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NEWSLETTER Newsletter Volume 34/no. 1/July 2016

In this issue, among others: • Kick Ebola Out - p 16 • The Art of Being Born - p 18 • Students Workshop - p 27

Editorial Dear Readers,

It’s time to say thank you and goodbye! Six years ago I felt honored and glad to accept the challenge of editing the Newsletter, although communication was not one of my core activities at that time. Twelve Newsletters later I can say it has been an exciting and very rewarding experience. Taking part in the various conferences, interviewing competent speakers and looking for interesting topics in articles, was very inspiring and enlightening! The nicest part of the job was being able to meet so many of you and listen to your amazing stories. But I would never have been able to do it on my own! That is why I would like to sincerely say thanks to all contributors showing their expertise in so many wonderful articles, thank you Amy and Anja for the finishing touches in language and lay out! And of course thank you all for reading and distributing the newsletter to the target readership! I hope the newsletter will continue giving expert evidence of what The Network: TUFH ultimately stands for: a network of wonderful people and all the tremendous professional work they are performing! I’m very confident that our new office in Philadelphia will keep up the good work. Good luck to all of them! Goodbye and for the very last time … … enjoy your reading!

Julie Vanden Bulcke, Editor

In the Newsletter we refer to The Network: Towards Unity for Health as The Network: TUFH.


Contents Foreword 3 Message from the Secretary General

The Network: TUFH in Action 4 Annual International Conference 4 Preview next conference 5 Education for Health

Looking forward to Shenyang Exclusive Preview of the 2016 Shenyang Conference in China Efh featuring Arun Jamkar

Improving Health 6 7 8 9 10 12 13 14 15 16

Care for the Elderly Health Promotion Health Promotion Women’s Health Mental Health Health Services Health Services Health Professions Integrating Medicine and Public Health Great Stories from Great People

Fighting Malnutrition in the Elderly Awareness on Environmental Sanitation in Nigeria Health Promoting School Project in India Men’s Perceptions Related to Maternity Services in India Promoting Mental Health through Educational Counselling The Community Pharmacy Network in Nicaragua Community Outreach Centers in Pakistan - Moving beyond cure Impacting Communities through Internship in Uganda Health and Hygiene Project for Syrian Refugees in Lebanon Kick Ebola Out

Projects That Work 17 18

Improving Health of Women in Garment Industries The Art of Being Born

International Health Professions Education 20 Medical Education 21 New Institutions and Programs 22 Problem-based Learning and Community-based Education 23 Interprofessional Education 24 Leadership Column

Joint Mental Health and Family and Community Medicine Internship at the Rio de Janeiro Federal University The Win Project Education that Makes a Difference to Palliative and End Of Life Care at the Bedside in a Resource-Poor Context: The Situation in Cameroon Interprofessional Learning in a Quality Improvement Course at Linköping University Jacqueline van Wyk

Students Column 25 26 27

Out of the SNO Pen Big five Students Workshop at Bambanani Conference

Being Part of the Conference: What it Takes!! Jonathan Dangana Curriculum Changes at Ghent university

Member and Organisational News 28 28 29 30 32

Taskforces Taskforces Taskforces Message from the EC Taskforces

Community-Based Care for the Elderly Updates from the Women and Health Taskforces Social Accountability and Accreditation EC Eminences: Jan De Maeseneer Thanks Editor Julie Vanden Bulcke!


Message from the Secretary General The big aim is to become really global. Our next meeting offers us this possibility to build together a new avenir to the Network: Towards Unity for Health Our organization The Network: Towards Unity for Health carries a great potential to modulate health professions education (HPE) in the world, through the reinforcement of community-based education, through the awareness that the response to community needs must be the basis of the educational process, which can in a longer perspective, represent a significant contribution to improve the health care work force inadequacy and shortage. Our next meeting next July in China should give us the opportunity to reflect on how can we be more effective in contributing to the improvement of the health of the populations throughout the world. It is a time of renewal, of reorganization with new bylaws and a proper definition of tasks assigned to all instances of our organization. Henry Campos In its sense more genuinely human and social, education impulses us to always search new possibilities for action, to update our individual and collective potentials, from actions based on the radical hope that the human being, through conscious reflection and the development of its potentialities can reach the stage of being more fully human, more singularly person and more consciously citizen of the world. In this direction we must recognize, ratify and engage with the fundamental role of a transformative education, centered in the human condition, in the development and comprehension of sensibility, as well as in the respect to cultural diversity and the plurality of knowledge. This should be the road pursued by HPE and the basis for its ethics. Despite the undeniable effort of the academic community throughout the world, changes in HPE have occurred slowly, with large evidence that in health the more needed continue to be the more unassisted. The gap between curricula, educational process and societal needs is still there. Our similarities and above all, our peculiarities, should stimulate us to create a worldwide culture of learning and serving. The Network Towards Unity for Health can invest more in partnerships. It can be, for example, the educational arm of the World Health Organization. With these and additional perspectives in mind we can contribute to build globally what has been called a culturally aware health workforce. Our meeting in China will give us the opportunity to discuss these challenges and find better ways for together, make better use of these opportunities. Henry Campos, Secretary General, The Network: TUFH Email: henryhcampos@gmail.com

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The Network: TUFH in action Annual International Conference Looking forward to Shenyang The theme of this year’s annual meeting of The Network: TUFH is “Building Trust: A Global Challenge in Health System Reform.” The meeting, co-sponsored with China Medical University, will take place in Shenyang, China July 26 to July 30, 2016. Keynote speakers from China, Sweden, and the United States will address this complex issue. They include Ke Yang from Peking University and one of the co-authors of The Lancet report on transformative education, Sun Bao Zhi, former director of medical education research at China Medical University and principal investigator on a China Medical Board grant to define competencies of physicians in China, Bian Junhui, Dean at Shantou University Medical College and a leader in education reforms in China, Jim Withers, Founder and Medical Director of Operation Safety Net, and Moa Herrgard, a combined medical and law student from Stockholm, and a Deputy Organizing Partner for the UN Major Group for Children and Youth. In addition to over one hundred posters on health education and health system reforms, several workshops related to health education innovation will be presented. Workshops will address curriculum design, assessment and quality assurance, licensing of health professionals, inter-professional education, interactions with the community, and violence against health professionals.

Public confidence in the health system is challenged around the world. Possible causes, such as patient – provider communication skills, preparation of health professionals, rising patient expectations, increasing costs, and access to care, as well as their solutions will be addressed at the conference. A Post Conference Excursion will take attendees to the Great Wall of China in Beijing. See the post-conference itinerary and get more information on the conference program at www. thenetworktufhconference.org. On the home front, the transition of the Secretariat Office from Ghent to Philadelphia is running smoothly; both teams are busy working with the Executive Committee on the revision of the Bylaws, completing the revisions of the new website, as well as planning both the 2016 and 2017 annual conferences. As always, if you have any questions or concerns, or just want to say ‘hello’, please don’t hesitate to contact us. See you in Shenyang! Angele Russell/Alberta Steans-Parsons/Marianne Van Lancker/Caroline Van Lancker/Renato Zaratz Email: secretariat@thenetworktufh.org

Preview next conference Exclusive Preview of the 2016 Shenyang Conference in China: ”Building Trust: A Global Challenge in Health System Reform.” We did an interview with Professor Qu Bo of the Research Center for Medical Education, China Medical University, our local host. (This interview was held in September 2015 so our apologies if some details have changed)

this theme will cover all layers of medical education and is essential for a health system reform. Do you think it’s important that this year’s conference is held in China?

Can you tell us something about the venue of this year’s conference?

Yes of course, in the last few years the Chinese government has been paying more attention to medical education and health The conference will be held in Shenyang, the capital of the care. They made a series of documents to improve health care Northern Province Liaoning. and medical education. They are paying more attention to infraThe venue will be the China Medical University, built in 1931, structure. I think maybe this conference will show the Chinese the first medical school established by the Communist Party of Government the changes in health care and medical education. China. The co-host will be The Higher Educational Association Will there be a strong student involvement? of China. Yes we started meeting with our students and we have more than What is the importance of the conference theme: “Building 200 student volunteers participating. There will be a separate Trust”? student program or activities. Chinese students are very glad and Already in a doctor-patient relationship, building trust is essen- looking forward to this conference coming to China. tial. On a university level a similar trust has to be established Qu Bo, Director Professor Ph.D. Supervisor; China Medical Unibetween student and teacher. The Government, society and versity the Medical Schools should also build trust together. So I think Email: qubo@mail.cmu.edu.cn

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The Network: TUFH in action

Education for Health (EfH) EfH featuring Arun Jamkar

There are many people and organizations responsible for the ongoing success of Education for Health. We are the journal of an important and influential organization – The Network: Towards Unity for Health, which spans the globe in its people, groups and projects, all working to promote equitable health care and innovate health professions education programs. The journal has a dedicated staff at Maharashtra University of Health Sciences (MUHS), to conduct the day-to-day work of publishing EfH. The journal is also supported by the leaders and scholars serving on both our Operations and Editorial Boards. We could not be a successful journal without the energy and wisdom of these people. We are privileged here to feature one of our Editorial Board members: Dr. Arun Jamkar.

Dr Arun Jamkar

Dr. Jamkar’s contributions to EfH have been great. But first, here are few facts about Dr. Jamkar. Dr. Jamkar, recently retiring, has had an outstanding (35 year) career as a surgeon, medical teacher and an academic leader, which culminated in his becoming the Vice Chancellor of Maharashtra University of Health Sciences, and holding the position from 2010-2015. Driven by humility, compassion and a strong belief that nothing is impossible to achieve, throughout his career, he strived relentlessly and succeeded in bringing out the best in himself, his students, colleagues and all those whose paths he crossed. His contributions include promoting quality in education and administration, a culture of research and innovation in the university that he led. On the recommendation of Dr. Bill Burdick, Dr. Jamkar and MUHS was contacted as a potential home for Education for Health. His immediate support to the conversations of moving the journal to MUHS, which were happening when he took over as Vice Chancellor, and the support extended to the Journal Team at MUHS is only one example of his exemplary leadership. Being at MUHS gave a venue to several authors from the region to publish educational innovations from all over India and the Indian subcontinent, an audience from a new region to the journal. Dr. Jamkar has also been instrumental in carrying on the work of the journal. As a member of both the Operations and Editorial Boards, Dr. Jamkar provides input and insights into the current status and future development of EfH. With his background and experience, he is an excellent resource. Dr. Jamkar also is an excellent reviewer for the journal. We can count on him for both timely and thorough summaries of papers submitted to EfH – with information not only helpful to the co-editors in decision-making but also important feedback to those who submit papers for publication in the journal. It has resulted in an excellent relationship where MUHS and Network: TUFH have flourished together. Dr. Jamkar certainly had the vision for linking his university with a global initiative. As mentioned, Dr. Jamkar stepped down as Vice Chancellor of MUHS this year, but we are pleased to have his ongoing contributions to the journal. We wish Dr. Jamkar the best in his retirement – and want to forewarn him that this only means he will get more EfH papers to review each year! Sincerely, EfH Staff Email: efh@muhs.ac.in

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Improving Health Care for the Elderly Fighting Malnutrition in the Elderly: How to Change Nurses’ and Doctors’ Attitude Towards Malnutrition in Elderly In-Patients. Despite the fact that Belgium is a highly developed country, malnutrition in the elderly is not a rare phenomenon. More specifically, older in-patients often are at risk for malnutrition or suffer from undernutrition. In a 2007 survey, more than 35% of people older than 75 who were admitted to a geriatric ward suffered from malnutrition, another 40% was at risk. There is a huge lack of knowledge and awareness concerning malnutrition in the elderly. Patients and their families often do not believe it when the doctor tells them they are malnourished. But also nurses, doctors and policymakers are often unaware of the problem. People often think that malnutrition is rare in highly developed countries, and that, when it exists, it is only in lower socio-economic classes, called “the fourth world”. Despite the fact that economic aspects such as poverty

hospital. In cooperation with a dietician and the kitchen staff of the hospital, a calculation of caloric content of different meals and their ingredients was made: 100 kcal counted for 1 point. Nurses had to take note of the patients’ score at each meal during the first three days of admission. Introduction of the tool on the geriatric ward led to the detection of a high rate of insufficient caloric intake: mean caloric intake during the first three days was 1100kcal/day (May 2012 - May 2013). Nurses considered the tool as being very useful, but quite labor-intensive. Especially in the evening, scores were noted less frequently. The use of the tool led to a higher awareness in nurses and doctors towards undernutrition. As a result, dietary interventions were applied earlier in admission compared to the period before the introduction of the tool: for example adding extra calories to the meals or administering nutritional support.

People often think that malnutrition is rare in highly developed countries, and that, when it exists, it is only in lower socio-economic classes, called “the fourth world”. can play a role in malnutrition, having enough money to buy Counting caloric intake during the first three days of admission (healthy) food does not mean that an older person is free of on a geriatric ward leads to a higher awareness towards malnuthe risk for malnutrition. trition in nurses and doctors. Moreover, it helps to apply dietary interventions faster and more efficiently, which could lead to a Malnutrition in the elderly can have several causes. In most of better outcome. the cases, it is due to the “anorexia of the ageing”. That lack of appetite can be caused by many acute or chronic illnesses, such Every opportunity should be used to discuss food-intake with as infectious diseases, cancer, Parkinson’s disease, depression patients and their relatives. Weighing, talking about their meals, and dementia. The risk for malnutrition can even be bigger in looking what’s in the fridge, should be as important as measucases of poverty, loneliness, and lack of social support. ring their blood pressure. Nurses, general practitioners and other doctors, as well as policymakers should be made aware of the Undernutrition in elderly in-patients can have a negative improblem. Fighting malnutrition in the elderly can be a long and pact on outcome in acute or chronic illness. Patients that are hard fight, but can have positive effects on the patients’ health, malnourished are at greater risk not to survive their disease or as well as on the total health cost. are at risk to face a longer and more difficult rehabilitation with a greater loss of functionality afterwards. Use of screening tools for malnutrition is often not efficient nor possible in an Wim Janssens, Geriatrician, Ghent University Hospital, Ghent, acute setting. As a consequence, fighting undernutrition is of- Belgium ten delayed. Nurses are well placed to detect insufficient calo- Email: Wim.Janssens@UGent.be ric intake but often lack a tool to objectivize it. In our project, we tried to assess caloric intake in the first three days of admission on a geriatric ward in a secondary Belgian

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Improving Health Health Promotion Awareness on Environmental Sanitation in Egbeta Community, Ovia North East Local Government Area,Edo State. Nigeria The Millennium Development Goals (MDG) for Sanitation is to halve by 2015 the proportion of people without sustainable access to basic sanitation and safe drinking water. It is 2015 and Nigeria doesn’t seem to be on track with meeting this target. Medical records from Egbeta Community Ovia North East Local Government area, Edo state and Igbinedion University Teaching Hospital, which is a Major Health Care provider in this region, revealed that over 60% of presenting complains from patients in the community were medical conditions that could be attributed to poor environmental sanitation and hygiene. This prompted the need to raise awareness on the need to improve environmental sanitation and personal hygiene. The aim was to educate the community on the need to improve environmental sanitation. The Educative Forum was carried out in Egbeta Grammar School. Firstly, we visited the leaders of the community, explaining to them our goals and the role they had to play to make it a success. Next was Egbeta Grammar school which occupies a land mass of about 200*200metres, with an estimated 600 students. We had an interactive section with the head teacher and some of the teachers. An interactive section also took place with the students in public assembly ground and in some classrooms. Pupils were sensitized on the importance of keeping their envi-

ronment clean, and how it relates to diseases and living a healthy life after which a question and answer section was held. Items like proper waste disposal bins, brooms, toiletries, and bowls were presented to the school by me and my team. The level of awareness significantly improved, with extension to other areas of the community. However a revisit to the school after 4 months showed that some of the items donated were not in place. The head teacher explained to me some of the challenges they faced in sustaining the system. The main challenges were the lack of a portable water supply, lack of proper waste disposal e.g. excreta, lack of finance from the government and the poor knowledge on how poor sanitation affects health. Proper environmental sanitation should be an integral part of our day to day activities and my team and I have gone a long way to encourage community participation in improving the health of the people living in Egbeta Community through good environmental sanitation. Dr Irogue Eghosa Desmond, Igbinedion university okada, Nigeria Email: datseghe@yahoo.com

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Group discussion with adolescents

Improving Health Health Promotion Health Promoting School Project in Two Tribal Residential Schools of Yelagiri Hills, Tamil Nadu, India Context: The present student-led project was carried out in a setting of two residential schools of tribal children in Yelagiri hills, in Tamil Nadu, India. There were 230 students studying and residing in these two schools.

Health Organization recommended ‘Health Promoting School’ (HPS) approach for overall improvement in school children and their immediate environment. Over the period of three years, the School Health Committee could mobilize the resources and ensure the activities on 1) construction of toilets, 2) provision of safe drinking water and ensure waste disposal, 3) improvement in hostel and school building, 4) playgrounds, 5) installation of water heaters/washing machine in the hostel, 6) developing a kitchen garden, and 7) facilitated an appointing a social worker to ensure personal hygiene and sanitation. A team of medical students, post-graduates in community medicine and faculty undertook periodic health checkups and weekly Iron Folic Acid supplementation with the help of the local primary health care facility.

What was the problem: A project leading student, who also has Social Mapping Exercise been a resident in Yelagiri hills, was touched to see the poor conditions of the school children with respect to their poor personal hygiene, poor living conditions, infectious disease conditions and their poor nutritional status. There was no good care and support for these poor children, who were residing away from their family members and home. He then decided to improve the living conditions of these school children and initiated the process of team formation.

Finally, over the period of three years, we were able to improve the personal hygiene, environmental sanitation and nutritional status as well as correct anemia and improve overall health condition of the students. The improvement in health status positively influenced their academic performance. The entire project plan and its evaluation approach were approved by the Institutional Ethics Committee of SMVMCH, Pondicherry. Later, SMVMCH also offered partial financial assistance to this project and encouraged the service learning among its students.

What was done: A team of medical students, postgraduates in Community Medicine and teaching faculty in Community Medicine from Sri Manakula Vinayagar Medical College and Hospital (SMVMCH), Pondicherry took an initiative to address the problem through an approach called ‘Participatory Action Research’. The purpose was to empower students, teachers, other school personnel and leaders in the community such as ‘Panchayat’ members (local self-government) and local Non-Government Organizations in problem solving and facilitate the change.

Lessons Learned: ‘Participatory Action Research’ stimulated the Action-Experience-Learning cycle of the community members and team members and empowered them to take care of themselves and thus brightened the scope for the project’s sustainability in the future. School children, teachers and community members were active members in the overall change process. This collective effort fostered team spirit and leadership qualities among medical students and also gave an opportunity to the medical school to demonstrate its social accountability. Students disseminated their success story in two student level conferences in India. The project is ongoing to sustain and consolidate the gain so far achieved.

First of all, a school health survey and qualitative data collection through mapping exercise, transect walk, and a Strength, Weakness, Opportunity and Threats (SWOT) analysis in school campus were done to know the health problems and understand it from students’ and teachers’ view-point. Anthropometric and hemoglobin examination of all school children were done. The common health problems identified were poor personal hygiene, acute infectious morbidities, nutritional anemia and malnutrition. In qualitative enquiry, the other issues identified were related to poor maintenance of toilet facility, lack of regular water supply, poor security at night time and lack of hot water supply Medical examination for bathing.

Dr. Karthikeyan.V, Final year postgraduate student, Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India Email: karthikeyanveerabadran@gmail.com

In order to intervene, a School Health Committee of the above mentioned stakeholders was formed for needs assessment, development of context specific action plan, implementation and evaluation of the results. We adopted World

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Improving Health Women’s Health Men’s Perceptions Related to Maternity Services in a Low Resource Tribal Hilly Forestry Region of India In Indian society, men mostly make decisions for family, including women’s health, especially in villages. While this needs to be changed for gender equity, as of now it is essential to understand men’s perceptions about maternal care, for mission Safe Motherhood / Womanhood. In India, 30-90% births are at home either because there is no facility around or is too far away or women feel comfortable, secure at home or for other reasons. Project area, Melghat, Amravati, Maharashtra, India, is a hilly forestry region with a tiger reserve, wild life sanctuary and tribal population. Compared to other parts of Maharashtra which is one of the few provinces of country with better health indicators, women of this region are more than twice at risk of dying because of pregnancy and/or birth complications and neonatal, infant, and child mortality are high. One child under six years of age dies every day and two women die during birth every month. Fertility is high and sterilization, in almost all women, is not accepted in families with only female children, regardless of numbers, when couples decide to stop. Spacing methods are hardly used (Unpublished research). Objectives of study were to know maternity related perceptions of men of the region. The study was conducted in 65 villages. Married men from every 10th house of the village whose wife had given birth within 5 years, (with scope for change as per criteria) were in- Village men are interviewed terviewed with a predesigned questionnaire in the local language. Information about perceptions of maternity care was recorded on the questionnaire. No study subject was given a questionnaire. Focus groups with age of study subjects, birth interval relaxed were also conducted to get the needed information. Analysis of information was done. Most study subjects were of 25 – 29 years, 44% had primary school education, 40% till secondary school with few beyond. Except for a few, all belonged to low socio-economic status. The majority of the men opined that antenatal care is important, however some said it does not matter, whatever has to happen will happen. Most men didn’t like the idea of a male doctor examining their wives and preferred nurse midwives but objection to male doctors decreased with increasing education, though only in a few. Some educated said that it does not matter. Better educated men also said antenatal care should be by midwife if not a female doctor. None said Anganwadi worker or Accredited Social Health Worker (ASHA) should provide antenatal care. Very few, those too better educated men, said a husband should be present for delivery, others said mother or traditional birth attendant. Mother-in-law was also not suggested. Most men said

home births are safe, traditional birth attendants do a good job and it is good to have a home birth. Men seem satisfied with antenatal care in the village which actually lacks completeness and quality and with home births, all the risks. Over the last several years, research on male involvement in reproductive care has shown incredible impact on the birth outcomes. Male involvement strategies are intended to encourage men to get involved in pregnancy care. In the present study in a hilly forestry region we looked into men’s perceptions. Some men are aware that prenatal care and birth preparedness are essential but do not know basics and what constitutes quality prenatal care. They are not aware of likely dangers at home birth. However there are many issues. While attending antenatal clinic with a male partner is indeed honorable and augurs well for the family, it unfairly puts pressure on women to convince partners to tag along for Antenatal Care (ANC) services, in cultures where this has long been a woman’s niche. Using men in the media, community or outreach to fellow men with prevention messages tailored to suit specific audiences may reduce perceptions of antenatal care as woman’s domain was found in a study related to prevention of mother to child transmission of HIV (PMTCT). Kiwanuka (2015) reports that a woman is at risk of domestic violence if her spouse finds out that she took another man for an ANC visit. It is essential to encourage men to accompany women during antenatal care not only because the baby is of couple, but both need to feel responsible and ensure everything remains fine and also for encouraging compliance to advice at the clinic, have birth preparedness and knowing the dangers during pregnancy labour. But men do not seem to be aware of these issues as per the perceptions. There are many challenges to increase male involvement / participation in maternal care. There needs to be awareness programmes about prenatal care, what, why and how. Enlightenment programs should be carried out by governmental and nongovernmental organizations, to stress involvement of men in promoting maternal care and being agents of change in improving quality maternal care. With the end Millennium Development Goals (MDG) looming, and plans for sustainable development goal prioritizing, critical issues related to maternal health will be critical to progress and male involvement is crucial.

Shakuntala Chhabra; Director Professor; Obstetrics Gynecology; Mahatma Gandhi Institute of Medical Sciences; India. Email: chhabra_s@rediffmail.com

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Improving Health Mental Health Promoting Mental Health through Educational Counselling INTRODUCTION There is a current global movement towards highlighting mental health issues within the bi-directional relationship of physical and mental aspects of wellness within human functioning. In the South African context, The Mental Health Care Act (MHCA) recognizes two important aspects:

vince. This initiative provided an opportunity for a more comprehensive practicum for the Bachelor of Education Honours counselling students of the NWU by exposing them to various relevant community matters outside the formal school and educational environment – whilst at the same time mental health care services were made available to the community.

• “health is a state of physical, mental and social well-being and that mental health services should be provided as part of primary, secondary and tertiary health services.”

THE REGISTERED COUNSELLOR The qualification, Registered Counsellor, is aimed at producing competent, ethical and professional practitioners who will meet the needs of South Africa in order to make primary psychological services available in diverse settings thereby enhancing psychological well-being of the public and provide good quality psychological care at primary health care level. The focus of the Registered Counsellor is on prevention, promotion and community based care.

• “there is a need to promote the provision of mental health care services in a manner which promotes the maximum mental well-being of users of mental health care services and communities in which they reside.” South Africa is no different, the burden of mental illness in the country is substantial. In an effort to address the challenges which exist within the primary health care system in line with the MHCA, an initiative was undertaken by the North West University (NWU) to place Student Registered Counselling students at the Potchefstroom Hospital in the Kenneth Kaunda District of the North West Province.

THE ROLE THE STUDENT REGISTERED COUNSELLORS PLAYED AT POTCHEFSTROOM HOSPITAL The Student Registered Counsellors started at the hospital in February 2015. After an initial orientation within the hospital environment, the Student Registered Counsellors were introduced to the multi-disciplinary teams which consisted of medical staff, social workers, nutritionists, physio and occupational therapists. The psychological services that are provided by the Student Registered Counsellors included individual, family group and community interventions with a strong focus on preventative and psycho-educational aspects. Student Registered Counsellors worked on a systems approach highlighting the dynamic interaction between all role players, the unique communities and society in general. As the primary role of a registered counsellor is to prevent, promote, and intervene with the main aim of appropriately referring, these professionals were ideally situated at the hospital to meet the needs regarding primary mental health challenges.

On the 26 November 2014 a memorandum of understanding was signed between the Department of Educational Psychology, North-West University (NWU) and the Potchefstroom Hospital in the Kenneth Kaunda District of the North West Pro-

PREVENTATIVE COUNSELLING Wellness Clinic: This HIV/AIDS clinic services many individuals within the Dr Kenneth Kaunda district. Students provide HIV/AIDS preventative counselling for individuals, families and community groups as well as providing routine weekly counselling sessions for individual clients to promote adherence to medication and to give general support. Educational activities

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Improving Health Mental Health

General Hospital environment: In the general hospital environment children are actively engaged and supported scholastically. No child is forgotten when it comes to a long hospital stay. The child’s family and educators are contacted to ensure scholastic continuation during the child’s hospital stay. Assessments (academic, developmental, scholastic, learner support) are also undertaken with the children during a hospital stay and if there is no specific academic requirements, Student Registered Counsellors then read to the children or provide appropriate educational activities and stimulation. Psycho-educational support: All patients are supported during their hospital stay which minimises further psychological stress. General information regarding the procedures, in conjunction with medical officers, are discussed with the patients and families. Motivation and support regarding the adherence to rehabilitation and medication regimes are undertaken in support of other members in the multi-disciplinary team. Family members and significant others are also given appropriate information in order to empower them in supporting the patient in hospital and after they are discharged.

Educational activities

CONCLUSION For the Student Registered Counsellors of 2015 it has been a year full of challenges and breaking new ground. Further research is being planned for this yearly intake of honours students as well as for the medical staff at Potchefstroom Hospital. In order to create an optimal relationship for this project constant communication and interaction is needed, which in 2016, when we start PROMOTING PRIMARY PSYCHO-SOCIAL WELL-BEING a new year with new students we aim to build on and improve. Promotion of primary psychosocial well-being is always of the However thanks to our 2015 students who provided a solid founutmost importance. In this manner the community is made dation it seems that it will be an easier task. more aware of positive aspects of mental health and a healthy lifestyle. This concept is also carried to other areas of the com- Lynn Preston, Senior Lecturer, Department of Educational Stumunity by the Student Registered Counsellors. Health Promoti- dies, North West University, South Africa on in schools is encouraged by engaging the parents, educators Email: 10521402@nwu.ac.za and learners themselves. INTERVENTIONS Individual and group counselling sessions for in-hospital patients was provided. The individual and group interventions focussed on the evaluation of depression and anxiety, their overall psychological functioning and coping abilities and general support. This was done in order to timely refer for further clinical interventions and to encourage health promotion even after discharge. Furthermore, community networking was promoted for a greater more far reaching support for patients when they re-entered their communities. Student Counsellors also worked very closely with the Multidisciplinary team (MDT) in the hospital. This provided the students with holistic insight into the patient and also into their communities. Counsellors were used in conjunction with social workers, occupational therapists, physio therapists, nutritionists and the general medical staff; this gave the multidisciplinary team insight into psychological aspects that were previously not available.

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Improving Health Health Services The Community Pharmacy Network for Access, Quality and Rational Use of Essential Medicines in Nicaragua The Problem Globally 1.3 billion people have inadequate access to essential medicines for primary care needs. Patients are at risk because of inappropriately prescribed, poor quality and fake medicines, or by not taking medicines properly. An estimated two-thirds of global antibiotic sales occur without any prescription, contributing to resistance. “Lack of access to medicines is symptomatic of wider problems relating Community pharmacist counsels patient on to the way health services are organized, product use financed and delivered.” (WHO) of Nicaragua. The main characteristics of a In Nicaragua most of the country’s 6.2 mil- community pharmacy network are to gualion people are impoverished and have rantee quality products, provide geograpinsufficient health care services due to hic and economic access to medicines, difficult road or aquatic access to rural promote the rational use of medicines areas and limited presence of government and empower local leadership with adservices. Of private pharmacies, 84% are ministrative and technical skills to run the located in urban areas, half of those in the pharmacies, and provide health education capital Managua. Despite the efforts of to communities. the Nicaraguan Ministry of Health (MOH), only 50% of the population has access to Accion Medica Cristiana (AMC) is a Nicara­ guan faith-based, nongovernmental orgamedicines. nization with a multidisciplinary profesA Response sional staff and 30 years of experience in According to the World Health Organiza- health and development in indigenous tion, “access to medicines depends on a regions of the country. AMC’s Community rational selection and use of medicines, Health Strategy implements a health sysaffordable prices, sustainable financing tem of local leaders trained with basic priand reliable health and supply systems.” mary care skills who actively participate in (WHO) a referral process with the MOH. A community pharmacy network is a sustainable model that fills these criteria by providing ongoing availability of quality, low-cost generic medicines for primary care health issues in remote communities

The AMC Community Pharmacy Network was created with the goal of responding to a social and economic problem that is faced widely by the population through the relief of primary health diseases and improved health.

areas where no other services provide medicines. Generic medicines are purchased from national suppliers in compliance with the MOH. A supply chain is created from a central warehouse to community pharmacies which, in turn, supply smaller satellite pharmacies. Communities with satellite pharmacies are often only accessible by motorboat, on horseback or on foot, making delivery of products and supervision a challenge, but also providing an important service to populations of people that would otherwise not have access to even the most basic of primary care medicines. The economics of community pharmacies in Nicaragua demonstrate that prices of generic medicines are from 30 – 80% lower than commercial pharmacies. The seed money required to initiate a community pharmacy is approximately USD 5500. This includes inventory, licenses, training, and shelving. Locale construction or rehabilitation is a separate cost. The expected monthly revenue from the sale of medicines is approximately USD1,000 after deducting costs of inventory, salaries, supervision, and basic services (electricity and water) a surplus amount of USD 50 per month can be reinvested in the pharmacy for maintenance and increased and/or diversified inventory. Successes for Replication In ten years the AMC Community Pharmacy Network has grown to 47 community pharmacies and 112 satellite pharmacies, each with trained community pharmacists, while delivering over USD5m worth of products and benefiting 200,000 people. The model has saved lives and reduced costs for the population and achieved a level of sustainability such that little or no outside financing is necessary.

AMC helped to establish the Nicaraguan Inter-institutional Bureau of Essential Medicines and the elaboration and implementation of Law 721, passed in 2011, that provides the legal framework for AMC’s Community Pharmacy Network is community pharmacies in Nicaragua. an innovative solution to an historic proThe operational design of the network blem.

Delivery of medicines to rural community

model is to provide training and seed funding with the goal of creating a financially self-sustaining community pharmacy that is run as a non-profit in urban and rural

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Belinda Forbes Gutierrez, DMD, Accion Medica Cristiana, Managua, Nicaragua, Central America. Email: forbesba@gmail.com


Improving Health Health Services Community Outreach Centers in Pakistan - Moving Beyond Cure

Outreach centre

A strong Primary Health Care (PHC) acts as a backbone for health system of any country. In a developing country like Pakistan, where children are still dying of infectious diseases and malnutrition, the burden of non-communicable disease is on the rise like a slow epidemic. Moreover, psychiatric problems like depression , anxiety and stress are among the most frequently encountered diseases in PHC clinics. To handle this havoc, a high quality functioning PHC system is essential. A system which focuses not only on cure of disease, but forecasts future health problems and effectively plays its role in prevention of disease. In Pakistan , though government offers affordable PHC services through Basic Health Units and District hospitals, but the quality of health care provision is questionable. So a common man is left with limited options for health care. Most of them would visit a tertiary care hospital after getting a couple of months’ appointment and waiting for hours in the hospital for the specialist, eventually to get treated for an organ specific disease and being referred to another specialist for other symptoms. These results in patients visiting multiple specialists for various symptoms thus, fragmenting the concept of comprehensive health care, exhausting resources, putting an undue load on the specialists increasing the overall cost of treatment. Another option is to visit private general practitioners, more likely with no formal postgraduate qualification or expertise to deal with common health problems. This leads to mishandling of patients leading to complications for a condition that could have been well-managed by a trained PHC Physician.

Liaquat National Hospital carries forward the mission of developing a sustainable model of Primary Health Care by developing a chain of outreach services centre, equipped to provide high quality consultation services, laboratory services, physiotherapy and radiology, thus capable of dealing with vast majority of conditions in the community. The vision is to provide high quality, affordable and comprehensive health care within the reach of community through qualified and trained Family Physicians. These physicians follow the holistic health care model, thus deal with almost 90% of the health problems before complications occur and refer to appropriate specialist in tertiary care only when required. Moving beyond cure, the vision is to develop a healthy society and population by large, providing “Health� in its true sense as specified by World Health Organization as a state of physical and psychosocial well being, not merely absence of disease. At present there are four outreach centres working in different areas of Karachi, namely Shah Faisal, Nazimabad, Gulistan e Jauhar and Gulshan e Iqbal. These centres are located in thickly populated areas, catering to health care needs of community belonging to lower and middle income class. We serve healthcare needs of the whole family. This includes acute and chronic management of diseases, providing comprehensive health care, focusing on prevention, disease screening and making referral to hospital campus whenever indicated. Specifically, these centers have child health care services including routine immunization, screening, nutrition and growth clinics. Comprehensive care for diabetic patients is being provided by integrating its management with Primary health care. The highly qualified and trained staff is capable of managing various aspects related to Diabetes including foot care, wound dressing, nutrition and exercise counselling. Complicated cases are being managed with sharing of care with other specialist within the hospital campus. Other services include women health clinic, Geriatric clinic, Pre employment checkups and Executive health checkups.

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Another interesting and unique feature of these centres is organizing free screening camps and health awareness sessions for community. Every month thousands of people get themselves screened for Diabetes, Hypertension and Obesity, and get counseling for lifestyle modification. Free child growth monitoring and women health clinics are being organized frequently to provide health care privilege to those who do not have capacity to utilize health care resources. The novel concept of Family Health registration is gaining wide acceptance and popularity in these outreach centres. Through health registration, patient and their family can avail various benefits from time to time in terms of discounts on consultation fee, and lab services .

Family medicine team

This concept of providing affordable, accessible and comprehensive health care service through a high quality PHC service under supervision of trained Family Medicine specialists, will eventually reduce the burden of tertiary care hospitals, enabling other specialists to focus on genuinely complicated cases, hence preventing exhaustion of health care resources through unnecessary as well as delayed referrals to hospitals for diseases that can be managed well in community settings.

Dr. Rabeeya Saeed, Dr Faridah Amin; Department of Family Medicine, Liaquat National Hospital, Karachi Pakistan Email: rabeeya.saeed@lnh.edu.pk; faridah.amin@lnh.edu.pk


Improving Health Health Professions Impacting Communities Through Internship. Filling the Health Worker Gap. A Lived Field Experience in Mbarara South Western Uganda The shortage of health professionals to serve the various communities in Uganda continues to be an impediment to achieving optimal health care. Much as internship is a pre-requisite to acquiring a practicing license, it is one of the ways in which

In western Uganda, a minimum of 300 patients seek health care daily in Mbarara Regional Refferal Hospital. This is quite an overwhelming number for just one physician and two nurses employed in the various hospital departments (medicine, pediatrics,

The primary goal for internship training is to build competence through having practical hands on clinical experience thus impacting communities in a positive way! this shortage is overcome. All hospitals eagerly await receipt of surgery and obstetrics and gynecology) to provide holistic patient interns, due to the shortage of health workers as they strive to care. However, with the presence of interns, there is a significant change. Not only do interns take over most of the patient care, promote health in the various communities. they are also the very first people to interact with patients, hence The primary goal for internship training is to build competence building their capacities. The internship placement comes with through having practical hands on clinical experience thus imits own burden including longer tiresome working hours, skipping pacting communities in a positive way, through health service meals, and working with very limited resources. However they delivery using the best clinical skills gained through medical rise above all this to provide optimal health care to the commutraining. nity and endure to become resilient health professionals, with values and integrity to deliver holistic care regardless of the setting. Given that the Ugandan health workforce relies heavily on interns, internship placements are key and imperative in training the future health professionals who are committed, selfless, resilient and skilled to serve and cope with the various community health concerns globally as we focus on education for change. Faith Nawagi, Dave Dhara, Makerere University, College of health Sciences, Department of Nursing. Uganda Email: fnawagi@gmail.com

Impacting community through internship

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Improving Health Integrating Medicine and Public Health Health and Hygiene Project for Syrian Refugees in Lebanon Since the beginning of the Syrian crisis a few years ago, Lebanon has been the destination to citizens escaping from the fireball eating their country. This is greatly attributed to the geographical and historical proximity between Lebanon and Syria. In the lack of official statistics, it has been estimated that more than 2 million refugees have crossed the Lebanese borders through both the official and unofSavo Bou Zein Eddine ficial routes. This has put an enormous pressure not only on the infrastructure from electrical and water resources to the sewage network, but also on the health care system and public health. With the limited resources available to the refugees and the poor sanitary conditions, epidemics became a real risk facing the nation. From here, we, as medical students, decided to act. We had to step in and help in preventing an expected crisis.

health practices, we can reach more people. A child will teach his/her friend how to properly wash his/her hands, how to cough properly, or how varicella is transmitted. S/He will also tell his/her parents that information. Moreover, the knowledge one learns will stay with him/her wherever he goes. In parallel to all this, we ran a CAN drive, a drive that aimed at getting donations of major sanitary materials (e.g. soap, toothbrush, toothpaste, cotton, 70% ethanol, showering sponge, etc…). We visited local minimarkets and put boxes for donation. With every visit, we brought the refugees the material we got in the hope of making a small difference in their lives. This year, my successor was elected. The project will run with a new vision and higher goals. We are collaborating with other Standing Committees in Lebanese Medical Students International Committee (LeMSIC) to introduce a “peer-ED session” to the diverse workshop we hold. It will focus on sexual health and education. By providing better sexual education, we will have targeted nearly all aspects of primary health education. Savo Bou Zein Eddine, Medical student, American University of Beirut, Lebanon Email: savobouzeineddine@gmail.com

As part of Standing Committee on Human Rights and Peace (SCORP), the National Officer and I set the grounds in 2013 for the “Health and Hygiene” project for the Syrian refugees. The idea is simple: by teaching people good hygiene practices, you can help break the chain of disease transmission. Efforts of a team formed from the major medical schools in Lebanon came together to form a training booklet tailored to the resources available to the refugees; from washing one’s hand with limited resources, to knowing more about infections and how they are transmitted, to wound care and first aid knowledge. Page after page, we wrote the booklet and had it reviewed by doctors. With the funding of UNICEF-Lebanon and support of Arcenciel NGO, we ran the project for that year. We held a one-day workshop to train medical students to go and conduct interactive sessions and seminars. Every other weekend, Arcenciel gathered around 100 refugees of different age groups in one of its many centers around Lebanon, and a group of 4-5 students went and held the workshop. The year after, I was elected as the National Officer on Human Rights and Peace (NORP) for the term 2014-2015 and the project continued. More medical students have joined from additional medical schools. We collaborated with Caritas Lebanon NGO and went to their shelter houses. This time, we focused more on children. We believe that by teaching children good

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A group of refugees in the last workshop with the medical students


Improving Health

Great Stories from Great People Kick Ebola Out In Johannesburg, at the Bambanani Conference in September 2015, Asad Naveed, gave an inspiring keynote about an International Federation of Medical Students Associations (IFMSA) project he was coordinating: Kick Ebola out! Asad Naveed, is the president of the Sierra Leone Medical Students’ Association (SLeMSA) The Kick Ebola out campaign aims to spread awareness about the disease that was ravaging parts of Africa, and distribute supplies for prevention, such as soap and chlorine. They conducted awareness campaigns by visiting communities but also through facebook and twitter. They developed an app for awareness and education and also sat up an Ebola orphan care program. Money was collected through a crowdfunding page with a large support of students from all over the world. Of course we couldn’t resist an interview with such an inspiring student! Your project is an excellent example how students can take social accountability and responsibility.

would be a great added value to their education. Because they will experience health care in more developed countries. This will be of great help for their own country. Students in my country think our health care system is fine, because they never saw something else.

But this outbreak makes us to reflect, although this virus was discovered in 1986, we never expected it to have this global impact. How can we be more proactive, because it seems there are no more local problems?

I had the opportunity to go to the UK, in Kings College. It was an eye opeOf course we should be more proacner. Everywhere there were isolation tive and take every problem seriously. Asad Naveed and his fellow students during the rooms, people were taking measures If there’s an outbreak in Madagas- campaign for prevention of spreading infectious car, even if it’s a remote island, it can diseases. Nothing like that happens spread to anywhere else. We should care and have a backup in Sierra Leone. Our government will never react until someplan, in case something like the Ebola outbreak happens again. body raises his voice who has experienced otherwise. For example in Sierra Leone we never expected an Ebola outbreak, we have so many other issues like poverty and infant What context should we create for African students in order and maternal mortality. Our president wasn’t even sure Ebola to have a positive experience in a Western clerkship? We can would spread and only gave a speech on television 4 months imagine if you are exposed to technology that your country after we’ve been infected. That’s when he realized the impact. will not be able to afford in the next years, it can become very frustrating and even want you to go and work abroad? You need transparency to address a problem, as long as it’s not known, you cannot address it? Students should be prepared that heath care systems in Western countries are very different and more evolved. Some are You should acknowledge the problem and accept it early. almost perfect. There is a lot of competition between doctors Worldwide there was a big delay in responding to the outand the recognition of an individual health care professional break and sending help. Fast response is essential! is not so high. Should we invest in vaccines and medication for diseases In Africa there will be no competition, you will be the best guy that have only touched a few communities? and you can help a lot of people. Rare diseases aren’t of interest to pharmaceutical companies We should create a dialogue between students from Africa but can create big problems like the Ebola outbreak. and Western countries to exchange visions and ideas. The You and your fellow students did a wonderful job. What is focus of the clerkships should be on the things they can imyour opinion about Western univerplement in their own contexts like for sities sending students to Africa for example community health centers. clerkships? Should we give someAsad Naveed; President of Sierra thing back for the opportunity they Leone Medical Students’ Association get from you? Email: slemsa-sierraleone@ifmsa.org If African students could also go for clerkships to Western countries this

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Projects That Work Improving Health of Women in Garment Industries Through Needs Assessment and Peer Health Education Introduction India has made a name for itself as a garment manufacturing centre of global renown. The garments industry provides employment to around 3.5 million people across the country. But India’s niche in the global garments market has been carved out at the cost of hundred thousand workers in this industry’s predominantly female and migrant labor force. Roughly 80% of garment workers are women between the ages of 21 and 25. Many are undereducated migrants who move from rural areas. These low-wage women workers often suffer from anemia, poor hygiene, inadequate pre- and post-natal care, sexual violence, and exposure to infections and illness. Lack of education and access to resources contribute to unsafe sexual behaviors, sometimes leading to unwanted pregnancies or sexually transmitted infections. Occupational health problems also add on to these existing problems. The majority of these diseases or health conditions are preventable with proper care and safe behavior.

among women in textile industries in Southern India. Our mission is to “Increase women’s health awareness and access to health services through sustainable workplace programs”.

the time allotted by the management for training and during tea breaks. Where workers stay in a residential facility trainings are conducted in leisure times.

Process of implementation

An endline assessment is conducted after completion of all 6 modules which takes around 15-18 months among 10% of randomly selected workers to find out the change in awareness and practice in general, reproductive and occupational health issues

Industries including spinning and garment factories within 100kms radius of our institution who were interested in implementing the program were identified. An orientation about importance of women’s health and about the program was given to the top and middle level staff of the factory. Interview and focus group discussion were done among a few workers selected in random to find out the health needs in general, reproductive and occupational health. Based on the identified needs modules were developed by faculty of our department.

Endline assessment and sustainability plans

We help the management in devising a plan for continuation of the program in a manner that is feasible for them.

Peer Education process

The peer education process is the back bone for the program. Peers are an effective means of transfer of knowledge, skills and awareness. Peer educators develop leadership and communication skills which enables them to take additional responsibilities in factories. They also serve as role models to the co –workers. From the trainer’s perspective, we can cover a large population in limited time by this process. Hence the staffs at supervisory level were oriented about about ‘peer education process’. The importance of good peer educator (PE) selection was emphasized and a checklist containing criteria for identifying peer educators was given. The supervisors are required to use this checklist to identify peer demonstration of stress relieving yoga educators from their respective sections. Availability of peer educators from all sectiAwareness-raising, is extremely effective in ons of the factory ensures smooth running of challenging these issues. Women are grate- the program without affecting production. ful for information they have never before received, and for the focus on their needs The faculty from the institution conduct the and those of their families. Also workplace training for peer educators in each of the settings offer an efficient and largely underu- identified topics using flip charts, videos etc. tilized entry point for educating and empowe- Participatory methods are used for active involvement of participants. Feedback is obring women. tained at the end of the session. This process With the support of Business for Social Res- is repeated once in two months until the six ponsibility (BSR) and Ethical Trading Initiative modules are completed. (ETI) our team from the Department of Community Medicine, PSG Institute of Medical Outreach sessions Sciences and Research, India made an effort The peer educators then conduct formal and to educate and increase access to health care informal sessions for the other workers during

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Demonstration of lifting weights

Impact The program has been implemented in 14 factories (spinning and garment). Some key areas of success include increased awareness and practice of workers about healthy diet, personal and menstrual hygiene, and use of personal protective equipments at workplace etc. More workers access the factory clinic and approach health facilities for screening of cervical cancer, diabetes etc. The workermanagement relation has improved in most factories and some factories report decreased absenteeism among workers. Conclusion Addressing women in workplace through peer education process could been an effective, replicable and sustainable method to impart health education and behavior change communication. Dr.K.Suvetha, FAIMER Fellow 2012, Associate Professor, Department of Community Medicine, Coimbatore, India Email: sksuvetha@gmail.com


Projects That Work “A Arte de Nascer” (The Art of Being Born)

“Before I was born, I was made of light Yes! I used to play with stars” Around the world, women continue to have a high risk of illness, injury, and death during pregnancy or childbirth. Despite numerous efforts, health systems often do not prioritize maternal health, and violations of women’s rights are common. In Brazil, women living in rural areas have little access to information on good practices during pregnancy and infant care, in addition to a lack of medical attention during the prenatal period and child birth. In 2008 we founded a citizen sector organization in an impoverished Northeast region of Brazil. It was called, “The Art of Being Born”, which introduces arts as a tool to help mothers during pregnancy. By incorporating music and poetry into traditionally ‘scientific’ medical workshops and parental education, the program allows mothers to connect with their babies, and helps to empower women during pregnancy and instill good habits during pregnancy and new born care.

“I used to travel around I played around the sun And lay colors on the face of the moon” This methodology has had good results in low-income communities in Brazil, including; women having a higher number of prenatal visits, as well as women with more knowledge about delivery and care in post delivery, and a longer duration of breastfeeding. In 2010, the first book was released called, ‘The Art of Being Born- 12 meetings for the formation of health in pregnant women’. It contained the design methodology to be replicated in different communities, by volunteers or community workers who wish to improve maternal and child health. After that, more replications emerged in other states of Brazil. In 2010/11, the program was offered in rural areas of Mali, West Africa, for young women and girls with unplanned pregnancies. Similar to the project in Brazil, the art (songs, lullabies, poems, stories, crafts, cinema,etc.) was used in workshops, assisting in the dissemination of information, increasing the bond between mothers and babies, and making pregnancy a positive experience.

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Projects That Work

“ One day, I came to this world And I saw So many people struggling And I said I want to bring some justice”

rish the strong bond that exists between them and their child will help them to become stronger mentally and emotionally, and shows that all children must be born and cared for with dignity and love.

“Remember! Long before I was born I was made of light And I used to play with stars” (Coumba Toure)

To this day, ‘The Art of Being Born’, is offered to expectant mothers attending The Institute Santos Dumont, a health, teaching, and research center. It is also used as a teaching strategy for students of medicine, physiotherapy and psychology. According to their own perceptions, students enhanced their medical communication skills throughout the workshops, and improved doctor-patient relationships. They also experienced a strong humanization of medical practice and developed skills to assist in project development, implementation, advocacy and leadership.

Carolina Araujo Damasio Santos, M.D Infectious Diseases, Santos Dumont Institute, Macaíba, Brazil Email: carolina@isd.org.br

Helping a woman to become a mother is much more than just health assistance. To teach every woman to discover and nou-

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International Health Professions Education Medical Education Joint Mental Health and Family and Community Medicine Internship at the Rio de Janeiro Federal University (UFRJ), Brazil. Mental illness is a grave problem worldwide and the poorest populations are not only more vulnerable but also the most lacking in care. Often people with mental illness receive none or merely inadequate treatment. Regarding Brazil specifically, there is a shortage of public health care professionals to offer the broad mental health care required. Aside from a lack of psychiatrists and mental health professionals for the most grave cases, medicine schools do not prepare graduating doctors (regardless of future specialties) to provide an integrated approach to patient care able to assess unique needs that involve psychological care.

goal of creating a Mental Health Training asing the number of MFC medical residents model for general practitioners. and establishing partnerships with public and private universities. Interestingly, psychiatrists did not at the time have pre-set ideas regarding “mental Many factors contributed to establishing health training requirements for a gene- an integrated Mental Health-Family and ral practitioner” expressing various views, Community Medicine Internship. Among them, a consolidated partnership between the university (UFRJ) and the City Health Office (Secretaria Municipal de Saúde do Rio de Janeiro), the participation of ESF doctors and UFRJ professors, the fact that family doctors had pointed out a need for mental health training, the high incidence of mental health illness in primary care, and the possibility of promoting a mental health teaching and care provision model In 2013, the Brazilian Association that goes beyond psychiatric disorof Medical Education held workders. The resulting model dedicated shops with medical school profes70% of the study hours to the Fasors across the country on “commily Health Strategy Program and petencies for recently graduated Students at the Zilda Arns Family Clinic, with the Complexo do 30% to settings of psychiatric care, doctors” that is, core knowledge, Alemão community in the background which includes: child, adolescent, abilities and attitudes every medipsychogeriatrics, alcohol and other cal doctor should have in order to provide generally related to their own activities: a drug abuse, and psychiatric emergency. A appropriate patient care. The inclusion of good doctor-patient relationship, an ap- pilot of the program was launched in April some mental health “competencies” was proach for non-severe mental illness, sui- 2015, with daily intern supervision by Faseen as progress although it was limited to cide risk identification, and prevention of mily Clinics preceptors and weekly integrapsychiatric emergencies and similar hospi- indiscriminate psychiatric drug use. It also ted activities with two MFC/Mental Health tal-centric situations. In 2014, the gover- became clear that general practitioner trai- professors. nment made mental health training com- ning should not be limited to exclusively The ESF and Mental Health share common pulsory during internship (the last stage psychiatric environments as had been the principles such as “longitudinality”, the proof medical school, when students interact case previously. vision of care centered on people in a famiwith patients under supervision). However, a great stride took place with the ly, social and community setting, a holistic The UFRJ lacked a formal Mental Health introduction of mental health discussion to view of human beings that translates as ininternship program until 2014. In practice, the field of family medicine. The UFRJ has tegrated care. Mental health training in the the Psychiatry Institute (IPUB) received stu- an internship program in Family and Com- territory of the ESF allows medical students dents interested in the specialty (approxi- munity Medicine (MFC, the acronym in Por- to experience the inseparability of mind and mately 3% of the graduating students) as tuguese) since 2006. The head of the MFC body, objectivity and subjectivity, and how interns during the last semester. These stu- Internship program (3) encouraged the in- providing listening-based doctor patient dents would provide treatment for patients teraction of Psychiatry professors with the interaction is therapeutic and essential in with essentially psychiatric illnesses (schizo- Family Health Strategy Program (ESF in Por- care. Suffering is bigger than diagnosis and phrenia, bipolar disorder etc). tuguese) teams. Rio de Janeiro has been im- both can and should be the subject of care. plementing a policy of investing in primary The head of the Internship Program (1) Lucia Azevedo (1), Maria Tavares (2), health care since 2008 that includes setting started a series of individual meetings with Maria Kátia Gomes(3); Faculty of Medicine, up well equipped health care centers in vulPsychiatry professors that grew with the Federal University of Rio de Janeiro, Brazil nerable communities, as well as providing mediation of the IPUB director (2) with the (UFRJ) continuing education for preceptors, increEmail: lumazevedo@globo.com

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International Health Professions Education New Institutes and Programs The Win Project In the Faculty of Health Sciences on the Potchefstroom Campus of the North-West University (NWU), South Africa, we place large emphasis on rural health promotion. One of the custodian projects in the Faculty in this regard is the WIN project. WIN is no acronym but represent what the word means: to WIN - for both the communities and for our students at the NWU. The WIN project is an overarching project for multiple integrated and coordinated activities from 10 different healthrelated disciplines hosted within the Faculty. All these activities and interventions are based on building inter-sectorial partnerships to holistically improve rural health and well-being and to serve our students through research and training in work-integrated and service learning. The main goal of this project is to promote health and to create sustainable livelihoods using a multi-level transdisciplinary approach. To secure and maintain sustainable livelihoods the following sub-objectives are followed: • Promoting health and healthy lifestyles; • Empowering and uplifting rural communities; • Developing processes towards strengthening resilience; • Creating a virtual education centre for community-based learning. During 2012 the CSIR (Council for Scientific and Industrial Research) got involved with the project as a partner with the installation of a Digital Doorway (WINDoor), a general and health information platform which the community members can access at a very low or no cost basis. The information available on this platform is managed by the NWU. The WINDoor includes a training platform which can be accessed by professional healthcare workers, students or facilitators for more specific information. During this partnership the WIN project was invited by LLISA (Living Labs in Southern Africa) to become part of their association, and consequently received the status of a living lab. Through this partnership, the WIN project is currently in the process of redesigning a programme which can be accessed by community members via mobile services (e.g. WhatsApp or Google talk) at a low or no cost basis, and be used as a ‘call centre’ via texting. This will eliminate traveling costs and information received can be used for further intervention or research purposes.

inclusion of other disciplines creates an interprofessional learning environment through the community-based learning and participatory asset-based community development strategy. The WIN project is accredited the status of a living lab from the LLiSA network. The purpose thereof is to create a virtual rural health centre for this community, not by building or creating new facilities however, but by enhancing and upgrading the current facilities that are already in these communities. The rural health centre will include community gardens, upgrading of the clinics, an information centre, a health care facility for the students to engage into work-integrated learning, tourism and the recreation centre; water park and play park. Combining education, research and community engagement activities in the context of sustainable livelihoods creates an enabling environment to empower communities and prepare students through work-integrated learning to become rural health professionals. Employing research and/or intervention activities, different subject groups of each School of the Faculty of Health Sciences have addressed three key aspects of rural health and well-being, namely (1) physical health (sport and recreation centre, local clinics/ hospitals), (2) socio-economic & psycho-social well-being (local clinics/hospitals), and (3) food and nutrition security (schools and community food security centres/nodes). Of equal importance, long-term effective inter-sectorial partnerships with communities, local Governments, and the private sector have been built to ensure successful and sustainable project outcomes. Moreover, emphasis is placed on practical training of students in health and social professions to deliver experts in rural health and social services, advancing rural communities in South Africa in the longterm. Practical mono-and multidisciplinary teaching-learning of undergraduate and postgraduate students in all disciplines of the Faculty of Health Sciences can deliver experts in rural health and social sciences. The WIN project as platform empowers and uplifts resource poor communities and creates a virtual environment for students to receive reliable community-based learning within rural communities to be trained as rural health professionals. Elizabeth Barratt, Project coordinator, Faculty of Health Sciences, Noordwes University, Potchefstroom kampus, South Africa Email: 20317638@nwu.ac.za

Different multi-level approaches are utilized for various disciplines not only from the health sciences. The Students at work

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International Health Professions Education Problem-based learning and Communitybased Education Education that Makes a Difference to Palliative and End Of Life Care at the Bedside in a Resource-Poor Context: The Situation in Cameroon Introduction This study is a PhD research project funded by the Life-Cycle Studentship of the University of Nottingham, United Kingdom. It was undertaken by Nahyeni Bassah, a Nurse Educator from Cameroon, under the academic supervision of Prof. Jane Seymour and Prof. Karen Cox, of the University of Nottingham, United Kingdom. The need for this study was driven by the following issues. First, current trends in demography giving rise to an ageing worldwide population and changes in disease patterns such as increasing incidence of HIV/AIDS, cancer and other non-communicable chronic conditions, are increasing the demand for palliative and end of life care (Worldwide Palliative Care Alliance, 2014). Second, nurses play a significant role in the care of patients with life-threatening illnesses and often encounter dying patents in their everyday practice, and thus they need to be competent and feel confident in applying palliative care in their clinical practice. However, nurses do not receive adequate education on this topic during their preregistration nurse training, particularly in resource-poor countries. Third, the few palliative care educational intervention studies that have been conducted with nurses so far did not show whether the improved competencies from these interventions are eventually translated to patient care in practice. Aim The aim of this study therefore was to develop, pilot and evaluate the impact of a palliative care course on preregistration student nurses’ palliative care knowledge and self-perceived competence and confidence in palliative care, using Kirkpatrick’s framework for training program evaluation. Course development and implementation At the initial stage of this project, I reviewed the literature on the education of nurses in palliative care, to understand trends and identify gaps. It was noticed from the literature that a palliative care course could either be developed as a discrete course in

red educational strategies.

Kirkpatrick’s framework for training Program Evaluation

the curriculum or palliative care contents could be embedded into related courses throughout the curriculum. It also showed that palliative care education is best delivered using both didactic and experiential educational strategies, and most preferable by expert palliative care educators. Based on my experiences of the context, the findings from the literature review, and informal interviews with nurse educators and palliative care experts in Cameroon and the UK, I developed a 30 hour classroom-based palliative care course and piloted it with second and third year preregistration student nurses in one University in Cameroon. This course was delivered by a team of Cameroonian facilitators including 2 nurse educators, 2 specialists palliative care nurses, a chaplain, and I. Given the lack of both material and human resource for palliative care education, I negotiated and obtained some core palliative care textbooks, and audio-visual materials from the University of Nottingham, UK. These educational resources were distributed to facilitators, based on the topics allocated to them, to guide their preparations for the sessions. The participants of the course were also supplied with a palliative care toolkit, developed by Help the Hospices in the UK, and also had access to palliative care textbooks, to enhance their learning. A wide variety of educational strategies were used for course delivery, including experiential, interactive and student cente-

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Course evaluation and findings A quasi-experimental design, incorporating both quantitative and qualitative data collection and analysis methods, was employed to evaluate course impact. There was a significant improvement in the palliative care knowledge of the students. There was also improvements in students’ perception of their competence and confidence in palliative care provision. The students could transfer their learning to practice, in the care of patients who are approaching the end of life, with perceived positive benefits. They reported providing patients with physical, psychosocial and spiritual support and communicating patient information to the wider care team. They did however perceive some barriers to this transfer which were either related to themselves, qualified nurses, the practice setting or family caregivers and patients.

Some Cameroonian preregistration nurses

Conclusion The findings of this study suggest that palliative care education with preregistration nurses in a resource-poor context is feasible, acceptable, and beneficial. Nurse training institutions in these contexts therefore need to take that bold step towards including palliative care education in their training curricula. They can identify already existing local resources and maximize their potential in the training of nurses in palliative care.

Nahyeni Bassah; Instructor, Department of Nursing, Faculty of Health Sciences, University of Buea, Cameroon. Email: nahyenibassah@yahoo.com


International Health Professions Education Interprofessional Education Interprofessional Learning in a Quality Improvement Course at Linköping University dy programmes are presented with cases or problems identified by clinicians in the community. An example of a previous project is to create an information pamphlet about screening. Students visit clinics where they can make observations, interview staff and explore different avenues to help them with their task. Students also participate in lectures on tools for quality improvement. After working with the case for two weeks students have “Interprofessional education occurs when two or more profesthe opportunity to present their findings at a seminar with other sions learn with, from and about each other to improve collastudents. This is an opportunity to receive feedback from both boration and the quality of care”. peers and mentors alike. Results are presented in a written report The Faculty of Medicine and Health Sciences at Linköping Uni- and feedback is given from a supervising teacher. versity encompasses undergraduate programmes in medicine, physiotherapy, speech and language pathology, nursing, occu- The groups work according to the PDSA-cycle (plan-do-study-act) pational therapy, medical biosciences and biomedical labora- which was introduced by W. Edwards Deming in the 1950’s. It tory sciences. IPL runs longitudinally through the curriculum is a method for continuous systematic quality control in which, for all of these programmes. The first semester involves a after planning and completing a task, you interpret the results course consisting of introductions to theories on health, ethics and reflect to see if you can make further improvements. One and learning. This is achieved via a combination of lectures and very important aspect of the PDSA-cycle is making a new plan acproblem based learning in interprofessional student groups. In cording to your reflections, then starting over and repeating your the 4th or 5th semesters students participate in a course focu- scrutiny of the results. This illustrates how quality improvement sing on quality improvement. In the final year of their under- is never finished but a continuous process. graduate training student teams spend a couple of weeks wor- After the seminar the students present their case at the clinic king on a clinical training ward where they get the opportunity in which they made their observations. This puts students in a to run a fully functional ward under supervision. position where they can suggest changes in a real world setting, which is normally difficult for university students. This system has many benefits. Students are forced to think about the community as a whole and they gain experience and a deeper understanding of situations and problems which may occur in their future workplace. Clinicians are also provided with the perspectives and ideas of young people within the community and they may go ahead and implement some of the students’ ideas. The Faculty of Medicine and Health Sciences at Linköping University has, since it was founded in 1986, always had a strong tradition of utilising interprofessional learning (IPL). A commonly used definition of interprofessional education comes from the Center for Advancement of Interprofessional Education (CAIPE):

By working as part of an interprofessional group students learn how to function effectively as a team. This is a vital aspect of health care where a patient centred approach is of the upmost importance and staff from many different professions co-ordinate their efforts to create the best care and patient experience possible. This course encourages students to address issues from different perspectives and to value each other’s opinions. To conclude, interprofessional relations are a vital part of everyone’s daily lives in the workplace. It is key for every workplace to continually evaluate and attempt to improve their performance which leads to increased patient and job satisfaction. I believe PDSA-cycle this course gives young undergraduates all the tools necessary to go forward and improve not only health care but many aspects The objectives of the course in the 4th or 5th semester is to of the professional world through interprofessional quality imteach the process of quality improvement and then apply it to provement. a real life scenario by combining the knowledge and different backgrounds of each member of the group. In the first phase Linn Wedén, Medical student at Linköping University, Sweden. of the course groups of six to eight students from different stu- Email: linn.weden@gmail.com

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International Health Professions Education Leadership Column

Jacqueline van Wyk Dr. Jacky van Wyk has been actively involved in higher education since 1995. She joined the Nelson Mandela School of Medicine as a consultant to implement the problem based learning (PBL) curriculum. Currently she is the Program Director and executive member of the SAFRI board (South African Regional Faimer Institute). She is also a founding member of the Women in Leadership leverage group at the faculty of health sciences at University of KwaZulu-Natal (UZKN). She is highly engaged in health professions research and received the SAAHE Distinguished Educator Award for 2015. Nowadays she is still involved with UZKN where she does faculty development. What change processes have you been part of in the past? At local school level the main change processes for me have been the implementation of a PBL curriculum in 2000. That was a major undertaking because it involved a different philosophy. I joined the school in 1998. I had to prepare the faculty for their different roles they would have to play in this PBL program, and of course this all happened in a resource poor setting. People were not that keen to collaborate or to integrate. At a more regional level I was involved in the implementation of the SAFRI, starting in 2007. We had a first intake of health care professionals in 2008. What is the first step towards a successful change? South Africa is a multi-cultural country with lots of historical and political factors that implemented our views of change, either going backwards or forwards. People with very different backgrounds had to come together and speak openly about education. We went through a long process of finding common ground, making sure that people understand the value and the benefits of the program at school level and at community level. Power relationships are also a tricky thing to negotiate in this field, because often power is so closely related to education. If it’s perceived that a specific group is in charge, others will just not come to a negotiating table. There had to be a lot of negotiation about how are we sharing the information, how are we sharing the roles, how do we not put too much power in one specific

discipline. Trying to balance the books was Networking is important, which is not often very important. I can conclude that in some thought at a school level. areas we are still not there yet and power In South Africa environment, there is this sharing is not easy in South African context! feeling we went through an inferior educaWhat kind of leader would you say you tion. If you beat yourself down about the are? lack of all the things that you might not have I’m hoping that I’m a participating leader. been exposed to, you will not progress. I try not to dominate. I try to know what It makes a lot of reinforcing that you can the change implements from the ground make a difference. Continue to learn, surand play a more supportive role. I prefer to round yourself with people where you can be one of the team and see different views. learn from, be part of a network without As I’m part of a minority group myself, I can being swallowed by it. understand better. Our context is so hard How do you make a change sustainable for to explain to outsiders. the future? Do you have any examples of successes or It’s very important that along your process failures that you faced during this change you bring fresh, young creative approaches process? on board. I always look at the European The biggest success of course is the imple- countries, where professors are so young mentation of a program. At all levels, at the and so energetic. Somehow in South Africa lower level it’s important that people feel we have a culture that people are not rethat they are being heard and involved, at cognized until they are in their fifties. You higher levels you want to know that people only respect the elders. are learning as being part of the group. It is difficult to measure if our program contri- At SAFRI this is much easier for me then in butes to better health care, but it’s what we an academic context. are aiming for! Do you have any final advice for our reaOf course we had also many setbacks. Edu- ders? cation is still a much undervalued professi- Most of the changes that we have to imon. I mainly do staff trainings, try to change plement, has to happen in a context, so be perceptions. But people don’t see this staff conscious of this context and the changes, training as part of a teaching function. I’ve and whether there is a good match is what struggled to be promoted in my academic you need to strive for! Solutions from elseinstitution. Why should we teach teachers where need to be adopted so that people as well as we teach students? Opinion nee- can understand how it will be better from ded to change that they are equally impor- them, therefore you need great stakeholtant, if not even more! Through this I’ve der involvement! learned to be persistent. Dr Jacqueline van Wyk What lessons have you learned from this Email: Vanwykj2@ukzn.ac.za process?

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Students Column

Out of the SNO Pen

Being Part of the Conference: What it Takes!! It is said that every journey commences with a single step. But how much does one inject in each step?

part of the Bambanani Conference” had swung into history. A week following this feedback, I went to the head of Nursing department’s office to share my situation with her. She is my good friend and she too was optimistic that I would be part of the South African Conference. “One’s destination can never be altered but can be delayed.” These were her concluding words of our one hour discussion. I moved out of her office; quietly and sickly found my way back home.

Bambanani Conference 2015 stands to be memorable. This is because it was the first of its kind in my life. I got to know about it through a The Network: TUFH information session at my University that was organized and facilitated by a colleague who had attended one before. Her wooing tale about it infected me with the desire to long for it month after the other. I very much wanted to have a physical feel of what she had narrated to me. I started by submitting an abstract to the 2015 call for abstracts. This is a study I had conducted while in year three of Nursing school. While waiting optimistically for the abstract acceptance notification, my mind went on a race with a lot of questions. “Who will fund my travel, registration, and accommodation? Who to approach? And if any, how to approach them was another worry.”

In approximately ten minutes past our separation time, I received a call from her “Samson first come back to my office!” and the phone went off. In the middle of a conflict of interest - making a u turn and continuing home, I decided to rush back. “Pat, this is Samson, I have always told you about. He wants to go to South Africa for a research Conference but all his plans seem to be futile. The head of department made a preamble of my situation to Pat. “Patricia as she is famously known is Pat, she is the chief Nursing officer for the peace corp volunteers in the Nursing department at Mbarara University of Science and Technology.

The long awaited D-day came unexpectedly. My Gmail account had been in-boxed with “Your abstract has been accepted My poster presentation for a poster presentation.” For a while, I thrilled with happiness. Little did I know that my being part of the Bambanani Conference wasn’t as direct as the statement in my inbox.

“Samson, sorry to hear that.” Pat responded.” This is the plan, I will get you a funder for your plane ticket and accommodation only if you can get a passport and a VISA.” To me, this was life after death. Registration for the Conference was another issue to ponder. But thanks to Josephine Najjuma, a committee member of SNO, through whom this was possible.

The “game” of try and error started. I mean pursuit of any possible benefactor to have me explore beyond Uganda. One day on a chilly evening, lying quietly on my bed, I heard words whispering in my ears,” You set your goals low, next time set your goals high!! “I recalled these were words from one of my lecturers, (who I even consider to be my mentor) after I had missed being part of the Royal college of Nursing Conference 2014-UK. And this was also on grounds of lack of funds.

In conclusion, it takes a number of considerations to have a breakthrough; self-determination backed by commitment to what you need to achieve, knowing the right thing (what to do and who to contact) and patience.

I needed to act - it dawned on me. I got up and drafted two travel grant requests; one to my university and another for a GHETS fellowship. The heartfelt and demoralizing moment was created by the feedback of regret from the two applications. I felt like tears rolling down my cheeks. I knew the golden treasure “being

Wakibi Samson, Nursing student; Mbarara University; Oeganda Email: wakibisamson2011@gmail.com

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Students Column Big Five Jonathan Dangana How do students from all over the world perceive the educational programme at their Faculty, or the educational system in their country? How do they see the future, for their nation and for themselves? And what changes would they make, if they had the chance? We wanted to know. Therefore, we will ask one student five questions.

1. Why did you choose to study Public Health?

As a Public Health Student, I had long desired to be a voice and a tool of help for persons who are in health need so I opted for medicine but along the way I realized a million and one routes exist to make a difference and help people who are desirous of health. 2. Can you as a student influence the educational programme of your Faculty?

Yes it’s very possible for me to influence the educational programme of the faculty. This is possible simply through engagement, dialogue, and organizing symposiums between faculty and the students.

thods which yielded results in their active days in school and expect that those methods will still yield the same and even better results/output. 4. Imagine if you were to choose: a practice in a town or in a rural area. What would you choose and why?

I will love to swing into being a community health education professional. I realized that the burden of disease lays in that population that is based in rural communities, and resources abound within those communities to address the specific identified problems. 5. Do you ever get in touch with the community?

3. What would you change if you were Dean of your Faculty? Or on a national level if you were Minister of Education in your country?

Yes I did and the experience still remains a huge part of what drives me and keeps me moving in school knowing fully well that much is required to be achieved for the betterment of all especially at the community level.

I would like to ensure that compulsory short courses are taken by teachers (which they call continuous education) to enhance their potential to be reachable in thought and language by students. Most of the teachers/faulty rely on old teaching me-

This interview was conducted with Jonathan Dangana, 31 years old. 1st year post graduate student, Public Health Babcock University, Nigeria

Jonathan Dangana

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Students Column Students Workshop at Bambanani Conference Curriculum Changes at Ghent University It all began on February 3rd 2015, the day we received the invitation for The Network: Towards Unity for Health conference in South Africa. We immediately thought “Bambanani! Let’s do this!” We did not hesitate and started working on our project. We were thrilled when we heard the news that we were selected to present our workshop during the conference. This would be our first workshop! We are proud of what we – as student representatives at Ghent University - had achieved in the past years and we wanted to share our experience (and maybe expertise?) with the rest of the world. Our hopes were also to learn something from the bright ideas of our colleagues of the international student representations. So we made a preparation for our workshop, but were we fully prepared? This slight doubt came to us right before the start of our workshop. Fortunately, our enthusiasm and excitement soon outweighed that doubt, and grew with every participant that entered our workshop room.

discussions at the separate tables. To set the mood, we asked the participants to talk about some of the achievements and accomplishments of the student representation at their university. Thus the participants could get to know one another a little bit better. To make our following discussions more vivid, we tried something fun and different. We had several theorems prepared where we wanted our participants to answer these theorems with yes or no. We asked our audience to stand up and choose their side after we introduced a theorem (yes = the right side of the room, no = the left side of the room). Once everyone had chosen their side, we asked for some opinions and left some room for discussion. The audience was allowed to change sides and thus to change opinion at any time. But then of course, we harassed them with the difficult question to explain why they changed their mind. This led to some beautiful and interesting debates. We would close this part of the workshop beautifully with the last theorem where we asked “Is student participation necessary to acquire certain competencies as a physician?” The left side of the room was completely empty. Afterwards, we showed some of the findings from a recent study at Ghent University where we tried to reveal the skills that students can acquire by joining the student representation. Unfortunately we know that student participation is not always fully developed in certain countries. We asked the audience if they had experienced some difficulties or problems they could not solve. So in the third part of the workshop, we tried to combine all of our experience to come up with possible solutions for those who needed some advice to address the difficulties.

Fraternization with other students

We need to admit, we kind of lured the doubters into our workshop with Belgian chocolates in three different colors. Everybody just loved it! The workshop started off with really good vibes. We arranged four tables in our workshop. What we aimed for was a mix of students, health professional educators and curriculum managers at each tables. This is where the chocolates came in handy... Our workshop started off with a brief introduction about the Belgian system of student representation at Ghent University, so that the participants would have a little background information on how we built our student representation. After the introduction, we asked the participants which kind of color their chocolate was. We asked all people with the same color to sit at the same table so that we got an interesting mix of all sorts of nationalities and institutions. We thought that this would be very constructive for the discussions: everybody has a different kind of view on all sorts of topics and this would be very helpful for the little

After the last discussion, we concluded with a plenary SWOT analysis of the gained knowledge. We hope that after our workshop, the audience could value the personal benefits of student participation more, especially leadership competencies. We hope that we have given the participants some tools to integrate research findings with the perspectives acquired during the workshop in order to address local situations. We would feel honored if the participants started organizing their student participation on different levels and adapt it to local needs and problems after attending our workshop. We really enjoyed the enthusiasm and involvement of our participants, making this workshop so much more than a lecture of the view from some students living in Western Europe. Lastly, we would like to thank everyone who made it possible for us to organize this workshop! Yasmien Depaepe, Siem Decleyn, Miet Vandemaele; Medical students, Ghent University, Belgium Email: miet.vandemaele@ugent.be

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Member and Organisational News Taskforces Community-based Care for the Elderly Projects for Geriatrics training in medical schools While in South Africa at last year’s conference the slogan was Bambanani (working together) and that is what the elderly task force is doing this year in promoting education of geriatrics to undergraduate students in medical schools. The task force has continued with activities started in the last year that further the goal of community care for the elderly. Findings from those projects indicate that indeed many students are not aware of problems that afflict this vulnerable population. Further emphasizing the continued need for training of the students if they are to serve as wholesome next generation doctors. The Network: TUFH Elderly Care Task Force promotes ways in which students learn to value older persons as a community of individuals requiring a care delivery system characterized by responsiveness and consideration of the collective as well as the individual. The projects for this year are in line with the characteristics of the task force that emphasize: • Composition of health professionals from around the world with experience in health education and programs for the elderly.

• Creation of training modules and new service models to address the social and health related needs of the elderly in developing countries. With support from the Global Health through Education, Training and Service (GHETS) a call for proposals was posted on the Network website. A selection of four projects was made and these are ongoing in Nigeria, Uganda, and India. We hope more countries to join in the next round of projects as we promote and continue to build on the force that will caters for today and tomorrow’s elderly. These program include training of teachers to be more aware of what to pass on to their students as regards geriatrics care (Uganda), involvement of students in designing elderly research (Nigeria) as well as enhancing community projects to harness elderly care (India). All are welcome to the task force activities including the meeting at this year’s conference in Shenyang, China. We believe China will offer a wonderful opportunity to learn more about longevity and graceful aging as this country is lucky to have. We look forward to seeing you! Noeline Nakasujja, Chair Email: drnoeline@yahoo.com

Updates from the Women and Health Taskforce The Women and Health Task Force (WHTF) continues to make great accomplishments as a network of advocates for women’s rights and improvements in women’s health around the globe.

Workshop to Promote Women’s Health by Students for Adolescents using the ABC of Women’s Health: A Handbook for Girls: Prof. Godwin Aja, Nigeria

The task force hosted many exciting activities at the 2015 Network: Towards Unity for Health Conference in Gauteng, South Africa in September. WHTF representatives led an extremely important workshop on strategies to create safe environments for women students at university campuses. Participants of the workshop engaged in meaningful discussions around the topic pulling examples and experiences from their own universities to create prevention strategies. They also hosted a film screening with three short documentaries on women’s health issues in South Africa that addressed the resilience and creativity of South African women as they face complex realities and make positives changes in their lives. This was followed by a group discussion led by plenary speaker and women’s right activist, Mary Hames.

Promoting Early Screening and Treatment of Cervical Cancer amongst Women Living in a Slum of Kampala, Uganda: Faith Nawagi, Uganda

After a rigorous selection process spearheaded by the WHTF Management Committee, four projects were selected to receive WHTF Mini Grants for 2015. The following projects were presented to the WHTF at their annual meeting in Gauteng:

Using Service Learning to Develop Social Responsibility Among Medical Students and Addressing Iron Deficiency Anaemia in Child Bearing Age Women and Adolescents in Rural Pakistan: Dr. Rukhsana Ayub Aslam, Pakistan Currently, the WHTF is collaborating on the 3rd edition of the Women’s Health Learning Package, a comprehensive learning tool used at training institutions around the world, mentoring new members to become future global health leaders, and preparing for the 2016 Network Conference. You can keep up to date with the WHTF on their blog at womenhealthtaskforce.wordpress.com. Deyanira González de León, Chair of the Women and Health Task Force Email: deyaniragonzalezdeleon@gmail.com

Educating Women in Rural, Indian Villages Workshop on violence against women some about Sexual and Domestic Violence by uti- of our task force members led in India. lizing Auxillary Nurse Midwives (ANM) and Accredited Social Health Activists (ASHA): Dr. Surekha Tayade, India

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The WHTF in Gauteng 2015


Member and Organisational News Taskforces Social Accountability and Accreditation (TFSAA) The TFSAA has continued its work in a wide variety of venues as the concept and practice continues to expand around the world. Only some of this is under the official umbrella of the TFSAA since the Network: TUFH continues to express itself as a “network of networks”. Indeed, members have been involved in the revision of the bylaws that the network is undertaking and the concepts and actions are translating there in an enduring way. Social accountability is increasingly seen as an important idea in each of the WHO regions of the world and in some, such as EMRO it has become an organizing principle. Dr Boelen has been very active in developments in that region. Schools such as the Northern Ontario School for Medicine, Zamboanga and others designed on the principles of social accountability are coming to maturity and newer schools are reflecting these principles. Patan Academy of Health Sciences graduated its first students as they provided invaluable service during last year’s earthquake in Nepal. Your co-Chair is just flying home from a major conference in Montreal where the second Charles Boelen International Award for Social Accountability was awarded to the Fran-

cophone Project for their powerful work in developing a worldwide network of schools in la Francophonie dedicated not only to the practice of social accountability but the assessment of its impact—a multi-year project inspirational to the rest of us. When the TFSAA was launched in Kampala we set an ambitious agenda to help define and foster social accountability around the world. Much of which the task force undertook initially has been achieved and the world is moving on. But a main focus of members of the task force, and particularly the co-chairs is now focused on actually animating an integrated approach to the vast work being done around the world. To this end, a World Summit of Social Accountability is being organized in conjunction with the 2017 meeting of the Network: TUFH in Tunisia in April of 2017. One of the four primary themes of that conference will be accreditation. The aim of the summit is to be action oriented in seeking global collaboration to enhance the relevance and efficacy of health professional schools in addressing the health needs of the societies in which they are embedded. The TFSAA will be meeting at the annual meeting of the Network: TUFH in Shenyang in July and it is hoped that will be a springboard, akin to the Kampala meeting, when we re-focus and redouble our efforts and think what value we can add in this network of networks. Charles Boelen and Bob Woollard, Co-Chairs Email: Email: woollard@familymed.ubd.ca/ boelen.charles@wanadoo.fr

winners of the AFMC- Charles Boelen International Award of Social Accountability granted by the Association of Faculties of Medicine of Canada (AFMC). From left to right : Geneviève Moineau, president and CEO of the AFMC, Charles Boelen, the 3 awardees: Joēl Ladner, University of Rouen,France, Paul Grand’Maison, University of Sherbrooke,Canada and Ahmed Maherzi, University of Tunis,Tunisia, and Hélène Boisjoly, Dean of the Faculty of Médecine of Montreal,Canada.

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Member and Organisational News Message from the EC

EC Eminences: Jan De Maeseneer Jan De Maeseneer was our Secretary General from 2007 until 2015. At the last conference he passed the torch to Henry Campos and Elsie Kiguli. We asked some other prominent members of our Network about his contribution to The Network: TUFH.

John Hamilton, Grey Eminence “Jan brought to the role of Secretary General a substantial experience of international work to sustain and build partnerships, through engagement with World Health Organization, with the Belgian Government, through bilateral partnerships in health. This background assisted in strengthening the profile and outreach of the Network and made an important contribution to reshaping its role as hub organisation for an expanded “Network of Networks” starting with a number of organisation of like mind and intent. Particular organisations are THEnet, The Global Consensus for Social Accountability, CLIC, FAIMER, GHETS. Expanded annual conferences have demonstrated the benefit to all of regular consultation and co-operation Parallel to his work in international health and health education has been his specific focus on Primary Care, and family Medicine in particular and he has contributed, in part through WONCA to WHO re-affirmation of the importance or Primary Care. He had given energy and commitment to the Network, has been an effective voice for the Network and has led it through some times of challenge as it re-shaped its aims and means.”

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Member and Organisational News Message from the EC

Björg Pálsdóttir, Chief Executive Officer And Co-Founder Of Thenet: Eminence “I’ve had the privilege of working with Jan not only through The Training for Health Equity Network’s (THEnet’s) collaboration with The Network: Towards Unity for Health, but also at the Washington-based National Academies of Sciences, Engineering and Medicine Global Forum on Innovation in Health Professional Education. During each of our bi-annual workshops he tirelessly promotes the work of The Network:TUFH and advocates for health equity, generalism and primary care approaches. At the Global Forum and other international health gathering Jan’s systems thinking approach, deep understanding of current health and health system challenges as well as his clear vision of how systems could be improved, continues to influence thinking at global and national levels. While his intellectual contributions to the global dialogue on health professional education are impressive, I’m most inspired by how Jan lives his values of equity, humanism and solidarity be it when he provides primary care services to immigrant communities and refugees arriving from Syria in Ghent or when he takes on powerful political groups to advocate against injustice and prejudice.”

Art Kaufman, former Executive Director and Grey Eminence “Jan brought tremendous energy to his role as Secretary General of The Network: TUFH. This energy was amplified by the high energy and competence of his staff at Ghent. Jan kept us connected to a whole range of kindred spirits and sister initiatives in Africa, South America and Western Europe. I very much valued his ability to forge connections with the WHO Regions, keeping us on their agendas and visible at their meetings. He was enormously generous to us “elders”, agreeing to encourage the formation of the “Grey Eminences.” This helped keep the history and values of The Network alive while finding a valued role for us elders in an advisory capacity to the Executive Committee and the membership. Finally, Jan’s passion for social justice was of great value to The Network: TUFH. It was appropriate to the many challenges and inequities we face as a global village. We will miss his role but welcome him as our newest elder.”

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Member and Organisational News Taskforces

Thanks Editor Julie Vanden Bulcke! This will be the last Newsletter that Julie Vanden Bulcke has realized as editor. Six years ago, Julie started to produce her first Newsletter, in the new lay-out and format that was developed. Julie Vanden Bulcke is a family physician, working in a group-practice nearby Brussels. Julie has always had an interest in international health: as young doctor she worked in Thailand to support primary health care in the Karen refugee camps at the Burmese Border. Moreover, in 2009, she worked in a project to develop primary health care and family medicine in Shanghai (China). These international experiences certainly contributed to Julie’s interest in The Network: TUFH. In her strategy to “renew” the Newsletter, she kept the good things that were already established when our friends from Maastricht, where responsible for The Network: TUFH. She also paid attention to remember the “history of The Network”: if you don’t know the history it is difficult to understand the actual situation and to forecast appropriately the future of an organization. Julie had special attention for topics like “The Network: TUFH in action”, improving health, projects at work, international health professions education and the students’ column. When interviewing persons, Julie always tried to focus on the specificity of everybody’s contribution to the cause of The Network. The 2 issues that were produced yearly, were very complementary: an issue specifically focusing on the conference (generally a short period of time after the conference), and a more voluminous issue with the broader general perspective.

motivate people to send their contributions in timely. So, quite a lot of you received the famous e-mails from Julie requesting “your urgent action” with the deadline… That is part of the job! We would like to thank Julie for her efforts, and for documenting an important faze in the life of The Network: TUFH. We also thank Ami Clithero for the appreciated improvement of the English language and Anja Peleman for the terrific graphic design! Julie, thanks a lot, all the best in your further private and professional life! It was a pleasure to work with you! Jan De Maeseneer Past Secretary General The Network: TUFH.

As an editor, the most difficult challenge, is to

Julie (green dress) in action!

B-9000 Ghent Belgium Tel: (32) (0)9 332 1234 Fax: (32) (0)9 332 49 67 Email: secretariat@thenetworktufh.org Internet: www.the-networktufh.org

Newsletter Volume 34/no. 1/July 2016 ISSN 1571-9308 Editor: Julie Vanden Bulcke Language editor: Amy Clithero The Network: Towards Unity for Health Publications UGent University Hospital, 6K3 De Pintelaan 185

Lay Out: Anja Peleman Print: Drukkerij Focusprint

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July 2016 Newsletter - The Network: TUFH  
July 2016 Newsletter - The Network: TUFH  
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