WONCA News March 2022

VOL 48 | NUMBER 2

NEWS

2022

M A R C H

WONCA PRESIDENT DR ANNA STAVDAL (NORWAY) EMAIL: PRESIDENT@WONCA.NET TWITTER: @ASTAVDAL WONCA IMMEDIATE PAST - PRESIDENT DR DONALD LI (HONG KONG) PRESIDENT-ELECT ASSOC PROF KAREN FLEGG (AUSTRALIA) EXECUTIVE MEMBER AT LARGE & HONORARY TREASURER PROF VAL WASS (UK) EXECUTIVE MEMBER AT LARGE DR MARÍA PILAR ASTIER PEÑA (SPAIN) EXECUTIVE MEMBER AT LARGE PROF SHABIR MOOSA (SOUTH AFRICA) REGIONAL PRESIDENT, WONCA AFRICA DR DAN ABUBAKAR (NIGERIA) REGIONAL PRESIDENT, WONCA ASIA PACIFIC ASSOC PROF MOHAMMAD HUSNI JAMAL (MALAYSIA) REGIONAL PRESIDENT, WONCA EAST MEDITERRANEAN PROF TAGHREED MOHAMED FARAHAT (EGYPT) REGIONAL PRESIDENT, WONCA EUROPE PROF SHLOMO VINKER (ISRAEL) REGIONAL PRESIDENT, WONCA IBEROAMERICANACIMF ADJ/PROF JACQUELINE PONZO (URUGUAY) REGIONAL PRESIDENT, WONCA NORTH AMERICA DR JEFF MARKUNS (USA) REGIONAL PRESIDENT, WONCA SOUTH ASIA DR TARIQ AZIZ (PAKISTAN) YOUNG DOCTORS' REPRESENTATIVE DR SANKHA RANDENIKUMARA (SRI LANKA) WONCA CHIEF EXECUTIVE OFFICER DR HARRIS LYGIDAKIS WONCA WORLD SECRETARIAT WORLD ORGANIZATION OF FAMILY DOCTORS AVENUE DES ARTS 7-8 1210 BRUSSELS BELGIUM EMAIL: SECRETARIAT@WONCA.NET PHONE: +32 (0) 2 329 00 75 WONCA EDITOR MARIA DOLORES ZAVALA EMAIL: EDITOR@WONCA.NET TRANSLATIONS DR JIE GU DR HUA YANG DR JULIEN ARTIGNY CREDIT COVER PHOTO: MINERVA STUDIO

CONTENT FROM THE PRESIDENT

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SUPPORT FOR UKRAINE

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WONCA STATEMENT ON UKRAINE

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FROM THE EDITOR

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WONCA CONFERENCES

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WONCA REGIONS

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EMR REGIONAL PROFESSIONAL DIPLOMA IN FAMILY MEDICINE

WONCA - WHO

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PRIMARY HEALTH CARE MEASUREMENT FRAMEWORK AND INDICATORS

FEATURED STORIES

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INTERNATIONAL WOMEN'S DAY WONCA GRIEVE: DR SALVADOR TRANCHE, SEMFYC PRESIDENT

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SIR ANDY HAINES, AWARDED WITH THE 2022 TYLER PRIZE

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GLOBAL LAUNCH OF THE LANCET-WORLD PSYCHIATRIC ASSOCIATION COMMISSION

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FEATURED DOCTOR

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ISTI ILMIATI FUJIATI

ANNOUNCEMENTS AND UPDATES

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FROM THE PRESIDENT M A R C H

2 0 2 2

CREDIT COVER PHOTO: CHEN LIU

“NO MAN IS AN ISLAND” From: “Devotions upon Emergent Occasions” by, John Donne, 1624

F R O M

The evidence is mounting steadily and it’s convincing: Health systems based on Primary Care achieve better health results and at a lower cost. Primary Care is now considered a prerequisite for achieving Universal Health Coverage. This commitment appears in various high-level political agreements approved by international leaders during the last 5 decades. In 2018, when members and leaders of WHO and the UN approved the Astana Declaration, WONCA was broadly represented, as were many other professional organizations representing Primary Care health workers.

T H E

Nonetheless, this prioritizing of Primary Care has proved very difficult to implement. Certain counterforces are easily identified and well known, the most obvious being the growing fragmentation of all medical disciplines, and the rapid development of technology driven by strong commercial interests.

P R E S I D E N T

These are general trends and affect many aspects of society, health and education systems in particular. Neither WONCA nor individual doctors could possibly alter the direction of this development on their own. Once we understand how these global, societal trends impact our local, everyday context, however, we can mobilize pushback, from the bottom up.

I have experienced it time and again, in practice and in advocacy: although Primary Care givers from differing professions share the same vision, we too often fail to identify and utilize the potential for synergy that our collaboration offers.

This is where self-scrutiny helps.

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WONCA NEWS

As the number of professions within Primary Care increases, are we at risk of withdrawing into separate silos, replicating the fragmentation we’ve watched increase within Secondary Care specialties? Might such fragmentation feed competition among Primary Care professionals? If so, where does that leave our patients?

For a reality check, let`s look at our own practices. You’re likely to recognize such questions as these: Who can offer the best care to a pregnant woman—her family doctor or the community midwife? Do Public Health Nurses have sufficient pharmacological knowledge to prescribe contraceptives, or should a medical doctor always be involved? Is the Community Health Worker just some cheaper stand-in for a fully qualified family doctor, or does his training enable him to make a unique contribution? What is the role of a Community Nurse with mental health training and experience as compared to that of a family doctor?

F R O M T H E

Two types of competition are implicit in these examples: competition for status, as in which Primary Care profession is hailed for providing the best care, and competition for assets, as in which Primary Care profession receives the most money.

The bigger and more complex the local health system becomes, the more likely professional competition and protectionism become. Then, instead of joining forces, we risk leaving the patient in the crossfire of our professional interests. That won’t serve the well-being of our patients, of our professions, or of ourselves.

P R E S I D E N T

‘Task shift’ is the new gospel according to policy makers. What would be the impact on the quality of services if certain procedures traditionally carried out by the family doctor were taken over by other Primary Care professionals? Would that cause medical service delivery to fragment, threatening the comprehensive approach that is the very hallmark of family medicine? Or, we might adopt a team approach. Instead of insisting that only doctors carry out specific procedures, we can join together to build Primary Care teams,

while also ensuring that the services delivered by the teams we participate in reflect and uphold the basic values of our trade: personal, continuous and comprehensive care. That seems to me to be the way forward.

We won’t stop advocating for everyone in the world to have a family doctor. On the way there, and beyond, however, we can also contribute, to the best of our ability, to providing good Primary Care in cooperation with our Primary Care colleagues from other professions. I know how clumsy that may feel at first, but I also know how quickly the added value begins to pay off, how the combined efforts of people from different professional perspectives and backgrounds create powerful synergies.

Let’s make it clear: Primary Care is not some ‘hospital-care light’. Clinical decisions are based largely on recognition of patterns, on what one has learned to expect. Decision-making assumptions that have been shaped through working with patients in the Secondary Care hospital context may not be valid within the context of Primary Care. Contexts differ, as do the rates and probabilities of diseases, depending on the context. Insight into epidemiological variations is crucial to tailoring clinical decisions to the population at hand. To a family doctor, this insight may seem so basic as to be self-evident.

But it is not. We must emphasize it, with clarity, and make sure it remains as the foundation of Primary Care teams’ clinical decision-making—no matter how many, or which, professions are represented on the team.

Even though Primary Care teams are bound to differ—they too are impacted by their local contexts—recognizing and acknowledging the value of the team can foster the emergence of a common Primary Care professional identity.

Through shared training and awareness, we can develop our team-playing skills. As with so much else, it’s a matter of trust and good communication.

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WONCA NEWS

F R O M T H E

WONCA is advocating co-training, within and on behalf of the Primary Care setting. My ambition is for this approach to be extended to the way WONCA works toward regional and global advocacy as well. Currently, we are exploring how we can ‘team up’ with other global professional networks to strengthen our advocacy for Primary Care. Yes, please. Health for all!

P R E S I D E N T

DR ANNA STAVDAL WONCA PRESIDENT

Also available in: Español Français

中文

NO MAN IS AN ISLAND No man is an island entire of itself; every man is a piece of the continent, a part of the main; if a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as any manner of thy friends or of thine own were; any man's death diminishes me, because I am involved in mankind.

And therefore never send to know for whom the bell tolls; it tolls for thee.

MEDITATION XVII Devotions upon Emergent Occasions John Donne

CREDIT COVER PHOTO: CHEN LIU

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WONCA NEWS

S U P P O R T

F O R

U K R A I N E DONATE NOW

WONCA ENCOURAGES MEMBERS TO TAKE ACTION People, especially those with medical needs, are suffering in Ukraine. Over two million people have already fled to neighbouring countries.

Here is how you can help:

1) WORLD MEDICAL ASSOCIATION: THE UKRAINE MEDICAL HELP FUND

DONATIONS CAN BE MADE TO THE FOLLOWING ACCOUNT:

The World Medical Association (WMA) has set up a support structure to funnel medical help to Ukraine. To support this, WMA, the European Forum of Medical Associations (EFMA) and the Standing Committee of European Doctors (CPME) have set up the Ukraine Medical Help Fund. The account holder for donations is the WMA.

Bank: SOCIETE GENERALE Domiciliation: ANNEMASSE ENTERPRISES (04335) IBAN: FR76 30003 04335 00050005353 78 BIC: SOGEFRPP

The funds will be redistributed to WMA’s partners in Poland, Slovakia and other bordering countries in order to help Ukrainian colleagues or the medical help for refugees from Ukraine.

The Fund is governed by the Taskforce Ukraine, which is composed of representatives of the medical associations (int/national) involved in the execution of the project, i.e. the WMA, EFMA, CPME, the Polish Chamber of Doctors and Dentists the Slovakian Medical Association and the Slovakian Medical Chamber. The Taskforce will recommend the use of funds to the Steering Committee consisting of the Secretary Generals of CPME, WMA and EFMA and is chaired by WMA Past President Prof. Dr Leonid Eidelman.

Account Owner: ASSO MEDICALE MONDIALE 13A Chemin du Levant 01210 FERNEY-VOLTAIRE FRANCE WMA, EFMA and CPME appeal to you to consider donating to the Ukraine Medical Help Fund to allow the medical community to coordinate and provide vital medical support to the humanitarian crisis. Please find here the official letter of appeal for donations.

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WONCA NEWS

S U P P O R T

U K R A I N E DONATE NOW

2) UKRAINIAN RED CROSS The Ukrainian Red Cross has set up a call for donations. You can donate directly on this website: https://donate.redcrossredcrescent.org/ua/donate/

3) INTERNATIONAL COMMITTEE OF THE RED CROSS The International Committee of the Red Cross — together with its partners in the Red Cross and Red Crescent Movement — remains active in Ukraine, saving and protecting the lives of victims.

You can donate directly here: https://www.icrc.org/en/donate/ukraine

SUPPORT

UKRAINE STAY TUNED FOR UPDATES ON HOW TO SUPPORT PEOPLE IN UKRAINE HERE.

4) COLLEGE OF FAMILY PHYSICIANS IN POLAND The College of Family Physicians in Poland can facilitate donations of funds to to the potential receivers in Poland who organise direct help (please contact the WONCA Secretariat for contact details).

5) FUNDACJA LEKARZE LEKARZOM – FOUNDATION DOCTORS FOR DOCTORS The charity is set up by the Polish Supreme Chamber of Physicians and Dentists; it coordinates deliveries of medical supplies. For information, please contact Dr Mariusz Janikowski, President of the Foundation, through https://fll.org.pl/kontakt/ or at fundacja@hipokrates.org

6) MÉDECINS SANS FRONTIERS Médecins Sans Frontiers (MSF) is one of international organisations active in Ukraine, delivering medical supplies in Kyiv, Mariupol, Kramatorsk and Pokrovsk, and sending emergency and specialist medical staff. MSF is supporting hospitals and doctors remotely, including by providing training on trauma care, and through telemedicine, while also working in neighbouring countries offering support for displaced people.

You can support their efforts with donations at: Beneficiary: ASBL MEDECINS SANS FRONTIERES BELGIUM Address: Rue de l’Arbre Bénit 46 IBAN: BE73 0000 0000 6060 BIC: BPOTBEB1 Reference: Corporate support Or by credit card here.

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S U P P O R T

U K R A I N E

WONCA STATEMENT ON UKRAINE

WONCA STATEMENT

WONCA URGES SUPPORT OF COLLEAGUES AND CALLS FOR AN IMMEDIATE END TO THE CONFLICT IN UKRAINE WONCA is profoundly saddened devastating developments in Ukraine.

by

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Family doctors of the world express their deepest sympathy with the affected populations. We offer our strongest support to all healthcare workers in Ukraine, now working under extreme duress to continue the provision of health care to civilians, who in crises, suffer the most.

People are suffering. A large-scale humanitarian crisis now affects multiple countries in Europe.

Families are split. Populations are displaced within Ukraine and into neighbouring countries.

Basic needs are threatened – water, food, sanitation, shelter, and not least, safety.

WONCA calls for protection of civilians from the collateral damage of military actions and for safe and bearable working conditions for all health personnel.

WONCA urges our members to reach out and support our colleagues in the affected region, and if possible, provide assistance on a practical level.

Our thoughts and prayers go out to all colleagues and their families and patients who are affected.

We call for an immediate end to the conflict in Ukraine.

DOWNLOAD THE STATEMENT AS PDF

A basic human right is the right to health. Conflict destroys health infrastructure as health facilities are decimated. Access to health care becomes problematic. Conflict adds to the health needs of peoples - severe physical injuries, need for medications, and mental health afflictions.

Medical supplies are scarce. Few, if any, health systems in the world could cope.

We know that the demand for coordinated primary health care increases in crises of conflict.

We also know that the pressure on our family doctor colleagues and their teams is drastically increasing and that the demand for primary health care exceeds supply. The impact is devastating for health care provision. The vulnerable, the aged, children, those with chronic medical conditions are particularly affected.

Our colleagues in Ukraine, in both pre-hospital and hospital care, are stepping up to meet the needs best they can. To those colleagues: we salute you, we salute your bravery, we share your despair. You have our deepest respect and support!

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WONCA NEWS

F R O M T H E E D I T O R WELCOME TO WONCA NEWS MARCH!

In this edition, WONCA makes an important call for solidarity and urges members and member organizations to take action and support in Ukraine. Discover how can you help and read our statement on Ukraine here.

In our Featured Stories section, find a tribute to recently departed, Dr Salvador Tranche, President of semFYC (Spanish Society of Family and Community Medicine); all the

information about the 2022 Tyler Prize to Sir Andy Haines, WONCA Life Member; and the details on the Global launch of the LancetWorld Psychiatric Association Commission. As our Featured Doctor, meet Isti Ilmiati Fujiati, chairwoman of the Host Organizing Committee for The WONCA Asia Pacific Regional Conference in Bali, Indonesia, on December 8-10, 2022.

Last but not least, we are happy to announce the theme for World Family Doctor Day 2022.

Join this year’s campaign: “Family Doctors, Always there to Care”. In the coming months, we will share more information about #WFDD2022, and a toolkit with the materials to join this campaign. Stay tuned!

I hope you enjoy this issue, and please remember that you can drop me a line (or an article!) at editor@wonca.net.

O D C Y TO L I M

RS

FA

In this issue, WONCA President Anna Stavdal reflects on Primary Care as a fundamental piece to achieve Universal Health Coverage, the importance of collaborative relationships in primary care and the growing fragmentation of medical disciplines. Read the latest “From the President” entry titled “No man is an Island”, inspired by “Devotions upon Emergent Occasions” (John Donne, 1624).

The March edition of WONCA News is also dedicated to women around the world, especially to our Primary Care colleagues and female family doctors, for their crucial work in ensuring health for all. We honour them by bringing together stories, quotes and reflections of our WONCA President, Dr Anna Stavdal, our Working Parties, Special Interest Groups and multiple members of the WONCA family.

Happy reading, and stay safe!

Sincerely,

A

YS

CA

AL W

RE

Maria Dolores Zavala, WONCA Editor

THERE TO

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WONCA NEWS

S A V E

T H E D A T E S A N D R E G I S T E R !

JUNE

17-20

WONCA CONFERENCES

WONCA RURAL HEALTH CONFERENCE 2022 LIMERICK, IRELAND

2022

JUNE JULY

28

1

27TH WONCA EUROPE CONFERENCE LONDON, UK

2022

NOV

10 -12

7TH WONCA EMR REGIONAL CONFERENCE MUSCAT, OMAN

2023

OCT

26-29

WONCA 2023 WORLD CONFERENCE SYDNEY, AUSTRALIA

2023

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W O N C A

R E G I O N S

EMR REGIONAL PROFESSIONAL DIPLOMA IN FAMILY MEDICINE Strengthening Primary Health Care (PHC) through a family practice-based model of care is a critical foundation for achieving Universal Health Coverage (UHC), as called for in SDG 3, objective 3.8. (1). However, the global scarcity of family practitioners, particularly in the Eastern Mediterranean Region (EMR), is a serious task. The present yearly production rate of family physicians in the EMR is roughly 700, compared to a needed estimate of 21 000 physicians per year based on one family physician/1300 population and the current EMR population growth rate, reflecting the Region's severe lack of family physicians.

The 63rd session of the Eastern Mediterranean Regional Committee (RC63) endorsed Resolution EM/RC63/R.2 which requests Member States to “establish bridging programmes on Family Medicine for general physicians”. Consequently, WHO in collaboration with UNICEF, the American University of Beirut and the Eastern Mediterranean Region World Organization of Family Doctors (WONCA), developed the initial proposal of a one-year programme entitled: “Regional Professional Diploma in Family Medicine (RPD-FM).

Through a blended learning approach, the regional diploma was specifically intended to meet the demands of full-time employed general physicians. The programme was developed in accordance with the competences of Family Medicine as defined by WONCA, the Accreditation Council for Graduate Medical Education (ACGME), and the College of Family Physicians of Canada.

The diploma, however, is not a replacement for full-time postgraduate programmes, which typically comprise of 3 to 4 years of structured training to create trained family physicians. It simply gives existing general practitioners the opportunity to improve their understanding of the core concepts and practice of family medicine in

WONCA REGIONS

order to transition their existing practices into a family practice-based model of care and help countries in the EMR to solve the gap in family physicians’ production in a realistic time frame.

The WHO EMRO Regional Director has formulated a Steering Committee (SC) for promoting family practice in the EMR. The Steering Committee agreed on the outline of the 24-month Regional Professional Diploma in Family Medicine (RPDFM) with two objectives: first, meeting the training duration of most accrediting bodies; second, opening career and training pathways to graduates through the option of completing the Arab Board training after graduation.

The Arab Board of Health Specializations endorsed the RPD-FM in the meeting of its Executive Board on December 18, 2021. Both ABHS and WHO have a generous plan to implement it in most EMR countries starting with the 12 countries that already have accredited family medicine training centers. Then it was suggested to gain the required competencies to make it 2 years to reach the target of three family physicians per 10,000 population by the year 2030.

February 2022 from 01:00 to 02:00 pm (Cairo time), virtually via Zoom. The event was launched

by Dr Ahmed Al-Mandhari, WHO Regional Director for the Eastern Mediterranean, and Dr Omar El Rawas, ABHS Secretary-General, followed by three ministerial interventions reflecting the country successful achievements in Family Practice. Register here.

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W H O

N E W S

PRIMARY HEALTH CARE MEASUREMENT FRAMEWORK AND INDICATORS

WHO NEWS

MONITORING HEALTH SYSTEMS THROUGH A PRIMARY HEALTH CARE LENS A primary health care approach can help countries equitably maximize the level and distribution of health and well-being by focusing on people’s needs and preferences (both as individuals and communities) as early as possible along the continuum of care – from health promotion and disease prevention to diagnosis, treatment, rehabilitation and palliative care – and as close as possible to people’s everyday environments.

Member States reaffirmed their commitment to strengthening primary health care towards the achievement of health for all without distinction of any kind through the Declaration of Astana, adopted at the Seventy-second World Health Assembly by resolution WHA72.2 on primary health care, and further emphasized this in the 2019 Political Declaration of the High-level Meeting on Universal Health Coverage. More recent events have placed even greater pressure on countries to rapidly respond to a global pandemic while continuing to protect people’s health and well-being, highlighting further the need to invest in strengthening resilient health systems based on a primary health care foundation.

To continuously strengthen primary health care, countries must be able to assess how decisions, actions and investments are addressing the broader determinants of health while improving service coverage, financial risk protection, and ultimately the health of individuals and populations.

WHO and UNICEF are jointly releasing the landmark Primary health care monitoring framework and indicators monitoring health systems through a primary health care lens, the first-ever globally normative and endorsed primary health care measurement and monitoring framework, and the official measurement framework in support of the Declaration of Astana and Operational Framework for PHC. As countries strive to reorient their health systems around the principles of primary health care, this Framework responds to Member States’ request to monitor primary health care performance to accelerate progress towards universal health coverage and the other health-related Sustainable Development Goals.

Source: WHO/ UNICEF Photo Credit: WHO

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F E A T U R E D

S T O R I E S FEATURED STORIES

INTERNATIONAL

WOMEN’S DAY We dedicate the March edition of WONCA News to women worldwide, especially to our Primary Care colleagues and female family doctors, for their crucial work in ensuring health for all. To all of them, we pay this special tribute in which we bring together stories, quotes and reflections of our WONCA President, Dr Anna Stavdal, our Working Parties, Special Interest Groups and multiple members of the WONCA family.

We thank the collaboration of our colleagues in Primary Care aroun the world, as we raise our voices for gender equality!

DR ANNA STAVDAL

WONCA PRESIDENT

WONCA PRESIDENT ANNA STAVDAL'S REFLECTION ON INTERNATIONAL WOMEN'S DAY In past years on March 8th, we’ve raised the megaphone to increase awareness of the unfinished business of gender equality. Today, let us use it to highlight the all too often unnoticed, un-hailed, ongoing, daily life bravery of those of carrying on with what used to be called ‘women’s work’. Somebody has to do it, and it never ends.

At this moment, even as some are fleeing, for hours and days, toward uncertain safety, women are caring for the families of soldiering men. All the while, as they are managing their own fear, and missing their husbands, fathers, brothers, sons, they are doing the feeding, washing, clothing, warming, comforting, nurturing, as best they can. During peacetime, many good, strong men join in doing that. But throughout history, at peace and at war, women have always managed it. Somehow. This is not a romanticization – it has simply been the case. Yet, there is no Nobel Prize in Caregiving.

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F E A T U R E D

S T O R I E S

INTERNATIONAL WOMEN'S DAY Many places have come far in equalizing women’s opportunities to join in the shaping of society.

More and more women are politicians, judges, doctors, peace-keepers, leaders of organizations, and of countries. Still, the division of labor during this crisis of conflict continues as before: As (primarily) men are bearing arms, it is mostly the women who are carrying their children and taking care of their parents, bearing the struggle for the basic physical and emotional survival of their families.

FEATURED STORIES

We at WONCA search for concrete ways to support these women, first and foremost, by demanding that the violent conflict cease. Meanwhile, we engage in the provision of genuine refuge.

Because we family doctors, and all health care workers, are woven into our communities, we clearly recognize and appreciate what women do to sustain life. It is part of what someone once called ‘Herstory’.

WONCA WORKING PARTY ON WOMEN AND FAMILY MEDICINE As the chair of the WONCA Working Party for Women and Family Medicine (WWPWFM), and on behalf of our members, I wish to thank all of the Female Family Doctors of the world who are working every day to make our planet healthier for all. Women Family Doctors are continuously leading and healing in a multitude of ways every minute of every day: including in medicine, academia, public health, health care policy and in their personal lives and communities. Women Family Doctors of the World—thank you and bless you!

The WWPWFM welcomes members to join us through our email listserve and at regional and world conferences. We are rebuilding our working party with an emphasis on networking and connection through social media and virtual meetings called Women’s Fireside Wisdom (modeled after the wonderful WONCA Rural Cafes), We look forward with great anticipation to meeting together in person in Sydney Australia.

Our proposed key themes for the 2023 WONCA World conference are:

1. Female Gender: diversity, equity and inclusion 2. Holding up half the world-Women leading in family medicine 3. Womens Health in a changing world 4. Women and Family-Intimate partner Violence

DR NOEMI DOOHAN

CHARI - WP ON WOMEN AND FAMILY MEDICINE

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F E A T U R E D

S T O R I E S

INTERNATIONAL WOMEN'S DAY

PROF JAQUELINE PONZO WONCA IBEROAMERICANA-CIMF On March 8, 2022, we witness a new war unleashed, the persistence of other armed conflicts, the ongoing COVID19 pandemic (plus all its consequences, the post-pandemic) and the planet continues to be threatened by climate change.

In this adverse context, we celebrate International Women's Day the way we all women do: carrying, caring, fighting: - We carry tiredness, losses and frustrations of these hard years of the pandemic;.

- We take care of our patients and communities - We take special care of our patients; women, girls and adolescents who bear a burden with poverty and violence in our societies, and repercussions on health and life (there were at least 4,091 femicides in Latin America in 2020, latest annual data communicated by ECLAC) - We fight so our countries can have health systems closer to people, families and communities, with a wide presence of family and community medicine. At the same time, we fight for the planet, dignity and health care rights.

FEATURED STORIES

Family and community medicine is probably going through one of its most challenging times.

Adapting to the needs and demands of a world that is changing rapidly and growing in complexity requires all eyes and contributions, but essentially, now more than ever, it requires women. Understanding and giving rise to this is a challenge for everyone. It is also a women's right.

And it's time.

Greetings to all family and community physician colleagues, residents and medical students who already dream of following this speciality: we have a huge task ahead of us!

Greetings to all the members of the health teams and to all the women, adolescents and girls in our communities who teach us every day, with their lives, the wonder and strength of being.

Greetings to all the women with whom we share spaces of management, governance, teaching, research, intersectoral work or daily life. The necessary change requires every one of us.

Let's think together about a world for the future.

Let's think together about family medicine/family and community medicine

Everything is very challenging, but we also celebrate this International Women's Day with joy and responsibility: - Because we are aware of the power and protection that sorority provides us, and we feel the joy and strength of knowing many of us, in many places, from many countries.

- We move forward with the responsibility of knowing that the greater participation of women is essential both in daily work, to reverse the destruction of our planet, and transform it into a habitable (sustainable) world, where human life and that of all species is valued and respected.

PROFESSOR JAQUELINE PONZO REGIONAL PRESIDENT IBEROAMERICANA - CIMF

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F E A T U R E D

S T O R I E S

INTERNATIONAL WOMEN'S DAY

FEATURED STORIES

WONCA SIG ON FAMILY VIOLENCE Nearly 1 in 3 women globally have experienced intimate partner violence or any sexual violence in their life time. Sexual abuse, child abuse, elder abuse and other forms of gender based violence are also major public health problems, more frequent than most chronic diseases we treat as physicians daily. Examples of Gender Based Violence (GBV) include domestic violence, sex based violence or harassment, female genital mutilation (FGM), forced marriage. COVID-19 has shaken society in all possible ways, leading to dreadful consequences not only caused, but definitely exacerbated, by the virus.

Governments’ responses to stop the spread of the infection have forced many families to stay at home, triggering or aggravating cases of violence within families, against all vulnerable members, including women and girls, and transforming this into what has been called the shadow pandemic.

Violence not only affects mortality, it has significant and long term physical and mental health consequences, and it and tremendous monetary and social costs to society. Fighting against Family and Gender Based Violence is society's responsibility. In the 2030 UN agenda for Sustainable Development proposed in 2015, many countries have committed to meet 17 goals by 2030. Two of them address violence directly, SDG 16 and SDG5. Global Goal 5 (SDG5) aims to achieve gender equality and one of its specific targets is to “eliminate all forms of violence against women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation”.

We – as primary health care providers - have a crucial role! We may see patients in acute conditions, but also mostly have long term relationships with several family members, providing many opportunities to recognize violence is occurring and to offer help and referral to other agencies and specific resources.

DR RAQUEL GÓMEZ BRAVO

ASST PROF NENA KOPČAVAR GUČEK

DR HAGIT DASCALWEICHHENDLER

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S T O R I E S FEATURED STORIES

INTERNATIONAL WOMEN'S DAY If these are not available we can provide a first line response, as guided by the WHO'S LIVES Model. Most of us were not trained sufficiently on this topic. Theoretical understanding of the complexity and dynamics of violence, as well as practical skills are necessary. We need to acquire the necessary competencies so we can do more good than harm. Let’s strengthen healthcare providers and systems, and primary care specifically, to play a more significant role in order to take proper care of our patients, especially the most vulnerable ones, without leaving anyone behind. Let’s act and move forward towards a zero-tolerance society.

WONCA SIG on Family Violence's recommendations, endorsed by WONCA Executive (February 2018): 1. Encourage each national college and academy to develop policy and implementation strategies on family violence identification and response for intimate partner violence, child abuse and elder abuse.

2. National colleges and academies promote basic training at undergraduate, graduate and continuing professional development on identification and support for family violence survivors and their children, recognising the critical need for a systems approach and adequate support for family doctors to undertake this sensitive work.

3. Contribute to the development of primary care based research, performance and outcome measures for general practitioners/family doctors and primary care teams in each of our member nations to enable evaluation of family violence care.

4. Assist in making information on family violence accessible on national and international web sites, sharing information and quality resources for interdisciplinary collaboration for health care, advocacy and legal support of families.

Policy and practice guidelines should recognise the need for culturally safe strategies for vulnerable groups and adaptation of care to health care settings in high, middle and low income countries We should not be confused: addressing and treating violence requires a systemic multidisciplinary approach, including many governmental and nongovernmental agencies and services. Nevertheless we cannot forget our own role and responsibility / response-ability as a group and as individuals!

WONCA'S SPECIAL INTEREST GROUP ON FAMILY VIOLENCE IS INVITING YOU TO JOIN US! We will be glad to workshops/presentations conferences.

meet you in our in upcoming

You can find more resources, including our May 2020 Webinar in the attached links: WONCA FAMILY VIOLENCE WEBINAR - Bing video Global Family Doctor - WONCA Online DV RESOURCES FV (globalfamilydoctor.com)

SIG

SIG FV call to (globalfamilydoctor.com)

action

5.5.20.pdf 18.pdf

Violence against women prevalence estimates, 2018 – Global fact sheet (who.int) WHO Global Database on the Prevalence of Violence Against Women – interactive map Map (srhr.org) World Health Organization. Health care for women subjected to intimate partner violence or sexual violence: A clinical handbook [Internet].

2014 [cited 2021 Sep 21]. Available from: https://www.who.int/reproductivehealth/publica tions/violence/vaw-clinical-handbook/en/ *References are available HERE

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INTERNATIONAL WOMEN'S DAY

WONCA SIG ON AGEING & HEALTH This is a space dedicated to caregivers and elderly patients, created with collaborations from the WONCA Special Interest Group on Ageing and Health. This section includes inspiring anecdotes for the simple purpose of adding value and quality to older patient’s lives.

For International Women’s Day, SIG Ageing and Health has put together some brief vignettes about extraordinary older women. Their courage and contributions despite great old age very much emphasise our need to recognize gender equality.

Jinan Usta ME was a 74-year-old lady who came in for progressively worsening epigastric pain over the past 6 months. She turned out to have a large pancreatic tumor on CT scan of abdomen. Her daughter, who was also a physician, tried to persuade her to have chemotherapy but she was refusing. In one of our meetings, she told me “I know my children love me and want me to stay with them as long as possible, but please tell them to stop crying for me. I know I will be a bird in paradise when I die. That is what my spiritual leader told me; I will be spreading happiness to people in heaven like I was doing it here on earth”.

She spent the last few months of her life visiting old women living by themselves, keeping them company, reading them stories, and making them feel less alone. She died peacefully in her bed 5 months after the diagnosis was made. Till now, 12 years later, I keep thinking of her whenever I hear birds singing.

Marita Long I can’t believe I am nearly 98! I feel so lucky to be so well cared for. I think its important to eat naturally and to laugh a lot. I know I must do my exercises every day and keep moving but it does hurt! Small things bring a smile to my face like seeing the sheep in the paddock.

I try not to worry and to accept people need to help me. Sometimes I feel useless but it passes. My daughter Maryanne tells me to not fight the river! I have a wonderful caring GP, Lyn. She always takes time to talk to me and we always have a laugh!

Brenda Age 97 Dimity Pond My patient Mary is 93 years old. She often discusses with me why she is still alive. I encourage her because really she is well known to our whole community, makes regular phone calls to the sick, and has a constant stream of visitors whom she welcomes but tells them to make their own cups of tea! Many years ago she felt a message from God that she had to keep going to look after her drug addicted son. Aged 70, he is now clean from drugs, but still lives with her. He does the shopping and the gardening, and she is training him now how to cook the vegetables he harvests from their lovely garden. She shares hints and tips about this cooking with me. Did you know for example that sweet potato leaves are very nice to eat? You can stir fry them in sesame oil, ginger and garlic, or cook them in coconut cream.

I tell her she has many reasons to stay alive!

PROFESSOR DIMITY POND

CHAIR - SIG ON AGEING & HEALTH

JOIN THE THIS SIG

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INTERNATIONAL WOMEN'S DAY

DR ÖZDEN GÖKDEMIR, CHAIR OF WONCA WOKING PARTY ON ENVIRONMENT Masculine thought in society is associated with a set of roles, behaviours, and values which attribute to women a disadvantaged position and lead to the perpetuation of the model of inequality.(1) Gender inequality affects both men and women. It is a significant impediment. There are inequalities and differences in health care between men and women, as well as biological sex. The sexist viewpoint also has a significant impact .(2) Male bias is also a factor in decision making. Adams et al. revealed a need for better developed risk and diagnostic models of Coronary Heart Disease for women, particularly with regard to the influence of age, which was the primary source of gender differences between patients.

(3). At this point, “gender blindness” become another problem.

To overcome these difficulties, community oriented primary care (COPD) could be a useful tool. (4) To counter economic burdens and the violence of war in different areas of the World, which transformed COVID-19 pandemics to syndemics, COPD employs basic steps, such as “community definition, community characterization, prioritization, detailed assessment of the selected health-problem, intervention and evaluation” (4) Two important examples of putting this concept into practice are from Turkey. The firstis from Karain, Ürgüp, Göreme, where the aim was to find the root cause of early deaths from “asbestosis”.

“To fix a problem” was the primary motivation, and this success of saving lives was based on evidence-based publications, and research with the collaboration of not only physicians and those living in the affected villages, but also with others including geologists, and teachers.

FEATURED STORIES

Emri also stated that “The research was not motivated by grants or publications. Moreover, the researchers did not give up because of the many problems encountered associated with conducting medical research in a remote part of the world.” This revealed the success of the team approach. (5) The second example is the work of Prof Dr Turkan Saylan, a role model in overcoming difficulties.

“She was one of the first female dermatologists in Turkey, and a leading figure in the fight against leprosy “. In 1989, she became a founding member of the Association to Support Contemporary Life (CYDD), a non-governmental organization (NGO) that has the aim of enrolling young girls in school. Saylan's years working in rural Turkey inspired the creation of CYDD. Saylan received a number of international honours, including the International Gandhi Prize in 1986.

In Turkey, she published seven books, including the autobiographical ‘The Sun Rises Now Out of Hope’.(6) The conclusion is from Prof Dr Saylan “Stop asking yourself, ‘Why was I born a girl?’ and aim at becoming the best you can be.”

DR ÖZDEN GÖKDEMIR

CHAIR -WP ON ENVIRONMENT

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INTERNATIONAL WOMEN'S DAY

"As a Family Physician, I believe in empowering women with preventive and promotive health skills that nurture and empower the next generation" DR JOY MUGAMBIE

MEMBER AT LARGE WONCA AFRICA

INTERNATIONAL WOMEN’S DAY #IWD2022

"Rural women are the backbone of our rural communities and our health services."

PROFESSOR BRUCE CHATER WONCA WP ON RURAL PRACTICE

"THE WONDERFUL TEAM OF WOMEN IN OUR PRACTICE WISHES YOU WELL"

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DR SALVADOR TRANCHE, SEMFYC PRESIDENT

SALVADOR TRANCHE 1957 - 2022

We deeply regret the passing of Dr Salvador Tranche, President of Semfyc (Spanish Society of Family and Community Medicine). WONCA sends its deepest condolences to family, friends and colleagues from the medical community in Spain and the world.

Difficult days for family medicine in Spain. Salvador Tranche Iparraguirre, president of Semfyc (Spanish Society of Family and Community Medicine), suddenly died on his way home on Sunday, 13 February. Salva had been president of Semfyc since 2016. Together with his team, they have advanced family and community medicine with a firm and determined commitment in many political, social and scientific forums, without neglecting the dayto-day work in his family doctor's surgery at the Cristo health centre in Oviedo in Asturias, Spain.

He has been an undisputed leader of family medicine in Spain during the COVID19 pandemic and developed a relevant activity in disseminating the role of family and community medicine in the Spanish health system. He had become a national reference when it came to checking and publicising the situation of the Primary Care network in Spain Given the great sadness of the semFYC community, we have decided to open this digital space for condolences.

Salvador Tranche, you left the way you have lived, always at the forefront of family medicine. Rest in peace. We will all carry on together, where your footsteps have left us.

Dr María Pilar Astier Peña WONCA Member at Large

SemFYC members will always be grateful for his support and leadership over the years. At the international level, we counted on his support in the WONCA working groups, in which semFYC members participate. He also actively participated in WONCA world, Ibero-American and European conferences.

He was a committed person, passionate about family medicine, conciliatory and open to dialogue.

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DR SALVADOR TRANCHE, SEMFYC PRESIDENT

FEATURED STORIES

HALFWAY - THE UNEXPECTED PASSING OF SALVADOR TRANCHE It was in Lima, during the 5th Ibero-American Congress of Family and Community Medicine, when we met Salvador. The first CIMF event after his assumption as the highest representative of Spanish family and community medicine, in 2016.

That was just the first day of many in which we saw him arrive with his projects and proposals under his arm: literal -physical, carried in foldersor even imaginary, but always very tangible. The projects never came alone, were always driven by passion and collective work behind each proposal: the participation as an Ibero-American region in the WONCA events, the strong presence of a Spanish speaking space in the events of our world organisation, the strengthening of our link between CIMF member associations, are just some examples.

National, regional and world events located in Barcelona, Braga, Cali and Seoul allowed us to share, in addition to the passion for family and community medicine, the human aspects, the affection and the meeting in a face to face times.

Later, Vitoria, Abu Dhabi, Guatemala and Mexico brought us together in events and missions on virtual platforms. The pandemic made us change our ways but did not stop our march. Of course, we miss hugging, walking, sharing meals; but since 2017, there was a continuous work and activities where Salvador was always present.

Sunday, February 13 2022, came with the news of Salvador's passing. We barely had a year to share the daily work of the CIMF Executive Committee.

In February 2021, he assumed the vice presidency of the Iberian subregion, succeeding Jorge Brandao from Portugal. That year was short and particularly hard, not only because of the pandemic and the multiple epidemic waves in our countries. The fatigue accumulated by previous months of COVID-19 weighed heavily, including the battles in defence of primary care, public health or family medicine/family and community medicine experienced in the region.

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DR SALVADOR TRANCHE, SEMFYC PRESIDENT

FEATURED STORIES

In Spain, this had been particularly intense.

During the pandemic, primary care and the public health system, proudly known by its citizens and a reference for Ibero-America, were threatened.

Semfyc redoubled the defence. Salvador, from a mentor position, repeatedly pointed out the lack of a hierarchy in "primary" and the necessary recognition of family medicine as an essential resource for care during and after the pandemic.

Of course, he wasn't alone. At Semfyc and CIMF, Salvador was a team person, and even in adversity, he brought joy, smiles, encouragement to each of his colleagues.

We know that family and community medicine is as necessary on one side of the ocean as it is on the other. We know that the difficulties to consolidate and preserve it are very similar here and there and that some problems are typical here, some others are there. We also know that each region is human and professional wealthy, enhanced by diversity. We know that there are grounds to think of ourselves together as an Ibero-American region that can work well jointly.

Possibly, Salvador's candidacy was essentially a vote for integration, a message to the future. We keep thinking about this.

Salvador gradually positioned itself as a regional benchmark, transcending its country. His experience, commitment, honesty and clarity of proposals always shed light on collective work. He knew that he had a lot to contribute to the Confederation, including his experience leading Semfyc. That clearly weighed on his decision to run for the ICMF presidency in our last election.

Salvador was not elected, but his participation in the Executive Committee continued with the same camaraderie and joy as always.

We know that family and community medicine is as necessary on one side of the ocean as it is on the other. We know that the difficulties to consolidate and preserve it are very similar here and there and that some problems are typical here, some others are there. We also know that each region is human and professional wealthy, enhanced by diversity. We know that there are grounds to think of ourselves together as an Ibero-American region that can work well jointly.

Possibly, Salvador's candidacy was essentially a vote for integration, a message to the future. We keep thinking about this.

Salvador's candidacy put on the table an issue that is not easy for our region: the integration between Iberia and Latin America. Incorporating WONCA as a single region, even though Spain and Portugal are also part of the European region, was a planned and thoughtful decision at the end of the 20th century, ultimately finalized between 2001 and 2004.

But the pain runs through the link between Iberia and Latin America from its origin. The conquest, loaded with deaths, gave way to colonization that in many aspects persists. That is why it is necessary to advance in a decolonizing perspective favouring the deployment of the maximum potential in all territories, also in Europe, strengthened by the richness of the encounter.

May Salvador's life, cut short in a moment of human and professional fulfilment, not be a loss but light to help us find the way to strengthen integration for Ibero-America. An integration that rescues, mixes, amalgamates the essence of our peoples from here and there, for a family and community medicine that is essentially human and mestizo like ourselves.

May Salvador's departure reaffirms his actions in life; actions that raised work in unity, eradicated distances and became a partner of a renewed family and community medicine in this complex 21st century.

Jacqueline Ponzo, WONCA Iberoamericana-CIMF President.

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SIR ANDY HAINES, AWARDED WITH THE 2022 TYLER PRIZE

FEATURED STORIES

Sir Andy Haines, WONCA Life Direct Member, is being recognized for his contributions in understanding the effects of climate change on public health, his leadership in expanding the scope of public health to one of Planetary Health, and for his mentorship of the next generation of health scientists and practitioners in preventive environmental health actions in the 21st century.

The 2022 Tyler Prize for Environmental Achievement – often regarded as the ‘Nobel Prize for the Environment’ – has been awarded to British physician Sir Andy Haines, one of the first scientists to sound the alarm that changes to the natural environment have dangerous implications for human health.

Haines worked as a family doctor and researcher before realizing that the greatest thing he could do for human health was to reveal its critical connection to the health of our planet. He has since committed over three decades to understanding and working to prevent the impacts of environmental change, especially climate change, on human health.

Tyler Prize Executive Committee Chair Julia Marton-Lefèvre said that since identifying this crucial interlinkage in the early ‘90s, Haines has worked urgently to establish the evidence base for global climate action and policy change.

“As a leader in Planetary Health, Sir Andy’s findings have been a wake-up call for humanity.

He has focused his life’s work on building international, multidisciplinary research and collaborations that form strategies and policies to protect global health – especially in vulnerable low-income countries – in our rapidly changing planet.”

Credit: Tyler Prize

Haines, who is Professor of Environmental Change and Public Health at the London School of Hygiene & Tropical Medicine, said it is a “great honor and privilege” to be selected as the recipient of the 2022 Tyler Prize.

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“I think it reflects the growing awareness that climate change isn’t just about damaging the environment – according to the World Health Organization, ‘climate change is the single biggest health threat facing humanity’. From the effects of extreme heat and wildfires to effects on infectious disease transmission, food supply, migration, poverty… climate change can affect health in so many ways.”

“Our future depends on taking urgent action, to adapt to the changes we are already experiencing, and to cut the greenhouse gas emissions causing climate change,” Haines said.

Haines was among the first to research the health benefits of low-carbon actions – including cycling, walking, and using public transport instead of driving, as well as using clean, renewable energy and eating a more plant-based diet.

“Policies and actions to reduce greenhouse gas emissions will not only benefit human health by reducing the risk of dangerous climate change in the longer term, but they also have positive nearterm benefits, including reduced air pollution, increased physical activity, and improved nutrition,” Haines said.

Dr. Jonathan Patz, Director at the Global Health Institute at the University of Wisconsin-Madison and member of the Tyler Prize Executive Committee, said that Haines’ work highlighted the need to approach public health from a global perspective.

“It’s timely that in 2022, now into the third year of the global Covid-19 pandemic, the Tyler Prize Committee chose to honor a ‘one planet’ leader in public health. We need urgent action on these interconnected issues – and Sir Andy’s interdisciplinary work is out front.”

Haines said the Covid-19 pandemic highlights the fragile relationship between society, the economy, and health.

“We live on a small planet – we are all connected whether we like it or not. We don’t have a lot of time to reduce the risks of climate change – inaction and pessimism are luxuries we can’t afford,” he said.

“We need to work together and cooperate globally to address the big challenges of our time.”

Haines will receive a US$200,000 prize and join the ranks of previous Tyler Prize Laureates such as Michael E. Mann, E.O. Wilson, and Jane Goodall.

Haines will be honored at an award ceremony in April 2022.

Credit: Tyler Prize

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GLOBAL LAUNCH OF THE LANCET-WORLD PSYCHIATRIC ASSOCIATION COMMISSION The world is failing to tackle the persisting and increasingly serious global crisis of depression it is facing, according to a Lancet and World Psychiatric Association Commission on depression, which calls for a whole-of-society response to reducing the global burden of depression.

Despite abundant evidence that much can be done to prevent depression and aid recovery even in resource-limited settings, an estimated 5% of the adult population around the world in any year are living with depression [1]. In high-income countries, about half of people suffering from depression are not diagnosed or treated, and this rises to 80-90% in low- and middle-income countries. The COVID-19 pandemic has created additional challenges, with social isolation, bereavement, uncertainty, hardship, and limited access to healthcare taking a serious toll on the mental health of millions.

Against this background, the Commission ‘Time for united action on depression’ calls for concerted and collaborative efforts by governments, healthcare providers, researchers, people living with depression, and their families to improve care and prevention, fill knowledge gaps, and increase awareness to tackle one of the leading causes of avoidable suffering and premature death worldwide. It is authored by 25 experts from 11 countries spanning disciplines from neuroscience to global health and advised by people with experience of depression.

“Depression is a global health crisis that demands responses at multiple levels. This Commission offers an important opportunity for united action to transform approaches to mental health care and prevention globally. Investing in reducing the burden of depression will give millions of people the chance to become healthier, happier and more productive members of society, help to strengthen national economies, and advance the

FEATURED STORIES

United Nation’s Sustainable Development Goals for 2030”, says Commission Chair Professor Helen Herrman from Orygen, National Centre for Excellence in Youth Mental Health and The University of Melbourne, Australia. [2] Co-author Dr Charles Reynolds from the University of Pittsburgh, USA says, “We know that most individuals with depression at all stages of life will recover if they obtain adequate support and treatment. With sound science, political will, and shared responsibility, depression can be prevented and treated and potentially disabling consequences avoided. We must empower people with experience of depression together with families, practitioners, policymakers and civil society to address the tsunami of unmet need— through sharing their experiences to reduce stigma, supporting others with information about the condition and possibilities for help, and advocating for greater resources for evidencebased approaches.” [2] A POORLY RECOGNISED AND UNDERSTOOD CONDITION Depression is a common condition worldwide, yet despite this, many myths continue to surround it, perpetuating inaction. These include common misconceptions that depression is simply sadness, a sign of weakness, or restricted to certain cultural groups. The Commissioners stress that depression is a distinct health condition characterised by its persistence, substantial effect on daily functioning, and long-term health consequences. It can affect anyone, regardless of gender, background, social class, or age, there is variability in types and prevalence of depressive symptoms and signs among cultures and populations. The risk of depression rises in settings of adversity including poverty, violence, displacement and gender, racial and other forms of discrimination.

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Depression is linked to a wide variety of chronic physical illnesses, and a person’s physical health can influence their mental health, and vice versa.

At its worst, depression can lead to suicide.

Studies indicate that 70%-80% of people who die by suicide in high-income countries, and around half of those in low- and middle-income countries, suffer from mental illness, of which depression is the most common cause.

Depression also has an enormous, underrecognised social and economic toll on individuals, families, communities, and countries.

Even before the COVID-19 pandemic, the loss in economic productivity linked to depression cost the global economy an estimated US$1 trillion a year [3].

“There is arguably no other health condition which is as common, as burdensome, as universal, or as treatable as depression, yet it receives little policy attention and resources”, says Commission Co- Chair Associate Professor Christian Kieling from the Universidade Federal do Rio Grande do Sul in Brazil. “Effective psychosocial and medical treatments are difficult to access, while high levels of stigma still prevent many people, including the high proportion of adolescents and young people at risk for or experiencing depression, from seeking the help required to have healthy and productive lives.” [2]

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PREVENTION IS ESSENTIAL TO REDUCING THE BURDEN OF DEPRESSION The Commission stresses the need for whole-ofsociety strategies that reduce exposure to both adverse experiences in childhood (including neglect and trauma) and across the lifespan to lower the prevalence of depression. Interventions are also needed at the individual level, focusing on lifestyle factors (eg, smoking, alcohol consumption, physical inactivity) and other risk factors such as intimate partner violence and stressful life events such as bereavement or financial crisis.

“Prevention is the most neglected aspect of depression. This in part because most interventions are outside of the health sector”, says co-author Dr Lakshmi Vijayakumar from SNEHA, Suicide Prevention Centre and Voluntary Health Services, Chennai, India. “In the face of the lifelong effects of adolescent depression, from difficulty in school and future relationships to risk of substance abuse, self-harm, and suicide, investing in depression prevention is excellent value for money. It is crucial that we put into practice evidence-based interventions that support parenting, reduce violence in the family, and bullying at school, as well promoting mental health at work and addressing loneliness in older adults. Common risk factors and high rates of depression among people with chronic health problems also support shared preventive approaches.” [2] A PERSONALISED, STAGED APPROACH TO CARE The Commissioners stress that the current system of classifying people with symptoms of depression into just two categories—either they have clinical depression or not—is too simplistic.

They argue that depression is a complex condition with a diversity of signs and symptoms, severity levels, and duration across cultures and the life course.

The Commission supports a personalised, staged approach to depression care that recognises the chronology and intensity of symptoms and recommends interventions tailored to the specific needs of the individual and severity of the condition, ranging from self-help and lifestyle changes to psychological therapies and antidepressants to more intensive and specialised treatments such as electroconvulsive therary (ECT) for severe, refractory forms of the illness.

“No two individuals share the exact life story and constitution, which ultimately leads to a unique experience of depression and different needs for help, support, and treatment”, explains Commission Co-Chair Professor Vikram Patel from Harvard Medical School in the USA. “Similar to cancer care, the staged approach looks at depression along a continuum—from wellness, to temporary distress, to an actual depressive disorder—and provides a framework for recommending proportional interventions from the earliest point in the illness.” [2] At the same time, the Commission proposes that collaborative care strategies are adopted to scale up evidence-based interventions in routine care.

They argue that using locally recruited, widely available and low-cost non-specialists such as community health workers and lay counsellors, not only addresses the acute shortage of skilled providers and financial barriers, but will also help reduce stigma and cultural barriers, while providing holistic care to patients and their families. While this is most important in lowincome countries it is also relevant and useful universally as nowhere in the world is depression care adequate.

[1] https://www.who.int/news-room/factsheets/detail/depression [2] Quotes direct from authors and cannot be found in text of Commission.

[3] Mental Health and Substance Use (who.int)

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ISTI ILMIATI FUJIATI

FEATURED DOCTOR

WONCA CONFERENCE CHAIR

INDONESIA Isti Fujiati is chairwoman of the Host Organizing Committee for The Wonca Asia Pacific Regional Conference coming up in Bali, on December 8-10, 2022.

1. WHAT ARE YOU CURRENTLY WORKING ON? I am currently a lecturer at the Community Department, Faculty of Medicine, Universitas Sumatera Utara in Medan, about a 45-minute flight from Penang, Malaysia. In addition, I am also the Chairwoman of the Indonesian Association of Family Physicians (IAFP), to which I was elected in December last year, after the passing of the previous IAFP Chair, Dr Yulherina, from Covid-19. As the new Chair of the IAFP, our focus is to develop a strategic three-year plan for IAFP aligned with the community needs.

The Indonesian Ministry of Health is currently carrying out a Health transformation based on six pillars, including a Primary Health Care Transformation Pillar focused on preventing stunting and non-communicable diseases. Now, it is a good time for changes. With the Universal Health Insurance financing system, quality primary services are crucial.

In addition, we also need to make quick preparations to welcome all WONCA members at the Asia Pacific Region Conference 2022 in Bali this coming December. With a deep longing to meet and share face to face, after more than two years, Bali will be a beautiful place to engage. We invite all WONCA members to come to Bali to share their visions and experiences for family medicine and primary care after the Covid-19 pandemic.

2. TELL US ABOUT YOUR EXPERIENCE AS A FAMILY DOCTOR? I completed my Medical Education in 1992 and mostly practised as a private doctor in companies and clinics before undertaking a 3-year compulsory undergraduate work at a rural community health centre called Puskesmas.

While working there, many questions arose regarding clinics. I encountered undifferentiated cases that were very diverse from what I studied in medical school. I learned a lot about clinical practice, but I was not exposed to simple problems that turned out to be very complex with a meaningful impact on families and the surrounding community.

One of them was the case of a woman with tuberculosis who was working part-time as a nanny for her husband's employer.

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I figured then there were so many things I needed to learn from that woman's case. Tuberculosis was one issue, but the bigger one was how tuberculosis impacted that woman's life as a wife with the stigma of a hereditary disease, as a mother, as a worker, and on her husband's work.

It shocked me, and I wanted to learn more, but I did not know where, as we don't have a special education on the topic in Indonesia.

I also thought of becoming an internal medicine specialist but by becoming an internist, I would have worked in a hospital because Specialist Postgraduate Education is only for doctors who work in hospitals. Are there services that look at patients not only from their disease? Is there Education for it? Can I improve my competence but still work in primary care? Is there a system where I can serve patients in practice, at home, in the community without having to think about whether I will be paid or not?

I found the answer to these questions when I had the opportunity in 2001 to continue my studies with a Master of Science in Clinical Medicine Family Medicine at the University of The Philippines, Manila. It turned out that what I was looking for the whole time was family medicine services, and Prof. Zorayda Leopando became one of my best teachers. I studied a lot in the Philippines because the culture and people are similar to Indonesia.

I fell in love even more with family medicine after joining WONCA, attending inspiring conferences and motivating me to build strong family medicine in Indonesia. WONCA is like a big family that makes me very comfortable. I can have everything, not only family medicine, but also the vision of the great people who are part of it, friendship from multiple countries, and sometimes even brotherhood.

In 2019, I had the opportunity to meet Prof. Lynda Redwood in Aceh and continued to meet new colleagues by joining the Besrour Center Advisory Board.

FEATURED DOCTOR

3. WHAT OTHER RELEVANT ACTIVITIES HAVE YOU PARTICIPATED IN? I am often involved in local and national activities related to diabetes, especially prediabetes, diabetes coinfection Tuberculosis, and vice versa since the incidence of diabetes and Tuberculosis in Indonesia is high.

For diabetes programs, I am an active member in the Cost and Quality Control Team called TKMKB of the Health Social Security Body called BPJS, in collaboration with Provincial and District of Health, designing many activities for the community that involved many professional organizations.

I have also been a national coach and pioneer developer of the North Sumatra Coalition of Professional Organizations for Tuberculosis Elimination called KOPI TB, with Provincial and District Health and non-profit organizations like USAID. We are trying to make a difference in tackling Tuberculosis in Indonesia. With this coalition, we have involved a lot of private practice doctors, where previously tuberculosis control has mostly handled by government providers at Puskesmas. Through KOPI TB, we support the public-private mix program to eliminate Tuberculosis.

At this time, I also started to work in maternal and child health for stunting prevention, a very strategic matter to implement family medicine based on life cycle services for prospective brides, pregnant women, nursing mothers, and children under five. The first thousand days of a child's life, from conception, will determine the quality of the nation's future human resources. We try to start stunting prevention upstream in teenagers, especially teenagers and young women, by conducting structured education with various universities.

DISCOVER THE FULL INTERVIEW HERE.

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A N N O U N C E M E N T S &

U P D A T E S

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ISN - KDIGO - WONCA JOINT WEBINAR With the global burden of kidney disease increasing, early identification and treatment is a worldwide imperative. To this end, the ISN-KDIGO CKD Early Identification and Intervention toolkit was developed to support kidney health professionals, primary care physicians (PCPs) and nurses working in primary care settings.

This webinar will explore the toolkit through the perspective of the PCP, discussing CKD identification and risk stratification in the primary care environment. Panelists will also discuss how to increase collaboration between PCPs and nephrologists.

DOWNLOAD THE CKD EARLY IDENTIFICATION AND INTERVENTION TOOLKIT.

VIRTUAL TORONTO INTERNATIONAL PROGRAM TO STRENGTHEN FAMILY MEDICINE AND PRIMARY CARE The University of Toronto invites you to join this 12-week course, taught by faculty leaders from the Department of Family and Community Medicine (DFCM) and international guest faculty.

The program provides an overview of how to leverage excellence in education, research, clinical services and leadership to deliver high quality family medicine globally, by sharing experience and building on lessons learned at the DFCM, in Canada and around the world.

MARCH 23 – JUNE 29, 2022.

REGISTRATION IS NOW OPEN!

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ANNOUNCEMENTS & UPDATES

DUBAI - HYBRID EVENT 5TH EMIRATES FAMILY MEDICINE SOCIETY CONGRESS 2022 EFMS Congress 2022 takes place March 10th to 12th in person only attendance in Dubai, followed by live virtual days March 14th to 17th.

The congress is in a scientific partnership between EFMS society and its international scientific partners, the Royal Australian College of GPs, the American Board of Family Medicine, the Canadian College of Family Medicine, the American Academy of Family Physicians and the UK Royal College of GPs. The submission form and guidelines are to be found online HERE. The link to registration and abstract is available HERE.

ONLINE - MARCH 14 - 17 2022 REGISTER NOW

ISTAMBUL - TURKEY

94TH EGPRN MEETING We cordially invite you to attend the 94th EGPRN meeting that will be held in İstanbul, Turkey between 12 - 15 May 2022.

The theme of this meeting is "Optimizing the organization of family medicine practice". Last day to submit your abstract is January 30th.

Find more information and register HERE. 12 - 15 MAY 2022 REGISTER NOW

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WONCA NEWS

A N N O U N C E M E N T S &

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WEBINAR

THE POWER OF TELEHEALTH: HOW CAN IT IMPROVE ACCESS TO CARE? Interested to learn more about how the coronavirus crisis has provided a new context for the use of digital health solutions in the delivery of hospital-based care?

One of the biggest ‘service shifts’ in the healthcare sector since the onset of the COVID-19 pandemic has been the widespread adoption of telehealth.

As well as being a viable option to provide continuity of care and treatment to patients during the coronavirus pandemic, telehealth has transformed how health systems can respond to chronic workforce shortages and optimise their clinical capacities.

Together, the International Hospital Federation (IHF) and the Africa Healthcare Federation (AHF) are hosting a special webinar on 16th March at 14:30 CET (13:30 GTM/UTC) to share learnings and knowledge about how telehealth can be harnessed to address disparities of access to care and medical expertise.

Chaired by Sharon Allen, Executive Director of the World Telehealth Initiative (WTI), this webinar will feature a mix of live presentations and panel discussions. Over 90 minutes, event participants will hear from clinicians and WTI coordinators about their work to provide sustainable medical expertise and capacity building amongst communities to deliver core health services.

16 MARCH 2022, 13:30 UTC REGISTER NOW

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