennie Qin who is the Development Assistant for Advocacy, Policy and Education for IFMSA Asia-Pacific explains what advocacy means for our profession and how you can contribute. One great way is by joining the IFMSA Asia-Pacific Think Tank on global health advocacy.

We have three conference reports from recent events that medical students have attended in the Asia-Pacific region. If you’ve attend a conference or workshop recently, we would love for you to write about your experience for Pulse. NZMSA-New Zealand is hosting a conference in May and it is inviting international delegates to attend the event. You can read more about it on page 12. This issue we introduce you to one of our newest NMOs – India. Look out in upcoming issues for more NMO updates to hear about what is happening in the region. Pulse is your magazine and we value your contributions. There are many ways you can be a part of us. You can write an article for us, or help us as part of the editorial team, or you can contribute to our newest segment called ‘What’s Up Asia-Pacific?!’ This is an informal way to share your ideas and opinions with us. We want to hear from you and find out what is happening in your part of the region. As always, please feel free to email us, we love hearing from you! Until next time,

Mariam and Airin

Thanks to our contributors:

Mariam Parwaiz

Airin Aldiani

Development Assitant for Publications & Communications IFMSA Asia Pacific

da.pub.ifmsa.asiapacific@gmail.com

Rennie Qin, New Zealand Joanna Choa, Philippines Shela Sundawa, Indonesia Christopher Halimkesuma, Indonesia Ken Ip, New Zealand Pratap Naidu, India Rudolf Kuhn, Philippines

ACT!on Social Determinants of Health by Shela Putri Sundawa

One of these days I found an old book published by WHO in the year 1977 titled ‘Global Strategy Health for All by 2000’. As I kept reading the book, there were a lot of questions I could not answer. This is 2012 and I don’t feel like anything closer to health for all.

the year of 2021 the problem to seek for health care in every country is still the same as 35 years ago:, cold, hard cash. Primary health care which was declared as the fundamental cornerstone of health care in the Alma Ata declaration in the year 1978 has only done a half of its job. Why half? Because the main problem with From 1977 to 2012, if we talk about human beings, I be- primary health care is the lack of facilities. In a study lieve they have grown up to be adults right now. I was done by Gadallah et al., about patient satisfaction with only born in 1989 and now I’m a university student. So primary health care in Egypt, shows that patient satisfaclet’s imagine if this Global Strategy proposed by WHO tion is high for accessibility, waiting area conditions and was a human being, he would be 12 years older than performance of doctors and nurses while availability of me. He probably graduated from medical school, then prescribed drugs, laboratory investigations and privacy in continued to study cardiology and he’s a cardiologist the consultation room are unsatisfactory.2 This is the core right now. 35 years is a long time. However he might be problem which later will keep us away from achieving raised in a poor neighborhood. His dad was a drunk- health equity as one of Alma Ata declaration principles. ard and his mom left him when he was two years old. He never finished high school and his main job is drug National Social Economy Survey held in Indonesia redealer. One day police caught him and now he’s impris- vealed that only 34% of sick people will seek help by going oned. 35 years is a long time. Everything can change in to a primary health care facility, while 25% will directly go 35 years, change to be better or change to be worse. to a doctor practice, 10% to a hospital (public and private), and the rest (31%) will go to a non-medical practice. This One of the major changes in the world during the last 35 data shows that primary health care is still not the choice of years is the population. From 1975 to 2000, the popula- most people. There are still a lot of people who will seek nontion in South East Asia Region increased by 61%. It means medical treatment for their diseases. The inequity is there. by the year 2000, every country in South East Asia re- The main barrier to be considered in this problem is probgion should have increased every public facilities, food, ably the health care system of the country. Countries like housing, clean water, and etc to accommodate the 61% Indonesia where out-of-pocket increase.1 Failure to provide them might contribute a new spending accounts for population problem which can lead away from achiev- more than a third of all There are still ing health for all by 2000. How can a country provide health spending, a lot of people w health for all if it cannot contend people’s basic needs? has an overall

still se

ek help t wide accepto n medical The other population problem which needs to be focused ance to use treatmen on t for on is the changing population proportion. Population less private sector their dis e than 15 years of age has declined 8% from the 1975-2000, providers for a ases. while population aged 65 years and above has increased range of health 1.2% in South East Asia.1 This proportion changing can be services and expected to shift the health problem from communicable products – even diseases to non communicable diseases (NCDs). Of the among the poor57 million global deaths in 2008, 63% were due to NCDs. est socioecoIndeed, it is one of the barriers to achieving health for all. nomic groups. These people do not covered by any kind of health When WHO proposed health for all by 2000 in 1977, insurance. Ironic, isn’t it? Compared to UK who apply they dreamed that health issues would be integrated with national health system and provide national insurance for other policy such as, the economy. However until today,

The ine quity is there.

”

all of its citizens,3 the inequity about seeking whether to use medical treatment or non-medical treatment is never a problem. To further compare the health indicator between these countries shows that from infant mortality, maternal mortality and life expectancy UK is ahead of Indonesia. However, since 1977 until today there are also a lot of things that have been achieved. The expanded programme on immunisation has succeeded to decrease the number of infant mortality by protecting children from polio, measles, diphtheria, pertussis, TB, and tetany. Some countries have considerably strengthened their health services, establishing a network of facilities and making health care available close to where people live. Also, the success treatment of TB, which once

time. Perspective of social determinants of health is not a new approach, as the Alma Ata Declaration implied it in the Primary Care Strategy. However, a lot of improvement is still needed to develop the programme. The main barrier to get a proper health care is finance. Primary health care has solved the problem since the health care is very cheap. However many of the primary health care services still lack facilities and human resources. In Indonesia, primary health care in a remote town, for example Jayapura, only has 22 general practitioners whereas in Jakarta, the capital city, there are 12,000 general practitioners.5 This example shows how health care is not well distributed in Indonesia. This condition might be not much different in similar continental country like Philippines.

What can be seen from here might be the spirit to eliminate health inequity and disparity that has been existed since a long time ago. declared as global emergency by WHO, has been in- The availability of the health care is merely one of the creased by 50% than earlier before DOTS implementation. important factor of social determinants of health. However there still not enough solutions for this problem. I Indeed there are a lot of things that has been achieved if don’t want to blame the government since they already we look back to 1977. But still, there are a lot of things that had so many programmes to attract health care providneed to be done. The core principles declared in the Alma ers especially physicians. As a medical students and a Ata declaration still remain a principle that has not been future health care provider, we should have some awaresuccessfully applied, Universal access and coverage on ness and aim to not only work in a big famous hosthe basis of need; health equity as part of development pital but also to have some will to foster the health of oriented to social justice; community participation in defin- every people including them who live in remote areas. ing and implementing health agendas; and intersectoral approaches to health.4 Back in 1978, member states who I believe that in our deepest of hearts we still have the good joined this declaration all agreed and did not object to what will of why we want to be a doctor: to help people. Not was declared. However 35 years from the declaration, only people in a big city but also people in remote small the implementation for this declaration can hardly be seen. islands that are far away from our hometown. What’s the Health inequity and disparity still exist around the world. good of educating people who are already smart? What’s the good of offering some medical advice to those who alWhat can be seen from here might be the spirit to eliminate ready have a private doctor? Let’s do the real act on social health inequity and disparity that has existed for a long

Let’s do the real act on social determinants of health! References 1. South-East Asia Progress Towards Health For All 1977-2000. World Health Organization Regional Office for South-East Asia. New Delhi: Facet. 2000. 2. Gadallah M, Zaki B, Rady M, Anwer W, Sallam I. Patient satisfaction with primary health care services in two districts in Lower and Upper Egypt. La Revue de Santé de la Méditerranée orientale, Vol. 9, NO 3, 2003. 3. Health care system in transition. United Kingdom. 1999. 4. World Health Report. Health system: principle integrated care. World Health Organization. 2003 5. Database Puskesmas. Departemen Kesehatan RI. Avalaible in: http://www. bankdata.depkes.go.id/puskesmas/public/report/

Shela Putri Sundawa Marketing,Campaign and Advocacy Director 2011-2012, CIMSA-Indonesia Global Cancer Ambassador for Indonesia IFMSA SWG on Health Disparity and Inequality IFMSA SWG on NCD

IFMSA Asia Pacific Region and AMSA-Philippines hold Confab towards Transformative Medical Education by Rudolf Kuhn “The remedy against... epidemics... in the future is, therefore, very easy and simple: education, with its daughters, liberty and prosperity” It must have been a realization short of epidemic proportions when Dr. Rudolf Virchow, renowned physician and statesman, dubbed as the father of social medicine, foretold already as early as 1890 the vital role social medicine would play as cure for epidemics.

Many years later, to be exact, on 19-21 December 2011, under similarly auspices probably, a trailblazing grassroots conference was held at the University of the Philippines Manila that sought to tackle global health problems on a local perspective.

The first day covered a lecture on the “Foundations of Global Health” by Ramon Lorenzo Luis Guinto, IFMSA Regional Coordinator for the Asia-Pacific and over-all coordinator of the said workshop-conference, which laid down the basics for the following days of the conference. The lecture provided an overview of the history of global health and defined certain key principles of human rights, social determinants of health and equity. Guinto, in his lecture, pointed out that social determinants of health were an important, but often neglected, aspect in the cause of human disease leading to systematic inequities.

With the theme ”Towards a Transformative Medical Education for a Healthy Asia-Pacific Future” the workshop-conference aimed to allow participants gain a deeper understanding of global health issues and trends, specifically the emerging disparity between the traditional curricula of medical schools and the health needs of the community they were intended to serve.

The next two lectures, delivered by Dr. Marilyn Lorenzo, former director of the Institute of Health Policy and Development Studies of the Philippines’ National Institute of Health, dealt with the mismatch between the needs of rural communities and the tertiary-care geared competencies of graduates produced by many of the medical schools. Lorenzo also noted the health inequities in the Asia Pacific region.

Gathering nearly 50 participants and volunteers from more than eight medical schools in the Philippines and from the Krishna Institute of Medical Sciences University in India, the three-day workshop-conference, coorganized by The Think Global Initiative and the Asia Pacific Region of the International Federation of Medical Students’ Associations (IFMSA) and the Asian Medical Students’ Association (AMSA) – Philippines, was jampacked with various topics on the global health situation, the current health workforce crisis, social determinants of health, social accountability and student advocacy.

The afternoon, meanwhile, provided a chance for the participants to gain a firsthand glimpse of the workings of the local seat of power and prestige, the Western Pacific Regional Office of the World Health Organization (WHO). Dr. Rodel Nodora, Technical Officer for Human Resources for Health, discussed in his lecture the role of the WHO as “health conscience” of the region. He also elaborated on some of the key findings of a landmark study that appeared in the 2010 issue of The Lancet seeking to scale-up health profes-

sions’ education to the demands of the times through multi-sectoral instructional and institutional reforms. The afternoon at the WHO also allowed for some light moments as the participants were allowed to lounge like the health ministers of the region in the oval session room. The next day’s scorching morning heat did not stop participants from visiting Gawad Kalinga, a community development project. In their visit, participants learned about healthcare delivery in those impoverished areas and how understanding and learning from the felt-needs of the community is the key in establishing effective projects towards sustainable self-reliance.

“

social determinants of health were an important, but often neglected, aspect in the cause of human disease leading to systematic inequities.”

The lecture series continued at the University of the Philippines, where Dr. Ramon Paterno, research faculty at the Institute of Health Policy and Development Studies of the National Institute of Health, delved further into the social determinants and inequities of health. He also discussed in his second lecture an approach towards universal healthcare plans in the Asia Pacific and emphasized learning from success stories of one’s neighbour countries; specifically, he mentioned Thailand’s booming healthcare sector. He concluded his lecture on a thought-provoking note, asking participants, “What good it is to treat diseases only to bring our patients back to the conditions that made them sick?”

The last set of lectures by Dr. Elizabeth Paterno, director of the University of the Philippines (UP) – San Juan, Batangas Community Health Development Program, and Prof. Jusie Lydia Siega-Sur, dean of the UP School of Health Sciences, contained selected lessons on the role of community partnerships – and not mere charity projects – in transforming medical education. Prof. Siega-Sur, furthermore, shared from her experiences as member of the Training for Health Equity Network (THEnet) which recently formulated the “Global Consensus on Social Accountability of Medical Schools,” a thematic approach that seeks to enhance medical schools’ responsiveness to the health needs of society and tackle the continuing brain-drain issue faced especially by many developing countries, such as the Philippines, by a number of measures, including a step-ladder curriculum in health professions education. The said stepladder curriculum banks on tight community integration in ensuring the continuous commitment of their health professionals and allowing them to seek further professional growth as midwifes, nurses and eventually Doctors of Medicine. The successful curriculum has recently been also replicated in other countries such as Timor-Leste. The last day fittingly concluded with an interactive workshop allowing participants to share their opinion on the current status of medical education in the country and transforming education towards being responsive and responsible 21st Century physicians. During the workshop, plans were made to engage in a dialogue with the Association of Philippine Medical Colleges, a network of the country’s medical schools, to air the student-participants’ perspectives about the future of medical education. Of course, none of the lofty plans should remain just that – elusive and neatly stacked on some drawing board – therefore, the participants vouched for their continuous commitment in a symbolic ceremony. The said event is thus expected to stir many more ripples and be truly transformative.

Dr. Edgardo Ulysses Dorotheo, project director of the Southeast Asia Tobacco Control Alliance (SEATCO), meanwhile, shared out of his rich experiences at SEATCO in advocating smoking cessation. His anti-smoking campaign also recently won him the 2011 Judy Wilkenfeld Award for International Tobacco Control Excellence. Dorotheo also encouraged students in starting their own advocacies with the help of a “9 Advocacy Questions” approach developed by SEATCO.

PUTTING PATIENTS’ SAFETY FIRST by Joanna Marie D. Choa

(Manila, Philippines) – The World Health Organization (WHO) recently launched the very first Multiprofessional Patient Safety Curriculum Guide starting here in the Western Pacific Regional Office in Manila. This auspicious event was attended by leading professionals and deans of schools from the fields of medicine, pharmacy, nursing, dentistry, and midwifery. AMSA-Philippines was privileged to be part of the guest list in the said event. The current president of AMSA-Phillipines Joanna Marie Choa and former External Vice President Miguel Dorotan attended the event, representing the voice of the medical students in the country. Held on 19 October 2011 at the world-class Marriott Hotel in Pasay City, this launching programme-workshop was under the initiative of WHO Western Pacific Regional Office (WHO-WPRO), in cooperation with the Philippine Alliance for Patient Safety (PAPS) and the Philippine College of Surgeons. Distinguished guest speakers and health officials from different countries such as Japan, Vietnam, Singapore, Cambodia, Laos, China, and many others, also graced the event and shared their insights regarding the policies governing patient safety.

AMSA-PHILIPPINES Representatives Joanna Choa and Miguel Dorotan with representatives from the medical field

Dr Hans Troedsson, Director of the Division of Programme Management WHO-WPRO, inspired the audience with a passionate welcome address. This was followed by messages from the Department of Health and from the Commissioner on Higher Education Professor Nona S. Ricafort. Sir Liam Donaldson, envoy for patient safety of WHO, sent in a video clip of his message for this event, focusing on the aims of the formulated workshop and sharing his vision for the outcome of this event. Notable specialists on the field of patient safety and the key persons who formulated the curriculum were Dr Agnes Leotsakos from the Patient Safety Programme WHOHQ in Geneva, Prof Merrilyn Walton from New SouthWales Australia, and Ms Stephane Newell represent-ing the WHO Patients for Patient Safety. They discussed important points and issues regarding the incorpora-

tion of the guide into each healthcare field’s curriculum starting at the earliest possible year of study. Aside from focusing on the benefits and advantages of having introduced the topic at a very early stage, the speakers also gave much emphasis on how to tackle the limitations, obstacles, and difficulties that may arise from it. Pledges from the participants were sought and acquired as each representative was requested to sign the proclamation supporting the curriculum. Closing the morning session with a concise summary was Dr Madeleine Valera of the WHO-WPRO Patient Safety Programme. The afternoon session was dedicated to a focused group workshop and discussion on the opportunities and obstacles to implementing the multidisciplinary patient safety curriculum. Strategies on how to enhance opportunities and how to overcome the obstacles were also brainstormed by each group of professionals. Participants were divided into their own fields and subsequently presented their outputs to the assembly, and were given opinions and comments from the experts. Interactive discussions and learning from the key promulgators of the curriculum was also done by each group. WHO Representative in the Philippines Dr Soe Nyunt-U gave the concluding message to the program and left the crowd with motivating messages to take home with. It was a truly enriching experience for all the professionals convened in this very successful event and was a good opportunity to share ideas with colleagues from the different healthcare professions that were in attendance. Advice for students from attending this event is to put the needs and safety of their patients as the top priority, and to be careful and focused on what they are doing in the hospital.

For more information, visit the website: http://www. who.int/topics/patient_safety/en/

AMSA-PHILIPPINES Representatives with professionals from the fields of medicine, dentistry, nursing, pharmacy, and midwifery

Report from 2nd Health Professional Education Quality International Conference

by Christopher Christian Halimkesuma From 3rd to 5th of December 2011, the 2nd Health Professional Education Quality (HPEQ) International Conference was held in Bali, Indonesia. This 2nd HPEQ International Conference is a part of HPEQ Project which is supported by Ministry of National Education, Republic of Indonesia and World Bank. This conference was attended by policy makers, deans, lecturers, and students from all across Indonesia’s health professions’ faculties. There are seven groups health of professions in the HPEQ Project: medicine, dentistry, public health, pharmacy, nutrition, midwifery, and nursery.

Center of Indonesia Medical Student Activities (CIMSA) represented Indonesia’s medical students at this conference. CIMSA members who attended this conference joined “Student Session” with other students from other health professions. Together, they were called the HPEQ Student. Parallel to this session, policy makers, deans, and lecturers attended their own sessions based on their professions, such as “Medical Sessions”, “Dentistry Sessions”, and other sessions. Of 150 students who attended the “Students Session”, 33 of these were from CIMSA. Futhermore, there was 2.000 participant who attended this conference. The “Student Session” was officialy opened by a representative from Indonesia’s Ministry of National Education and World Bank on December 3rd 2011. Then, Samuel Josafat as the chief from HPEQ Student give a report from last year’s conference and the progress of HPEQ Student in 2011. (Samuel Josafat served as CIMSA’s Liaision Officer for Ministry of National Education in 20092010 and Vice President of External Affairs in 2010-2011.) This year “Student Session” discussed two topics, which were curriculum accreditation and interprofessional education. Curriculum accreditation was presentated by Robert Duvivier, while interprofessional education was presented by Sarwo Bekti, MD and Mr. Mariyono Sedyowinarso. After each presentation, there was discussion and role play about the topics that were discussed. (Robert Duvivier served as Vice President of the European Medical Students’ Association in 20062007. In 2008 he was elected Liaison Officer on Medical Education issues to the executive board of the International Federation of Medical Students’ Associations (IFMSA). In this capacity he represented medical students on the executive board of the Association for Medical Education in Europe (AMEE) and on the executive council of World Federation of Medical Education (WFME). He worked with the World Health Organization (WHO) in their Reference Group on Medical Education as expert consultant in 2010. Sarwo Bekti, MD is lecturer in Faculty of Medicine Brawijaya University, Indonesia and member of Indonesia’s Medical Education Association. Mr.Mariyono Sedyowinarso is lecturer in Faculty of Medicine Gadjah Mada University, Indonesia.) Main idea of the discussion about curriculum acreditation was “What is role of student in cur

riculum acreditation?” Nowadays, Indonesian education uses competency-based curriculum and student-centered learning. Based on this method, students must act as a subject of education, not as an object of education. However, students’ participation in curriculum in Indonesia still relatively low. Policy makers and many faculties in Indonesia stiil do not involve Indonesian students, during curriculum making, implementation, and evaluation. During this session, we took a look at European Medical Students’ Association which produced European Core Curriculum – Students’ Perspective in 5th International Follow-Up Conference on the Bologna Process in Medical Education, which was held in the United Kingdom in 2006. This declaration later accepted by the United Europe as a part of their policy and nowadays, many European countries, based on this policy, enter students’ participation in curriculum development. This experience which was told by Robert himself was really inspiring and gave us a role model about student contribution in their education, especially curiculum development. In discussion about interprofessional education, we had a discution and role play about “How interprofessional education (IPE) be executed in real situation?” Currently, health professions’ education in Indonesia still doesn’t include IPE in their curricullum, meanwhile in real-life situations they must work together. So, in this session, students tried many models in which IPE be executed, such as joint lectures, case discussions, joint practicums, etc. The conclusion is there are still many models and systems about how IPE can be implemented in curriculum, but it’s very important to include IPE in health professions’ education. That’s all that Indonesian health profession studentshave done in the “Student Session” at the 2nd HPEQ International Conference. The end of this conference wasn’t meant that the “work” has been done, but it’s just the start of the “journey”. Indonesia’s health professions’ curriculum is still developing, but I am sure that this conference is a good start for the development. All we need is the experience and the opportunity.

Christopher Christian Halimkesuma University of Indonesia Liaison Officer for Ministry of National Education - CIMSA Indonesia

New Zealand Medical Students’ Association

A S M NZ presents:

The New Zealand Medical Students’ Association (NZMSA) is excited to announce that applications have now opened for international medical students to attend the largest and most ambitious event in NZMSA history - NZMSA Conference 2012: Catalyst for Change. The annual Conference began in 2006 as the Medical Leadership Development Seminar, but has since broadened in its breadth and scope to become the flagship event of the NZMSA, and the highlight of the New Zealand medical student calendar. In 2012, 240 medical students from New Zealand and the Asia-Pacific will be selected with one common goal; to unite together and work towards becoming the instruments of change in our generation.

An inspirational academic programme has been built around the five main pillars of Clinical Leadership, Healthy Equity, Global Health, Professional Well-Being and Community Empowerment. Featuring keynote presentations and interactive breakouts by speakers from across New Zealand and the globe, delegates will be encouraged to re-evaluate their privileged positions as the future leaders of the health profession; and to realize that our duty as physicians in the 21st century is not only to provide care for our patients, but also to be the leaders in taking action towards securing better health and wellbeing for our local and global communities.

The 2012 NZMSA Conference will be hosted from May 18th-20th in Rotorua - the tourism capital and cultural hub of New Zealand. It is an ideal opportunity for international students to travel to New Zealand and enjoy the breathtaking landscape made world-famous by the Lord of the Rings trilogy. The registration cost is approximately NZD$200 and will be finalised upon receipt of application. This covers accommodation on 18th-19th May, most meals and entry to an unforgettable social programme showcasing the best that New Zealand has to offer.

“Be the change you want to see in this world” — Mahatma Gandhi

NZMSA Conference 2012 will challenge you to contemplate what you will aim to achieve with your knowledge; in your career, and in your life.

We look forward to welcoming you to Rotorua, New Zealand! Applications for international students have now opened and will close on March 27th, 0:00 (NZST). For more information on the application process, please visit — http://conference.nzmsa.org.nz/international-applicants

NZMSA Conference 2012: Catalyst for Change Date: 18th-20th May 2012 Location: Rotorua, New Zealand Website: http://conference.nzmsa.org.nz Email: conference@nzmsa.org.nz

Say Hello to....

MSAI - India Medical Students’ Association of India (MSAI) is not merely a random association in the Republic of India, but an association that many medical students need and dreamt about. MSAI is designed in such a way that it mirrors IFMSA as a whole and at the same time brings all the Indian Medical Students under a single umbrella. MSAI prioritises events that are not only beneficial for the organisation itself, but also for the citizens of India.

last December even though we were just a NMO candidate for IFMSA. In the upcoming time, we will be hosting our first International Interactive Workshop with the theme of, ‘Global Health &Medical Education, for Better Public Health Standards in Developing Nations - Towards a Better Tomorrow’ for which we have confirmed participation from 6 countries so far and looking forward for more.

We are very excited about our candidature as an 18 months ago, the word IFMSA was quite unfamil- official NMO of IFMSA on March Meeting 2012. iar until Tani Kahlon from IFMSA Grenada intro- We are very optimist that the Republic of Induced it to us. Honestly, we were skeptical about dia will make it this time and will continue enits existence in India and the idea of establishing during its hand of support to all other NMOs in it just died down. Not long after that, we received IFMSA. We are looking forward to meet all of another email from Mariette, a student from Tamil you in Ghana and lastly as the saying goes ‘AthiNadu State in India, which was so inspiring and ti Devo Bhava’ which simply means Guest is since then there was no turning back and we have God - we welcome you to the Republic of India…! worked tirelessly towards our objectives and aims. Within months, we came up with what we call as ‘The Executives’ and started building our team (which has the cream of students). Today, we have spread the word of IFMSA and MSAI to almost every corner of the country and right now we have almost 4000 medical students as members from 92 different medical schools across India. Some of our recent milestones include our interview by Student -BMJ which featured in last October’s SBMJ. We have organized numerous events and workshops in India in favour of public health and also sent two delegates to the ‘Think Global Workshop’ in Manila

I chit Adhikari, MSA Kuldeep Shah & Ar ink Global Manila delegates for Th

y t i u q E h t l a e H l a b o Gl

in l a n io s s e f ro P re a c h lt Role of Future Hea Advocacy and Policy by Rennie Qin

Advocacy is not an unfamiliar concept to the medical profession. Physicians, by nature, act as advocates for individual patients taking extra steps to look after their health needs. Indeed, our profession never keeps us far from engaging in policy, as we have done so many times in the past, advocating for harmful health effects of cigarette smoke, nuclear weapons, ozone depletion and leaded petrol. As global health inequity continues to grow in recent decades, it becomes ever more important to recognize health as an essential human right and to realize the underlying social determinants that violate this right.1 This shift in our reality and thinking calls for a movement from individual and single-issue based advocacy to collaborated public advocacy for the root causes of poor health.

As young people, we are much more attuned to the unique social, economic and environmental problems that face our society in the 21st century. Few others possess the same energy, ideas and passion for social change. Our values and thinking ultimately shape that of the future society. Over the past centuries, the values of our society has changed drastically through anti-slavery, civil rights, anti-apartheid, women’s suffrage movements and more. The liberalization and enlightenment of today is the human right-based movement of development and global health equity. In his theory of social change, German philosopher Hegel suggests that the status quo ‘thesis’ will encounter an ‘anti-thesis’ converging to a new status quo – the ‘synthesis’. Development and global health equity is the ‘anti-thesis’ As future healthcare professionals, we witness suf- reaction to the global order of today. It is a tide of ferings daily and inevitably come face-to-face with change. And young people are at the fore-front of it. the shadowy, oppressive and omnipresent social determinants that hide behind and stage pathologies. There is a compelling call for future healthcare professionals to not only be excellent clinicians but also instigators of healthy social and political change, curing pathologies of society. As Virchow puts it, ‘Physicians are the natural attorneys of the poor and social problems fall to a large extent with their jurisdiction.’ Medicine is a social contract and we hold social accountability.2 The American Medical Association defines physician advocacy as ‘action by a physician to promote those so-

cial, economic, educational, and political changes that ameliorate the suffering and threats to human health and well-being.’3 The rationale for medical student ad-

vocacy is many-fold. Firstly, we have responsibility as future doctors and as youth. Secondly, we are trained in evidence-based, precise and scientific thinking. Lastly, as future doctors we possess public trust, access to policy maker and a certain leverage in influence.4

“Physicians are the natural attorneys of the poor and social problems fall to a large extent with their jurisdiction.” Virchow

Achieving global health equity is impossible without addressing the underlying international economic governance, political governance and structural injustice. It is a problem too grave for healthcare professionals to ignore and just leave to our policy makers and economists. It is a problem too urgent for youth not to step up as leaders today. Fortunately, today’s young doctors and students’ like to ‘span between the world of rich and poor’1, to ‘have fire in their bellies [for advocacy]’.

is to add an advocacy theme to these work. The initial step we must take is to equip ourselves with academic knowledge of global health problems and skills in campaigning, advocacy and policy. As young people, we will do what we are best at – taking innovative actions and creative stunts to mobilize the public and media. We will call for the inclusion of global health and advocacy training into medical school curricula and internship programs. We will use our skills and knowledge in focused advocacy on a wide range of health issues. We will run high impact advocacy camThe problem, therefore, is how. How do we achieve paigns and engage stake holders to create concrete sohealth professional advocacy? First of all, we have to cial, political and institutional change. We will create recognize that medical students already have a pen- a culture of advocacy leading to global health equity. chant for community work and charity, all is needed

As the 1st ever DA for advocacy, policy and education, I will work hard to set up a lot of the groundwork for these goals. Excited about advocacy? Join the Asia-Pacfic Think Tank which will lead our region's eforts in global health advocacy.

”

Rennie Qin is a 2nd year medical student from the University of Auckland, New Zealand. She is DA for advocacy, policy and education for IFMSA Asia-Pacific, Medical Students for Global Awareness MSGA Auckland coordinator and climate change campaign national coordinator. She is passionate about global health, advocacy, environment, development and travelling.

References 1. Farmer PE, Furin JJ, Katz JT. Global Health Equity. Lancet; 363(9423):1832. 2. Wen LS, Greysen SR, Keszthelyi D, Bracero J, de Roos PDG. Social Accountability in Health Professionals’ Training. Lancet; 378(9807):e12-3. 3. Association AM. Declaration of Professional Responsbility: Medicine’s Social Contract With Humanity. 4. Earnest MA, Wong SL, Federico SG. Perspective: Physician advocacy: what is it and how do we do it? Academic Medicine; 85(1):63-7.

The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries. So it’s our responsibility , young people as the agent of change to

Act on Social Determinant of Health!

for the brighter future, for the better world!

Write for our May Issue! Theme: Climate Change and Health

“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.”

The deadline for article submisson is April, 8th 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.

-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 , cif ic, t o Asia Pa 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 — Starting in our next issue, we will provide a new segment called ‘What’s Up Asia Pacific?!’ and you can simply join us to share your ideas, thoughts, opinions, projects, or anything else throughout the region in an informal way (less serious and lesser words than article). This segment will contain polls, opinions, and photos that have been submitted online by people all over the Asia Pacific region.

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):

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