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Sydney Medical School

Our India connections APRIL 2010

India and Sydney Medical School This newsletter provides some insight into the growing relationships across teaching, learning and research that Sydney Medical School and its affiliated research institutes are building with key partners in India. You will find that our activities and relationships vary enormously in partnerships, themes and in geographic locations across India and some to the broader Indian sub-continent. Here we also profile just some of these activities, the voices of some of our Indian students and the voice of the Indian Consul– General to Sydney. We hope that this publication sets the scene for increased engagement with Indian organisations and future students. 1


Erin Donnelley, a Med 2 student, on her elective at the Indian Institute of Mother and Child in South Kolkata

Global perspectives on health - Sydney Medical School BY Louise Freckelton, manager - international relations, office for global health, sydney medical school

Health is an international field. Health professionals are in demand across the globe and health issues do not recognize national boundaries. have also developed a number of special exchanges and No matter whether you decide to practice at home or international experiences with key partners. abroad, an understanding of the global burden of disease, how certain diseases link or are more prevalent according to These include opportunities to undertake an elective with ethnicity and how disease is changing across the globe due some of the best universities in the world like Cornell to modernization and climate change is imperative. and Columbia in the United States, Karolinska in Sweden, Shanghai Jiao Tong in China and with CMC Vellore in Sydney Medical School takes seriously the global India. In addition, our focus on building strong international dimensions of health and has built this aspect into both relationships in our region means that we have been able to the informal and formal curricula. The University of secure elective experiences for our students in Cambodia, Sydney Medical Program is committed to ensuring that its graduates are globally competent and globally mobile health Timor Leste and Vietnam. professionals prepared in part to interact in that borderless “We are constantly growing these opportunity for students world. and this will also develop in-line with where our students There are lots of ways that we aim to internationalize our students’ experiences.

International Exchanges Naturally there is space in the program for electives and many of our students organise placements in far flung corners of the world organized by themselves. But we

come from and what the interests of our students are. Our Indian students might find the elective placement with CMC Vellore or with Nepal’s Patan Academy of Health Sciences attractive, on the other hand they may be drawn to a health experience in Australia’s neighbourhood of Asia-Pacific”, says Associate Dean (International) and Director of the Office for Global Health, Associate Professor Lyndal Trevena. “We are also developing new electives with the University of British Columbia with the National University of Singapore and at the University of Gadjah Mada in Indonesia so the options continue to expand.”

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The Global Health Stream The ‘Global Health Stream’ is a new initiative for students in the Sydney Medical Program to explore areas of interest in Global Health. Students from all years meet approximately once a month to hear a speaker on an issue of Global Health importance. Each student is also encouraged to identify a project or specific area of interest to work on and this might include preparing for an overseas option or elective placement, advocating for global health issues or simply learning more about a particular health problem or country. Students are linked up with appropriate people and resources to help develop their ideas.

Student activities - GlobalHOME and Postcards from wherever Our medical students are passionate about global health issues and regularly hold student-run events on these themes. In 2010 GlobalHOME in conjunction with the Office for Global Health will hold a series of 9 lectures covering all aspects of global health. Our popular twice annual ‘Postcards from wherever’ evenings allow for short presentations by staff and students on their own global health experiences.

Members of the group participate in online discussion with Global Health events and links regularly posted via Facebook. Here are some examples of recent Global Health Stream gatherings: • Andrew Hewitt, Executive Director Oxfam Australia Andrew addressed the ‘perfect storm’ of the global financial crisis, climate change and the food crisis currently facing the world and most severely affecting the health of those in the developing world. • A conversation with the Indian Consul General, His Excellency Amit Dasgupta The Indian Consul General spoke on the health challenges in this populous nation. • A focus on China With China as the most populous patient in the world, their health will inevitably impact globally. Dr David Bray spoke about the historical, political and social context of China’s health in this age of reform. • Cultural Intelligence: How not to offend Dr Cynthia Hunter provided practical tips on culture and cultural awareness, particularly on how to make the most of a health placement abroad bearing cultural factors in mind. • Humanitarian and Emergency work in post-conflict countries Bronwen Blake enthralled us with stories about working with refugees in Africa and Asia. We heard about managing cholera outbreaks and delivering health services in incredibly challenging environments.

Office for Global Health Take a look at the Office for Global Health website to find out more about all these opportunities to position your medical degree for the world of global health. www.sydney.edu.au/global-health

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A conversation with the Indian Consul-General BY Kruthika Narayan, Medical student Sydney Medical School

Many of you may recognise the painting as Van Gogh’s Wheatfields with Crows. Each of you will be struck by some aspect of the painting and form your own impression of it. What if you were then told that this was Van Gogh’s last painting before his suicide? Given this key piece of information, do your perceptions then change?

“A health model which works in one developing country situation, may not necessarily be transplanted with equal effectiveness to another,”

The flying birds perhaps, are crows, harbingers of death; the chaotic landscape a reflection of his inner turmoil. In reality, Wheatfields is not Van Gogh’s last painting. Does this fact once again completely alter the perceptions proceeding from the previous one?

to Kathmandu. His wide experience is reflected in the numerous books he has edited and written in both fiction and non-fiction. Caught up as we are in the world of medical facts, the Consul-General’s talk was an important eye-opener into the more philosophical issues surrounding health policy.

This was the eloquent example with which the Consul-General of India, Sydney, Mr Amit Dasgupta, commenced his talk to medical students at the University of Sydney. As part of the Global Health Stream, the Medical Faculty’s international health curriculum, we had the valuable opportunity of speaking with the Consul-General on Thursday 17 September about health issues in India. Prior to his appointment in Sydney, Mr Dasgupta has held various diplomatic positions across the world, from Cairo

Van Gogh’s Wheatfields was a poignant illustration of how essential pieces of information shape the way we perceive a situation and how these perceptions may not always be correct. As the Consul-General emphasised, this is particularly important in addressing the various issues of international health. It highlights that a health model which works in one developing country situation, may not necessarily be transplanted with equal effectiveness to another. In India, as the Consul4


A conversation with the Indian Consul-General CONT. General explained, the diversity in language, culture and customs within states, let alone between them, makes the implementation of health policy a complex issue, requiring a different approach in each region. The burgeoning of chronic disease in India highlights the importance of targeted health intervention programs. According to 2009 WHO statistics, the age–standardised mortality rate for cardiovascular disease is 382/100 000 and studies suggest that chronic diseases, particularly cardiovascular, are fast becoming the main cause of

Another includes the health education programs, run by the Central Health Education Bureau, focusing on the education of women and children and taking into account the differences in beliefs between regions. These two The Consul-General spoke of some of strategies mentioned by Mr Dasgupta the health interventions implemented reiterate that approach is the key by the Government to counter this message. Health interventions need to increase in chronic illness. Recognising be tailored and not run as an identical that a centralised approach to health franchise from state to state, or as the policy would be less effective, one Consul General put it, ‘McDonalised’. strategy has been to empower village It comes back to how we interpret the councils or ‘Panchayats’, funded by, but picture of chronic disease in India, or not accountable to, the Government. in any country; ensuring the individual Composed of local villagers and an characteristics of that particular elected leader, these Panchayats have picture are what shape our perceptions a better picture of the cultural and and actions. social characteristics of a region, and This article originally appeared in Vector, Issue 9, November are in a position to know what policies 2009 and was reproduced here with permission. Vector is the official student publication of the AMSA Global Health Network. would be most suitable. www.ghn.amsa.org.au mortality in urban and rural populations. Not to mention diabetes, the prevalence of which was estimated to be greater than 31 million in 2005 and growing.

Collaborating together – projects with our partners in India In addition to teaching and learning, it is research that defines a university. It is these three activities that are a university’s core business. Sydney Medical School is committed to research that improves human health across the spectrum of basic science, clinical medicine and public health and that reaches across the globe to making a contribution to improving the health and wellbeing of our region. Profiled here are a number of the projects that our researchers are involved with in India and across greater South Asia.

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Cancer prevention project for rural women in Tamil Nadu Sydney Medical School, Weill Cornell Medical College (USA), Cancer Council Australia and Christian Medical College Vellore, India are working together to build a cancer prevention partnership for women in Tamil Nadu, India. Cervical and breast cancers are the most common cancers amongst Indian women. The focus of this collaboration is on breast and cervical cancer prevention. “This innovative cancer prevention program implemented by Christian Medical College, Vellore in partnership with International organizations has empowered rural women in India to have access to early screening and care for the highly prevalent cancer cervix at their doorstep at a very affordable cost”, said Dr Rita Isaac, Professor & Head of Rural Unit for Health and Social Affairs (RUHSA) Department. The ‘Educate, Screen and Treat’ program is intended to detect breast and cervical cancer and initiate treatment in the early stages of disease. The University of Sydney has an international reputation in cancer screening epidemiology and in health literacy. The Cancer Prevention project is based in RUHSA, the rural hospital of Christian Medical College (CMC), south of Chennai and is jointly funded by Sydney Medical School, the University of Sydney’s International Program Development Fund, Weill Cornell Medical College and Cancer Council Australia. The project involves community-based peer education and implementation of cervical cancer screening through 18 community-health-centre-based clinics in the K.V Kuppam block of Tamil Nadu. “In a resource-poor setting like rural Tamil Nadu, there is good evidence that visual inspection with acetic acid (VIA) is an effective and low-cost strategy for detecting early precancerous lesions of cervix and thereby reducing the incidence of advanced invasive forms of cervical cancer and that clinical breast examination might lower breast cancer mortality”, says Sydney project leader and Director of the Office for Global Health, Associate Professor Lyndal Trevena.

Dr Rita Isaac and Associate Professor Lyndal Trevena

Dr Rita Isaac with the community-based women’s group

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South Asia Infant Feeding Research Network The School of Public Health is partnering with researchers and organisations across South Asia to address one of the most fundamental of the Millennium Development Goals – a reduction in deaths of under-five year olds. The World Health Organization (WHO) infant feeding guidelines recommend that infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond. It is estimated that 10% to 15% of under-five deaths in resource poor countries could be prevented through achievement of 90% coverage with exclusive breastfeeding alone. However, despite breastfeeding’s numerous recognized advantages, breastfeeding rates in most developing countries are typically low and are only improving slowly. According to estimates from 1995 to 2003, only 38% of infants in the developing world were exclusively breastfed for their first six months.

Partners include: School of Public Health, Sydney Medical School, The University of Sydney; Indira Gandhi Government Medical College, Nagpur, India; Indian Council of Medical Research, New Delhi, India; Grant Medical College & Sir JJ Group of Hospitals, Mumbai, India; Society for Applied Studies, New Delhi, India; International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; Ministry of Health and Population, Kathmandu, Nepal; Pakistan Institute of Medical Sciences, Islamabad, Pakistan; Faculty of Medicine, University of Colombo, Sri Lanka; Family Health Bureau, Ministry of Healthcare & Nutrition, Colombo, Sri Lanka; and Center for Global Health Research, Tufts University School of Medicine, Boston, USA www.usyd.edu.au/global-health/international-networks/ saifrn.php

Dr Michael Dibley, Associate Professor for International Public Health in the School of Public Health

The South Asia Infant Feeding Research Network (SAIFRN) seeks to improve infant and young child feeding practices and thus leads to better health and development of children and reduced infant mortality in the South Asia region. “SAIFRN aims to create policy relevant information about the current situation, trends and key factors associated with infant and young child feeding in countries across South Asia. This activity will provide government health agencies, non-government health agencies and their international development assistance partners with critical information to advocate for the need to increase investments and efforts to promote appropriate infant feeding practices in the region” says Michael Dibley, Associate Professor for International Public Health in the School of Public Health. SAIFRN fosters and coordinates research collaborations among leading South Asian and international research groups that focus on infant and young child feeding and aims to identify key policy-related research questions and address them with high quality research and dissemination of the findings to ensure the development of effective interventions for improving infant and young child feeding in the region. SAIFRN is supported through funding from AusAID’s Public Sector Linkage Project and UNICEF.

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Collaborating together – projects with our partners in India CONT. Developing instruments for conducting low back pain research in India

The collaboration is based on a five year Memorandum of Understanding signed between The Indian Council of Medical Research, Sydney Medical School and The George Institute for International Health in late 2007. The Indian Council for Medical Research is the apex body (Government of India) for the formulation, coordination and promotion of health and medical research in India.

Managing the burden associated with chronic musculoskeletal health conditions is likely to be a significant challenge in India in coming years. The COPCORD (Community-Oriented Program for the Control of Rheumatic Disease) study in India demonstrated a point prevalence of back pain of around 13%; a rate similar to that found in other countries around the world. What is not clear Unintentional injury and Falls Research is the degree of disablement associated with back pain in Several senior researchers in the Injury Division of the India. Therefore, in collaboration with the All India Institute George Institute for International health are actively of Medical Sciences, Sydney Medical School and The involved in injury research in India. A study of mortality and George Institute are developing the instruments needed to morbidity in rural Andhra Pradesh found that injury is an measure the burden of low back pain in India. The project important contributor to disease burden and that falls in will translate and cross-culturally adapt English disability older people are a significant issue in India. measures into Hindi as well as test the measurement properties of the instruments developed in patients. In collaboration with the Centre for Global Health Research, Canada, researchers are also investigating unintentional Funding for this initiative has been provided by Sydney injury mortality in India using all cause mortality data from Medical School, The George Institute for International the Sample Registration System. A post-graduate student Health and the University of Sydney’s International Program from The George Institute and the Sydney School of Development Fund Public Health is leading research on falls and burns injuries Partners include: through a study of injury-related hospitalizations at the Post Graduate Institute of Medical Research and Education All India Institute of Medical Sciences (AIIMS); Sydney (PGIMER), Chandigarh. This body of research is informing Medical School and The George Institute for International the development of an Australian-Indian joint research Health program on falls prevention, a growing public health concern in India. Indo-Australian collaboration in nonPartners include: communicable disease and injury research The George Institute India; Indian Institute for Public Health The Indian Council of Medical Research, Sydney Medical Hyderabad; Post Graduate Institute of Medical Research School and The George Institute for International Health and Education Chandigarh; Centre for Global Health are collaborating to support projects in non-communicable disease control and injury prevention. The current initiatives Research, Canada. focus on diabetes research and road traffic injuries. A diabetes research workshop run in Hyderabad from 10th –11th February 2010 with the theme of ‘Adolescent Obesity and Diabetes’, included researchers and scientists from both Australia and India coming together to share ideas and discuss common problems. Main topics for discussion included epidemiology and determinants of adolescent obesity as well as interventional strategies. A road traffic injury workshop and seminar has been confirmed for 28–30th June 2010 in Sydney. The workshop will revolve around developing a research strategy that addresses vulnerable road users - the group bearing the greatest burden in terms of road traffic injury in India. These initial workshops will serve as a sustainable model for funded, truly collaborative and major research activities between University of Sydney and a range of Indian scientists. Funding for these initiatives has been provided by the Australia-India Council, the Indian Council of Medical Research, Sydney Medical School, The George Institute for International Health and the University of Sydney’s International Program Development Fund.

THE GEORGE INSTITUTE FOR INTERNATIONAL HEALTH The George Institute for International Health (a research institute of Sydney Medical School) is actively engaged in these public health projects and clinical trials in India through its office in Hyderbad. More information on all these and other projects can be found at www.thegeorgeinstitute.org

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Collaborating together – projects with our partners in India CONT. Electronic Decision Support for CVD Prevention in primary health care This study examines the feasibility of incorporating a simple algorithm for cardiovascular disease prevention into an electronic decision support system that has been developed for use at primary health care centres in low- and middle-income countries. The system has been particularly developed for use by non-physician health workers. Partners include: The George Institute India; St. John’s Medical College, Banagalore; The George Foundation, Bangalore Andhra Pradesh Rural Health Initiative This project is working towards improving the health status, prevention and management of non-communicable disease to prevent premature death and enhance access to health services for the people of rural Andhra Pradesh. Through the careful design, implementation and evaluation of affordable and sustainable interventions the project aims to be incorporated in the existing primary health care infrastructure of rural areas. Partners include: The George Institute India; Byrraju Foundation, Hyderabad; CARE Foundation, Hyderabad and Centre for Chronic Disease Control, New Delhi

Population Health Metrics Research Consortium Project (GC13) Addressing the Gates Grand Challenge #13 which seeks to develop new technologies that permit better quantitative assessment of population health, this project pursues a creative and bold approach by pooling epidemiology, biomedical research, and population health assessment and is a collaborative multi-country project including India, Tanzania and the Philippines. Partners include: The George Institute India; University of Washington, Seattle The UMPIRE (Use of a Multidrug Pill In Reducing cardiovascular Events) Study Funded by the European Commission, this trial will evaluate the effectiveness of a “polypill”-based strategy compared to usual care, in approving adherence to preventative treatments among people with or at high risk of cardiovascular disease. The study, which will be completed in 2013, will include 1000 patients from India and 1000 patients from 3 European countries. Partners include: The George Institute India; the Public Health Foundation of India; Imperial College, London. 9


Students & graduates of Sydney medical School in their own words volunteering experiences I’ve had as an undergraduate and then graduate student have played a key role in helping me make this decision. Good doctors command the trust and respect of the community and the responsibility of saving a person’s life or improving a patient’s quality of life can be quite humbling yet self-satisfying.” Why did you decide to come to Sydney? “In choosing a medical program, I considered two things: the structure of the medical curriculum and the city it was based in. For me, the two most important factors about Sydney University’s Medical Program were the problem-based learning (PBL) format and early clinical exposure. I felt studying academic and clinical medicine side-by-side made the learning process a lot more interesting. To top this, the university is based in Sydney, a city with a multicultural flavour and varied indoor as well as outdoor experiences to explore.” What has been your experience of the Med program candidature? Of Sydney?

Mithun Joshi from Mumbai is currently undertaking his 4th and final year of the University of Sydney Bachelor of Medicine Bachelor of Surgery (MBBS). The University of Sydney medical program is graduateentry.

then went on to pursue a Masters in Athletic Training from the University of North Carolina in Chapel Hill.” Why did you choose to do Medicine and how did you come to that decision?

“The medical profession has fascinated me from a very early age. However, I wanted to be absolutely sure that it “After completing high school in India, was something I would enjoy for the I completed a Bachelor of Science rest of my life before committing degree in Physiotherapy from the State to the long hard years of studying University of New York in Buffalo. I and work. I think the clinical and Where did you do your undergrad degree and what was it in?

“I’ve greatly enjoyed my time at the University of Sydney. Our class has students from diverse backgrounds, and sharing conversations with them during PBL sessions and clinical tutorials has enriched my student experience. The hospitals affiliated with the University are fantastic and getting tutorials from clinicians who are leaders in their field has been a privilege. There are also plenty of research opportunities for students to pursue. Friendly people, great weather throughout the year and something for everyone to enjoy make Sydney one of my favourite places to live in.” What advice would you give to someone considering applying for Medicine at Sydney Medical School? “Sydney University offers a wellrounded medical program and I would urge anyone committed to a career in medicine to strongly consider it.”

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Bhawna Gupta from Chandigarh is a recent graduate of the Master of International Public Health (MIPH) program. Where did you do your undergrad degree? “Belgaum, Karnataka where I did a Bachelor of Dental Surgery (BDS) Why did you choose to do the MIPH and how did you come to that decision?

for the students from these countries. The Medical School is very organized with a fantastic library and the provision of membership to the library of the University for one year after completion of the course enables you to enhance your knowledge and gives you a world wide exposure.” Deepak Thomas Abraham is a PhD candidate from Kerala. Originally from Bangalore he has also worked at the Christian Medical College, Vellore, in Tamil Nadu.

“India faces immense challenges in the field of public health and there is Where did you do your undergrad an extreme shortage of public health degree? professionals, more so in the field of oral health. After pursuing clinical “In Kerala, I did an MBBS straight from practice in both public and private school and then a MS (postgraduate sector in India, I realized that I’ll be degree in General Surgery) from CMC able to contribute more to the health, Vellore, Tamil Nadu.” especially oral health, by contributing Why did you choose to do a PhD? to public health programmes which will “I completed my residency in surgery, further make a difference to a much sub-specialized in Endocrine surgery, larger population than I would ever be and have been working as a member able to do through clinical practice. of faculty in the Department of Pursuing training in public health was Surgery at CMC Vellore for the last the first step for me to contribute to 7 years. Being a permanent staff, we the massive efforts required in the have the opportunity to take 3 years capacity building which have recently of sabbatical to train in your area started.” of interest. I chose to do my PhD Why did you decide to come to because research was a lacuna in Sydney? my department. Being a high volume tertiary care hospital, there is a wealth “University of Sydney enjoys the of resources available, which when reputation of being one of the top combined with high quality research universities in the world and I was will make my department a world class extremely lucky to be accepted for the unit. So I chose to be a student at this Masters programme, MIPH, at this stage of my career and learn new skills prestigious institution.” to take back at the end of my stint What has been your experience of the here in Sydney.” MIPH candidature? Of Sydney?

How did you come to that decision? “This happened by actually visiting centres of excellence in the US and speaking to reputed ‘surgeon-scientists’ who I met at various conferences.” Why did you decide to come to Sydney? “I had met colleagues from the University of Sydney Endocrine Surgical Unit at various conferences and came here because I had the opportunity to do clinical work along with research which was not offered by American centres as foreign trained doctors need to do the licensing exam.” What has been your experience of the PhD candidature? Of Sydney? “Great learning experience, but at the same time can be very challenging, especially when you realise you are not playing to your strengths. It does make you feel vulnerable. Sydney is a great place to come to and is a welcoming place for people new to the country.” What advice would you give to someone considering applying for PhD? And for PhD at Sydney Medical School in particular? “I would ask the question ‘why do you want to do this PhD?’ If that can be answered, I would encourage them to go for it, but warn them that there will be challenges which will in the long run be beneficial to them. You learn skills at problem solving and a PhD is always accompanied by problems.”

“It has been a lovely experience both academically and personally. This is one of the institution which gives a wide range of dynamic electives mainly focussed on the developing countries with flexible degree structure. The faculty is extremely cooperative and always welcoming to help the students in whatever they need. However, the accommodation for the International students is very sparse and needs more attention.” What advice would you give to someone considering applying for MIPH? And for MIPH at Sydney Medical School in particular? “This is one of the best universities in the world. Even though the course is done in Sydney, it focuses a lot on the developing countries which is a bonus

Deepak Thomas Abraham

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Studying at Sydney Medical School Sydney Medical School is Australia’s largest and oldest. At Sydney Medical School our aim is to develop caring, clear-thinking, clinically outstanding, research capable and globally engaged graduates who have the capabilities to become leaders in medicine, public health and research. Ranked by the Times Higher Education Supplement as 15th in the world for Life and Biosciences, you can be sure that our programs are world-class. Sydney Medical School offers programs in a large number of disciplines critical to contemporary health care. These include: Graduate-entry studies in: • Medicine (MBBS) Postgraduate study in: • Biostatistics • Brain and Mind Sciences • Clinical Epidemiology

• • • • • • • • • • • • • • • •

Health Policy Indigenous Health Promotion Indigenous Health (Substance Use) Infection and Immunity International Ophthalmology International Public Health Medical Education Medical Humanities Ophthalmic Science Paediatric Medicine Pain Management Psychotherapy Public Health Qualitative Health Research Refractive Surgery Reproductive Health Sciences and Human Genetics • Sexually Transmitted Diseases/HIV • Sleep Medicine • Surgery And research programs in any medical field. www.sydney.edu.au/medicine

DILHANI BANDARANAYAKE Dr Dilhani Bandaranayake is the Manager – International Relations with responsibility for India. Dilhani is responsible for developing key strategic relationships in India in regards to research and innovation, teaching and learning, the student experience and community engagement. Dilhani also provides advice to Sydney Medical School including information on current and potential partners, funding and research opportunities. Dilhani’s portfolio also covers the Pacific, Europe and other countries in South and South East Asia such as Timor Leste, Nepal, Cambodia.

Office for Global Health The Office for Global Health is part of Sydney Medical School and aims to internationalise the research we undertake, the experience of our students and staff, and our approaches to learning and teaching. We also aim to contribute to the health and wellbeing of our region by engaging in health projects with some of our nearest neighbours. Find out more about the activities of our office by visiting our website: www.SYDNEY.edu.au/global-health

Sydney Medical School

for more information contact T +61 2 9351 6942 F +61 2 9351 2433 E dilhani.bandaranayake@sydney.edu.au sydney.edu.au/global-health

CREDITS Copy: Dilhani Bandaranayake and Louise Freckelton Editor: Louise Freckelton Photos: David Boyd (students and graduates), Lyndal Trevena, The George Institute for International Health, Michael Dibley

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