President, Prof Dora Bernal, a rural doctor from Cali in Colombia, had the honour of presenting the John MacLeod Oration. It is thefirstwomanandthefirstpersonfromthe rural Americana to deliver this Oration in honourofoneofthefoundersofourWorking Party on Rural Practice She shared some of her work and that of colleagues from across SouthAmericainavideoofsixcountriesthat kept the engagement of the audience and inspiredusall. A / P R
In September, the WONCA World Rural conference “Ubuntu” was held in conjunctionwithTheNetworkTowardsUnity for Health (TUFH) in Cape Town, South Africa The conference was marked by the huge diversity of attendees from around the world There was a holistic approach presented alongside data and outstanding innovation of programs and workshops. Innovation included one day during the conference spent “on the move” visiting servicesinandaroundCapeTown
The word “Ubuntu” meaning “I am because you are” was an appropriate theme, with attendeesconnectingovermuchthatwehad in common as rural practitioners and realizingthat“youare”isthemostimportant thing
Photo: Dora Bernal, President WONCA Iberoamericana region, with WONCA President and Bruce Chater, chair, WONCA Working Party on Rural Practice
POST CONFERENCE IN THE WESTERN CAPE REGION
After the conference I joined the post conference tour - these regularly occur after WONCA rural conferences and generally as did this one enable us to visit various teachingandclinicalsitesinruralsettingsat some distance from the conference venue. My group was ably led by Ian Couper, Stellenbosch University (past chair of the WONCAWorkingPartyonRuralPractice)and Dehran Swart, Health Teaching Platform Manager,UniversityCapeTown
A second group was led by Lindsay-Michelle Meyer, Stellenbosch University, and Steve Reid,UniversityofCapeTown
Medical facilities visited were Worcester regional Hospital, Knysna Hospital, Harry Comay Hospital, Mossel Bay Hospital Dr Andries Brink and Dr Francois Potgieter, at Knysna Hospital, explained the high TB burden, 20% HIV rates in pregnant women, and the mental health burden since COVID resultinginsubstanceabuse
It’s hard to pick between many memorable moments, but I think meeting medical students on year-long rural placements and hearingtheeloquencewithwhichtheyspoke aboutthefantasticlearningexperiencesthey were having confirmed to me the universal value (in a multitude of countries) of extended rural placements for medical students
At the Inkcubeko Youth and Science Centre, Jo Scott-Jones of New Zealand and Ricardo CaravantesofGuatemalatestedoutsomeof thefascinatingexhibitsdesignedtohelpkids getinterestedinscience
Photos:
1 Group listening to explanations at Knysna Hospital during the tour
2 Students at Mossel Bay Hospital (left to right): Heinco Botha, Tanya Heyns, MeganRose Redmond, and Ane Ungerer with Dehran Swart (group leader)
3 Jo Scott-Jones (New Zealand)
4 Ricardo Caravantes (Guatemala)
WealsospoketohealthworkersatSAHARA, which provides support groups and free medications for harmful substance use (alcohol,nicotine,drugs)ineightcommunity clinics in George and the surrounding areas We visited one of their pop-up stations, part of SAHARA’s "My Journey" program for adolescents and young people, providing sexual-reproductive health screening, information, referrals, and HIV testing and counseling
SAHARA SOUTH AFRICA WEBSITE
Photo: WONCA President in one group at a popup clinic in Thembalethu, Geroge – an initiative of the SAHARA organisation
WONCA EUROPE MEETS IN DUBLIN
After this fantastic time with colleagues in SouthAfrica,ItraveledtoDublin,Ireland,for the WONCA Europe conference For me, it’s always meaningful visiting the country of many of my ancestors, and this visit was no exception There were 2,600 participants from 77 countries, listening to 10 keynote speakers and attending many more workshopsandpresentations
TheWONCAEuropeExecutiveBoardandthe Council met before the conference, and this will be reported on the WONCA Europe website.
Photo: WONCA Europe board during WONCA Europe Council meeting
A personal highlight in Dublin was being able to pay tribute to past president of WONCA, Prof Michael Boland, at the inauguration of an awardmadebytheIrishCollegeofGPsandnamedinhishonor Iwas joined onstage by other WONCA World past presidents who were present at the meeting, including Michael Kidd, Amanda Howe, and AnnaStavdal MytributetoMichaelBoland,whowasWONCAPresident from2001-2004,canbereadhere Indeed,hiscareerwasstellar,andhe ismissed. A / P R O F K A R E N F L E G G WONCA PRESIDENT
WONCA President with Past Presidents Anna Stavdal, Amanda Howe, and Michael Kidd, paying tribute to Prof Michael Boland (1948-2020) at the WONCA Europe Conference in Dublin Convention Centre
I am very fortunate to b f the recipients of this year’s Montegut Global Scholarship Fund awarded by the American Board of Family Medicine Foundation With this grant, I was able to attend the WONCA Asia Pacific Region (APR) Conference, which provided an avenue for me to gain valuable insights and connect with the international healthcarecommunity
Oneofmymainmotivatorsinattendingthis conference was to expand my perspective and gain knowledge from seasoned and expert physicians from all over the world. First on the list, I joined a pre-conference activitywhichwasalearningvisittoaFamily Medicinepracticesite Thelearningvisithad a limited number of participants, and I was very happy to secure a spot Our venue was the National University Polyclinics (NUP) in Bukit Panjang in the Western Region of Singapore
efore our clinic tour, a short introduction aboutNUPwasgiven.TheNUPistheprimary care arm of Singapore’s foremost academic healthsystem,theNationalUniversityHealth System (NUHS) The NUHS is one of three public healthcare clusters in Singapore I learned that almost 80% of Singapore’s healthcare is subsidized by the government, regardlessofincomeand/ortaxbracket,and that medicines are subsidized by Medisave, thus essentially bringing the cost to a minimumornil
Singapore is also working to integrate all healthcare clusters into a unified health system under the One Healthier Singapore initiative I was amazed at how fast they establishedthepolyclinics theydiditinjust under two years As of this writing, the WesternRegionhas7activepolyclinics,with 3upcomingclinicsstillbeingcompleted.
Montegut Scholar 2024
Onthefirstdayoftheconference,Mr OngYe Kung, the Minister for Health of Singapore, was our guest speaker I was taken aback when he mentioned that he recently visited the Philippines and learned that my country’s Department of Health launched BUCAS(BagongUrgentCareandAmbulatory Services) Center “A BUCAS Center is an intermediate health facility that aims to bridgethegapbetweenprimarycare
facilities (rural or city health centers) and higher-level health institutions (tertiary hospitals) by providing urgent health care services (minor surgeries and other ancillary services)” So BUCAS is basically like a “supercenter,” the equivalent of polyclinics inSingaporeorwhatitaimstobe.
IamcurrentlyworkingasaMedicalOfficerin SouthernPhilippinesMedicalCenter(SPMC), a tertiary public hospital in Davao City, Mindanao, which serves the poorest of the poor in the southern region of the Philippines UnderSPMC,Iamdeployedasa family physician to Marilog District Hospital, a BUCAS Center located 2 hours away from the city proper. In the past two months of workingthere,Ibelievethatwewereableto meet our goal of decongesting our tertiary hospitals by providing healthcare services directly in the community By doing so, we cut back on costs and manage resources effectively The waiting time of patients had also been reportedly reduced, which translatedtobetterhealthoutcomes.
IMPACT ON MY WORK
The theme for this year’s conference is Art and Science of Family Medicine One of the more controversial topics discussed was the useofArtificialIntelligence(AI)inhealthcare Prof. Enrico Coiera from Macquarie University presented scenarios wherein AI has caused patient safety issues, such as “hallucinating” or introducing confabulated information However, he proposed that AIaugmentedclinicaldecision-makingisbetter than that of the same person unassisted by AI. “If we are not accelerating our thinking and response to this tsunami of change, we are falling behind.” He then discussed the National Policy Roadmap, including recommendations that focused on safety, quality,ethics,andsecurityofusingartificial intelligence
Another plenary discussion was given by Dr Danielle Martin of the University of Toronto, wherein she presented the Primary Care paradox: “efforts to improve the parts may notnecessarilyimprovethewhole,”referring to her experience and learning from cancer care in Ontario, with patients ending up frustratedandhelplessbecauseoftoomuch specializationandthelackofcoordinationof care. She emphasized that relationships can be used as tools for change in primary healthcare
The workshops on research were of particular interest to me I attended the first workshop on Designing Research For Busy PrimaryCarePractices Thisprovidedtipsfor researchers and clinicians alike. One of the best practices that was shared, showed how wecanmaximizethedataatourfingertipsby using the very data we generate from electronic health records This is helpful especially to our resident doctors who are lookingforresearchtopics
The other research workshop I attended the next day was on Primary Care Innovations andResearch.Therewasashortintroduction butIappreciatedtheworkshopsmoreaswe gotmoretimetolistentoeveryone’sanswer Iwasgladtoseefamiliarfacesfrommyfirst international conference last year So honored and humbled to be sitting and standing with some of the giants of primary care in Asia Pacific and to be learning from their experience and perspective An added bonuswaswitnessingourveryownDr Karin Estepa-Garcia, immediate past president of thePhilippineAcademyofFamilyPhysicians, conferred as the Five Star Family Doctor Awardeefor2024.
PERSONAL REFLECTIONS
Seeing the best of what Singapore has to offerhasbeenanexhilaratingexperiencefor me.Singaporeisindeedaneyecandy.Ithas rekindled my passion for the arts and architecture. From its superb transportation system, enormous green spaces, bustling sights and sounds, multicultural society surrounded by great food it was just sensoryoverload
I hope that my attendance at WONCA. APR inspiresourjuniordoctorstorealizethatitis possible to enjoy and explore research and academebeyondtheconventionalpathways of clinics and hospitals We have so much untapped research potential in the Philippines, and I hope this small win of getting a grant motivates our young researchers to pursue their studies for the betterment of the Filipino family Plus, one getstotravelforfree!
Ifeelreallyluckytobeselectedasoneofthe recipients of this year’s Montegut Global Scholarship Fund awarded by the American Board of Family Medicine Foundation. This grant gave me the opportunity to attend virtuallytheWONCAruralconferenceheldin conjunction with the organization Towards Unity For Health tagged Ubuntu 2024 Aside missing the beautiful scenery of Cape Town where the conference took place, I enjoyed everymomentoftheconference.
My interest in rural health arose while working in two rural facilities in Ekiti State, Nigeria and now in Federal Medical Centre Abeokuta (FMCA) Family Medicine Department of FMCA serves as the primary careunitofthefacilityandprovidesprimary care services for patients from rural communitiesinOgunState,Nigeria.Mygoals of attending the conference were to gain ideas on innovative ways to enhance health care services to these rural dwellers and to have more insights on how to improve the rural posting experience of our family medicinepostgraduatetrainees
TUFH PRE-CONFERENCE
I attended the TUFH pre-conference, which was a panel discussion on social accountability The panelists were Sairu Philip,FirdouzaWaggie,JessikleciaJosinalva de Siqueira, and others They emphasized the importance of Social Accountability in building equity for rural health. This was my firsttimelearningwhatsocialaccountability is all about I got to know about the great worktheorganizationisdoinginpartnership with health institutions across the globe TUFH’s mission is to focus on the globe’s most vulnerable communities, who usually live insecurely on the fringes of society, in fearandwithoutaccesstoareasonablelevel of essential services, including health services
Dr Meredith del Pilar-Labarda presented the Topic; Social Innovation in Health; Catalyst for connecting people, place, and policy towards community wellness. She citedexamplesofsocialinnovationsfromthe Philippines, including: the use of humancentered design approaches to deliver essential health services in three rural areas during the COVID-19 pandemic, application of human-centered design for local telephone systems in southern Luzon, Philippines, introduction of modules on Social Innovation into their medical curriculum, community engagement, selfmonitoringstrategy,andothers Thiswasan eye-openerasIlearnedhowtheuseofsocial innovationcanenhancehealthcareforrural dwellers.
Another keynote speaker, Dr Malin Fors, presentedthetopicGeographicalNarcissism This is a term she used to explain the ruralurban interaction she encountered while workinginNorway.Ruralhealthworkersare often talked down to by their urban counterparts,whoaskwhytheyleftthecities to practice in rural areas and when they will return This can have a profound psychologicaleffectonruralhealthworkers, who may feel less valued than their urban colleagues.
The third keynote presentation was on promoting an inter-professional and collaborative approach to health service delivery by Prof Shenuka Singh from the UniversityofKwaZuluNatal.Sheemphasized the need for continuing educational support for students and inter-professional education, which will give health professionals the opportunity to learn from one another and better understand the perspectives of others. I loved when she explainedthatasiloedapproachtoteaching, as currently practiced in most places, will produce an ill-prepared and ill-equipped medicalgraduate
Thelastkeynotespeaker,ProfTeferaLema Belachew, addressed the need for universitiestraininghealthworkerstoadopt a paradigm shift towards redirecting their education to serve society and respond to the needs on the ground He stressed the interrelatedness of global and local health and stated the need for community engagement in managing noncommunicablediseases Heemphasizedthat community engagement is critical for achieving sustainable development, citing the Community Based Engagement (CBE) model currently practiced in Ethiopia as an example.
Montegut Scholar 2024
OTHER INSPIRING MOMENTS
JOHN MCLEOD ORATION
The oration honored significant contributionstoadvancinghealthforallrural populations. Attendees from the Virgin Islands, Iberoamerica, and New Zealand shared inspiring stories of the incredible work being done by Family Physicians in these areas They showed exceptional dedication despite the limitations posed by difficultterrains,lackofinternetconnection, andwatershortages.
VIRTUAL NETWORKING
I had the opportunity to meet Tiffany Maycook, Khalid Muhammed, Nilufer Demiral,YilmazAdelina,andRajanGhimire.I plan to collaborate with Tiffany on research focusing on elderly care and lifestyle and with Khalid, a medical student from Sudan who is working on a topic related to climate change
MY REFLECTIONS AND ACTION POINTS
Ubuntu 2024 was a great conference with excellentdeliveryofitstheme:People,Place, Policy for Community Wellness I hope to utilizeallIlearnedtomakeapositiveimpact on my patients and younger colleagues in postgraduate Family Medicine training. My actionpointsare:
To adopt the concept of Geographical Narcissism to explore the mindset of young family physicians practicing in Nigeria towards those who have migratedtodevelopedcountries
To initiate a discussion on the need for inclusion of social accountability in the postgraduate family medicine curriculumamongfamilyphysiciansand traineesinmyinstitution
TocollaboratewithTiffanyMaycookand Khalid Muhammad on research projects focusing on elderly care and climate change.
To contact the Social Innovation for Health Initiative Hub in Nigeria for more informationaboutthegroup’sactivities
VIDEO DOCUMENTARY: A JOURNEY THROUGH IBERO-AMERICA
TO EXPLORE THE WORK OF FAMILY DOCTORS IN RURAL AREAS.
WONCA NORTH AMERICA
INAUGURAL CONVENING
TheinauguralWorldOrganizationofNational Colleges Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) North America convening event was a resounding success, beginning with a business meeting attended by Canadian, American, and Caribbean representativesaimedatchartingtheteam’s path forward The meeting facilitated inperson interactions, networking among the memberorganizationleaders,andchartinga course forward for our region. Additionally, we celebrated the awardees for the North America five-star doctor and Montegut scholar awards for 2024, highlighting their significantcontributions
The business meeting was immediately followedbytheinauguralconveningchaired byWONCANorthAmericaPresidentDrVictor Ng Introductions by Dr Ng, Dr Vivianna Martinez-Bianchi (WONCA President-elect), and Shawn Martin (AAFP CEO and EVP) emphasized a shared commitment to the mission of WONCA to enhance global health by strengthening family medicine and primaryhealthcare.
The keynote speaker, Dr Carlos Gonzales, delivered an insightful presentation titled “Addressing Challenges: Primary Care, Rural Health,NativeAmericanHealth,TheBorder” Heprovidedahistoricaloverviewofprimary care in the region, highlighting the urgent need for a primary-care-centered health system with strong connections to specialists.
This message aligned closely with WONCA’s mission to improve the quality of life for people worldwide Dr Gonzales also offered valuable perspectives on the health challenges faced along the USA borders, in rural and Native American communities, leaving us with important considerations for ourongoingefforts
An engaging interactive exercise led by Dr David Polka (Canada), Dr Kim Yu (USA), and Dr Paula Henry (Trinidad and Tobago) highlighted the core values project from the North American perspective. Key values identified during this exercise include equity/social accountability, empathy/compassion, and professional autonomy Participants were reminded of theadaptabilityrequiredoffamilyphysicians andhowestablishingcorevaluescanhelpus navigatethedailychallengesweface.
Dr Brunèe Dorsett (Bahamas), chair of WONCA Polaris (North America Young Doctors' Movement), provided an update on theremarkableinitiativesundertakenbythe group Programmes such as the PolaRise mentorship programme, the PolarUs meetings, the empowerED podcast, and the Polaris newsletter are designed to inform, educate, support, and empower young family physicians as they embark on their careersinfamilymedicine
President-Elect, WONCA North America Region
D
President, WONCA North America Region
D
Threebreakoutsessionswereconducted,led by representatives and Board members of WONCANorthAmerica:
Impact of Climate Change on Clinical CareinNorthAmerica(DrsTaniaWhitbyBestandKimYu)
Community Medicine: Family Doctors as Connectors and Advocates for Health (Drs Julie Wood and Vivianna MartinezBianchi)
Feedback from participants indicated that these sessions were both informative and impactful. As highlighted in General Practice News (June 1948, p. 4), “the general practitioner should be the first line of defense for the patient the medical ‘clearing house’ The family doctor practices thebroadestspecialtyinmedicine”
Overall, the WONCA North America convening was a success We hope that this will be the start of an annual WONCA North American event that will allow Canadian, American, and Caribbean members to continue connecting with each other and nurturing established relationships It will alsobeaforumforustosharebestpractices, engage in collaborations on how we can support young doctors across our region, and contribute to strengthening family medicine.
Improving Diagnosis for Patient Safety
On September 17, World Patient Safety Day will be celebrated, an event that since 2019 has been part of the World Health Organization (WHO)’s public health campaigns.
With the theme "Improving Diagnosis for Patient Safety" and the slogan "Right Diagnosis Safe Patients!" World Patient SafetyDay2024highlightstheimportanceof accurate and timely diagnosis for patient safety.
Although diagnostic errors along with issues related to medication use have someoftheworstconsequencesforpatients and professionals, they have not been the focusofattentionuntil2015whenthereport "Improving Diagnosis in Health Care" was published.
InitsannouncementofWorldPatientSafety Day2024,theWHOdescribesdiagnosticerror as a situation where the patient's health problemisnotcorrectlyortimelyexplained This includes the absence of a diagnosis, incorrectdiagnoses,delaysindiagnosis,and failures to communicate the diagnosis. The UN health agency highlights that diagnostic errorsaccountforalmost16%ofpreventable harm in healthcare systems and estimates that most adults will face at least one diagnosticerrorintheirlifetime
TheWHOnotesthattoimprovethesafetyof the diagnostic process, action is needed on both systemic and cognitive factors. Systemic factors involve organizational shortcomingsthatpredisposetoerrors,such as poor communication between healthcare staff or between staff and patients, work overload, and deficiencies in teamwork Cognitive factors relate to the training and experience of professionals, their predispositiontocognitivebiases,andother factorsthatincreasetheriskofhumanerror inhealthcare,suchasfatigueandstress
It is noteworthy that most diagnostic errors related to cognitive biases are not due to a lack of knowledge but to failures in gathering, verifying, integrating, and interpretinginformation.
Therefore, for family doctors, keeping informationinthemedicalrecordup-to-date is essential for tailoring interventions to the patient's characteristics. The electronic health record allows all of a patient's health information to be included in a single support system regardless of where and when it is generated A traceability of information that was previously unthinkable withpaperrecords. On the flip side, if the information is not reviewed, organized, and updated, medical recordscanbecomeamazeofdisconnected data that complicates decision-making and increases the risk of inappropriate interventions. It is crucial to eliminate inappropriate, erroneous, or outdated diagnoses from the medical record. This contributestopatientsafety,justasregularly reviewing and adjusting pharmacological treatmentsdoes
A delayed or incorrect diagnosis, or the absence of a diagnosis, generally leads to a worse prognosis, can prolong illness, and sometimes cause disability or even premature death Failures in the diagnostic process are accompanied by delays in starting appropriate treatment and can lead toprovidingthepatientwithunnecessaryor harmful treatment, which also has psychologicalandeconomicrepercussions.
WONCA liaison person to WHO
THE ROLE OF FAMILY DOCTORS IN THE SAFE DIAGNOSIS PROCESS
Familydoctorsplayacriticalroleinensuring a safer diagnosis process in primary care. Their contributions to patient safety in diagnosisincludethefollowingkeyareas:
1. COMPREHENSIVE HEALTHCARE
Family doctors often have a long-term relationship with patients, allowing them to understand the patient’s medical history, lifestyle,andpsychosocialfactors Thisdeep understanding enables more accurate clinical judgments and timely diagnosis as they can consider the full context of a patient's health For example, knowing a patient's family history of heart disease, a family doctor might promptly recognize subtle symptoms of cardiovascular issues, leadingtoearlierdiagnosisandintervention
2. EARLY DETECTION AND PREVENTION
Family doctors serve as the first point of contact for patients, making them essential in detecting early signs of disease By performing routine screenings and physical exams, they can identify risk factors and symptoms that might otherwise go unnoticed For example, implementation of regular screening programas such as colon cancer or blood pressure checks in patients at risk of hypertension and cardiovascular diseaseshelppreventseriouscomplications.
3. CONTINUITY OF CARE AND MONITORING
Family doctors provide continuous care, which allows for the tracking of symptoms over time This helps in diagnosing conditionsthatevolveslowlyorpresentwith ambiguous symptoms Continuity also aids in adjusting treatment plans when conditionschangeornewinformationarises. For example: In chronic conditions like diabetes, family doctors monitor long-term health changes and ensure timely adjustments in treatment plans to avoid complications
4. COMPREHENSIVE PHYSICAL AND MENTAL HEALTH ASSESSMENTS
Family doctors are trained to assess both physical and mental health, which is crucial as many conditions have overlapping or psychosomaticsymptoms
This comprehensive approach helps prevent diagnostic errors, such as misdiagnosing depression for fatigue or vice versa For example, recognizing that a patient's physicalsymptoms(eg,fatigue,headaches) might be linked to underlying depression or anxiety, the family doctor can avoid unnecessary medical interventions and provideappropriatementalhealthcare.
5. PATIENT COMMUNICATION AND SHARED DECISION-MAKING
Family doctors often have well-established relationships with their patients, fostering better communication Clear explanations and discussions of symptoms, treatment options, and diagnostic tests reduce misunderstanding and ensure patients are activeparticipantsintheircare.Forexample, afamilydoctorexplainstheprosandconsof various diagnostic tests (eg, MRI, CT scan) andinvolvesthepatientindecidingthemost appropriate steps, ensuring that diagnostic testsarebothnecessaryandunderstood
6. COORDINATING WITH SPECIALISTS
When conditions require specialist referral, family doctors play a key role in referring patients, providing essential background information, and coordinating care. This helps ensure that specialists receive a clear picture of the patient’s health, reducing the risk of fragmented care and diagnostic errors Forexample,afamilydoctoridentifies potential early signs of cancer and coordinates with an oncologist, sharing detailed medical history and test results for more accurate diagnosis and treatment planning
7. ERROR PREVENTION THROUGH DIAGNOSTIC STEWARDSHIP
By avoiding over-testing or unnecessary interventions, family doctors help prevent overdiagnosis and unnecessary treatments that can harm patients They use clinical judgment to determine which tests and proceduresaretrulynecessary Forexample, a family doctor may avoid ordering an unnecessaryMRIforapatientwithbackpain whenconservativemanagementissufficient, preventing the patient from exposure to potentiallyinvasiveprocedures
8.
ADDRESSING COGNITIVE BIASES
By avoiding over-testing or unnecessary interventions, family doctors help prevent overdiagnosis and unnecessary treatments that can harm patients They use clinical judgment to determine which tests and proceduresaretrulynecessary.Forexample, a family doctor may avoid ordering an unnecessaryMRIforapatientwithbackpain whenconservativemanagementissufficient, preventing the patient from exposure to potentiallyinvasiveprocedures
9.
FOSTERING A SAFE ENVIRONMENT FOR OPEN COMMUNICATION
By avoiding over-testing or unnecessary interventions, family doctors help prevent overdiagnosis and unnecessary treatments that can harm patients. They use clinical judgment to determine which tests and proceduresaretrulynecessary Forexample, a family doctor may avoid ordering an unnecessaryMRIforapatientwithbackpain whenconservativemanagementissufficient, preventing the patient from exposure to potentiallyinvasiveprocedures.
In summary, family doctors contribute to safer diagnostic processes by combining theirclinicalexpertise,patient-centeredcare, and preventive approaches Their ability to build trust, ensure continuity, and balance clinical judgment with patient input makes them a vital part of the effort to reduce diagnosticerrorsinprimarycare.
THEME ANNOUNCEMENT
COMING SOON
BLOOD CLOT SURVEY
Dearfamilydoctors,
World Thrombosis Day kindly ask for your support in sharing an important upcoming survey focused on women’s education and awareness of blood clot risks during pregnancy and postpartum. The survey is available in 11 languages, making it accessibletoabroadaudience.
Their goal is to reach as many women who are pregnant or have recently given birth as possible.Bysharingthissurvey,youwillhelp usgathervaluableinsightsthatcanimprove educationandpreventioneffortsworldwide. Thank you for your continued support in promotingwomen'shealth.
ACampaignCreatedby
WONCA EXECUTIVE MEETS WHO LONDON
London, 29September2024.
AttheendofSeptember2024,WONCAWorld Executive Committee held a face-to-face meeting at the Royal College of GPs in London.Thisvenuewaschosenbecausenot onlyisitthecheapestcityforusalltoreach in in terms of airfares, it also has the lowest carbon footprint especially when the presidentisalreadyinEurope
This Executive meeting was remarkable in thatDrJohnFogarty,primarycareleaderthe WHO and our liaison person in the WHO, attendedthemeetingforhalfaday.Ibelieve that is a first for WONCA Executive and we must thank John for making the effort to cometoLondon
The WONCA Region Presidents, each gave a short presentation on the activities in the region with the WHO. A summary of these is asfollows:
AFRICA REGION
President Jane Namatovu reported on engagements with WHO to enable them to understand the contextual issues in the regionincludingaworkshoptohelpimprove thequalityofcaredeliveryinhealthfacilities and the WHO AFRO regional meeting There is ongoing advocacy for several activities including a project on three proposed WHO collaborating centres on PHC in the African region: at Stellenbosch University (South Africa),inMakerere(Uganda),andinBenin.
Meetings are ongoing with Hyppolite Kalambay Ntembwa who has the PHC portfolio at WHO AFRO and recently a meetingwithConstanceAssohou-Lutywhois responsibleforcollaboratingcentresatWHO AFRO In Geneva, ongoing engagements are abouttheSpecialProgrammeonPHCwhich officiallyendedinAugust2024andthehope is that the MOU with WHO Geneva will be signed imminently. This needs support from WHOAFRO.
Wearepreparingfortheupcoming2025PHC conference.WONCAAfricastillneedssupport from WHO through its country offices to supportFamilyMedicinebothintrainingand practiceinstitutions
ASIA-PACIFIC REGION (APR)
President Brian Chang (pictured ready to speak)notedthatWPRODirectorPiukalaand hehavemetseveraltimesincludingonWorld Health Day this year They have agreed on closercollaborationforthefuture,aimingto deliver the best healthcare for the people in this region. This year, Brian has received an invitation to the 75th Session of the WHO Regional Committee for the Western Pacific coming up, in October 2024 WONCA APR intends to share the WONCA statement on NCDsanddelivertheconceptsoftheWONCA APR Singapore Declaration of Planetary Health.
EASTMEDITERRANEANREGION(EMR)
President Abdulaziz Almehrazi spoke of the WHO Regional Diploma Collaboration, launched in 2022 It is a collaborative effort between the WHO EMRO, WONCA EMR, and theArabBoardofHigherSpecialisation This diploma program is a 24 month program tailored for GPs in the EMR and Arab countries, equipping them with essential knowledge, skills, and competencies to provide comprehensive and high-quality health care The curriculum is designed in alignmentwiththestandardssetbyglobally recognized bodies including WONCA Initially, 35 tutors underwent a Train the Trainersprogramand129studentsfromnine countries were selected for the course Now Abdulaziz believes that we need governments to empower family physicians and to increase the resources for training of familyphysiciansintheregion
EUROPEREGION(WE)
President Shlomo Vinker noted that WONCA Europe (WE) was represented in the 73rd session of the WHO Regional Committee for Europe Atthismeeting,ProfZalikaKlemenc Ketiš delivered a statement “Shortage of Europeanprimarycareworkforce”,co-signed by a significant number of other European NGOs with an interest in this topic Other activities include: Prof Mehmet Ungan, WE Immediate Past President, joined the WHO Europe short guide on the Therapeutic Patient Education (TPE) project; two WHO officerswerekeynotespeakersintheWONCA Europe2024conferenceinDublin-DrTomas Zapata-LopezYomas,WorkforceHealthUnit, WHO Europe)and Dr Pavlos Theodorakis, SeniorHealthPolicyAdvisor
WE conducted a talk session in April 2024 with Dr Toni De Deu (Senior officer, WHO European Centre for Primary Health Care, Kazakhstan) and Candan Kedir (OECD). For the future, WE is looking to cooperate in various WHO projects and plans, bringing to these our expertise and that of our member organizations, special interest groups, and networks
IBEROAMERICANA-CIMF REGION AND NORTHAMERICAREGION
Our respective region presidents, Dora Bernal and Victor Ng and their teams, have worked hard on a Memorandum of understanding (MOU) for improving primary healthcarethroughstrengtheningfamilyand communitymedicineinhealthsystemsofthe Americas
TheMOUaimstofostercooperationbetween PAHOandthesetwoWONCAregions,inareas of common interest including the prioritisation of primary care services. This involves promotion of the provision of primary care, and the central role of family doctors in developing and implementing specific programs A project working with PAHO and University of New Mexico to examine the scope of practice of family medicine in the Americas is an exciting opportunity.
An invitation for WONCA IberoamericanaCIMF and WONCA North America to attend the PAHO council meetings this year is an importantdevelopment
SOUTH ASIA REGION (SAR)
President K Sri Ranjan notes that our SAR regionhasmadeconnectionswithWHOata regional level by attending WHO SEARO meetings held in New Delhi last year This year,SriRanjanhasbeenabletostrengthen theseconnections Also,inSriLanka,weare engagedwithministryofhealthandWHO,in the primarycarestrengtheningprogram
THEWHO-WONCAWORKPLAN
Our WONCA executive liaison person, Maria PilarAstierPeña,madeapresentationonthe "WHO-WONCA Work Plan 2025-2027" This focuses on supporting WHO's efforts to strengthen Universal Health Coverage (UHC) bypromotingstrongprimarycarewithfamily medicine values and by improving access to qualityessentialhealthservices
Supporting the development of comprehensive primary care services which involves defining essential materials and human resources, providingdetailedfeedback,andoffering guidance for adapting the primary care services package to different health systemsintheworld.
Fostering patient safety improvements through contributions to the Global Patient Safety Action Plan 2021-2030 focus on primary care, providing expert recommendations and advocating for patient safety through global awareness and promotional efforts in primary care facilities.
Enhancing workforce development and growth through improved clinical decision-making tools, alignment with the ICPC-3, and the development of standardised postgraduate family and community medicine programs for healthworkers
An invitation for WONCA IberoamericanaCIMF and WONCA North America to attend the PAHO council meetings this year is an importantdevelopment
Dr Fogarty updated us on projects of the WHO in which WONCA input and collaborationwouldbeofvalue Wehopeto have input to training programs under the Integrated Management in Primary and Acute Care Training (IMPACT) initiative, alignment of clinical tools with international standards, and curriculum development for familymedicine.
Allagreeditwasavaluablehalfdayenabling Dr Fogarty to meet and get to know the WONCAWorldleadershipteam
Our seven region presidents continued their hard work by considering the aspects of WONCA’s Strategic Plan that can be worked onintheirregions
Thank you to my WONCA World Executive team and the WONCA secretariat (who also presentedontheirareaofwork)fortwodays of strong action and hard work on WONCA’s behalf.
WONCA liaison person to WHO
A V E
23 - 26 OCTOBER 2024
WONCA Iberoamerican - CIMF Region Conference 2024
PAMANA CITY, PANAMA
WONCA Conferences 2025
04 - 06 APRIL 2025
WONCA South Asia Region Conference 2025
BENGALURU, INDIA
24 - 27 APRIL 2025
WONCA Asia Pacific Region Conference 2025
BUSAN, SOUTH KOREA
17 - 21 SEPTEMBER 2025
WONCA World Conference 2025
LISBON, PORTUGAL
PAST PRESIDENTS ON CHINA MISSION
Past Presidents Donald Li and Anna Stavdal represented WONCA at the annual conferenceoftheChineseSocietyofGeneral Practice in Harbin on September 7-8 In her keynote speech, Anna Stavdal discussed the core concepts of Primary Care and Primary Healthcare, emphasizing how Family Medicine and its generalist approach are essential for delivering high-quality, personcenteredcare
Following the conference, the team participated in an academic exchange at Beijing University First Hospital’s Department of Family Medicine, joined by formerAPRPresidentMeng-ChiLi Keytopics included WONCA Accreditation, the Hong Kong Primary Healthcare Policy Blueprint, challengesindiagnosingdiseasesinPrimary Care, and the relationship between research and clinical practice Donald Li and Anna Stavdal also met with representatives from theChineseMedicalAssociation
Additionally, Anna Stavdal engaged in an academic exchange at Harbin University’s Department of Family Medicine, visited a Community Health Center, and toured Harbin University Hospital Discussions revisited WONCA Accreditation, alongside dialogues on core values, principles, and safeguarding the foundation of Family Medicineasadiscipline.
WONCA INTERNATIONAL CLASSIFICATIONS COMMITEE (WICC)
WICC MEETING IN NEWCASTLE
The WONCA International Classification Committee(WICC)isaworkingpartycreated in 1972 to discuss and develop tools that organize and collect information in the context of family medicine and primary health care. WICC met in Newcastle (UK) between September 22 and 24, 2024. The meeting was hosted by Nick Booth, a longstanding and active member of the group Therewere23participantsfrom14countries, including Australia, Belgium, Brazil, France, Japan,theNetherlands,andNorway
FEATURED DOCTOR
Dr Gustavo Gusso (Brazil) is a family doctor in Brazil and chair of the WONCA International Classification Committee (WICC)
We were pleased to have Prof Gustavo Gusso visit the WONCA secretariat last week on his way to attend a meeting of the WONCA International Classifications Committee (WICC) in Newcastle, UK
The main topics discussed were the implementation and updating of ICPC-3, the communication of the group's activities, training initiatives in classification and data collection Traditionally,thegrouporganizes atimewhenvariousguestsormembersgive presentations related to the Committee’s work. At this meeting, presentations were given by the EDGE AI Hub Project, PRIMIS (University of Nottingham), EAVESii (Strathclyde University) and INTEGO (UniversityofLeuven)
One of the meeting highlights was the presentation of reports from different countries about how they use classifications inprimarycarelocallyandprospectsforthe future With the availability of Large LanguageModeltools,therewillcertainlybe advances in the area of data structures and analysis in the primary health care context. Family doctors need to be attentive and active in order to be able to influence decisions about the choice of tools for the benefitofhealthteamsandpatients
Chair, WICC
REFLECTIONS ON THE 77TH WHO SEARO MEETING IN NEW DELHI
The77thsessionoftheWHOSouth-EastAsia Regional Committee (SEARO), held from October 7–9, 2024, in New Delhi, was a remarkableconvergenceofhealthministers, policymakers, and representatives from acrosstheregion AstheWHOrepresentative from WONCA, this experience allowed me to witness first-hand the power of regional collaboration in addressing complex public healthchallenges
The energy in the room was palpable from the opening session, where Mr. J. P. Nadda, HealthMinisterofIndia,assumedtheroleof Chairperson,withco-chairsfromBhutanand Timor-Leste The presence of Ms Saima Wazed, our Regional Director, added grace and dignity to the event, reinforcing the importance of strong leadership in fostering healthdiplomacy
The ministerial roundtable on building adolescent-responsive health systems was particularly impactful for me Adolescents are often left behind in healthcare discussions, yet they represent the future of ourregion Theconversationsreinforcedthe need to address their unique health challenges, especially mental health and reproductive health, with empathy and actionablepolicies
Oneofthemostsignificantmomentswasthe adoptionofresolutionsrelatedtoexpanding the South-East Asia Regional Health Emergency Fund (SEARHEF) and enhancing universal health coverage (UHC) These are critical steps toward strengthening our region’s capacity to respond to emergencies andprovideequitablehealthcareaccess The focus on sustainable financing also resonated deeply with me, as I believe financialresilienceisfundamentalforhealth systemstothrive
Organising Secretary WONCA South Asia Region Conference 2025
The meeting also highlighted progress in traditional medicine, vector-borne disease control, and mental health services. As someone passionate about the intersection of mental health and public health, I was encouragedbythecollectivecommitmentto the Paro Declaration on people-centered mentalhealthcare
For me, a key takeaway was the growing emphasis on digital health and AI-driven solutions,whichalignswithmyvisionforthe future of healthcare These innovations, when used responsibly, can revolutionize healthcare delivery and bridge gaps in access Iamexcitedabouttheopportunities this opens up for our region, and I look forward to working on these initiatives throughWONCA’seHealthWorkingPartyand theWorkingpartyforPolicyandAdvocacy
This session reaffirmed my belief that collaboration across borders, supported by strongleadershipandsustainablepolicies,is essential to achieving health goals. I left the meeting inspired by the collective determination of member states and committed to contributing meaningfully towardahealthierandmoreresilientSouthEastAsia
FAMILY MEDICINE PARADIGMS IN INDIA: A STRATEGIC IMPERATIVE
amilyMedicineinIndiaisrapidlyevolvingas an essential pillar of the nation's healthcare system. With its focus on comprehensive, continuous, and coordinated care, Family Medicine is uniquely positioned to address the diverse and complex health needs of India's vast and varied population As the country faces an increasing burden of noncommunicable diseases (NCDs), mental health issues, and an aging population, the roleofFamilyMedicinehasneverbeenmore critical
However, the integration of Family Medicine into the broader healthcare framework has been challenging Despite its proven benefits, there remains a significant gap in the number of trained family physicians, as wellasintherecognitionandsupportforthe specialty within the health system. This gap is particularly evident in rural and underserved areas where access to quality primarycareislimited
Inrecentpositivedevelopments,in2019the NationalMedicalCommission(NMC)Actwas passed by the Parliament of India, which mandatedtheinclusionoffamilymedicinein the mainstream medical education system Also,theGovernmentofIndiahaswrittento state governments to incorporate family medicine programs within the National Health Mission. The government has also offered funds to start MD/DNB Family Medicine Training Programs and to train statemedicalofficersinfamilymedicine Againstthisbackdrop,theWONCASouthAsia Region (SAR) Family Medicine Conference in 2025inIndiaholdstremendoussignificance. This conference will provide a platform for family physicians, healthcare policymakers, and stakeholders from across the region to come together and discuss the future of Family Medicine in South Asia It will facilitate the exchange of best practices, innovativemodelsofcare,andstrategiesfor overcomingchallengesuniquetotheregion Itwillalsoattractpolicymakerswhocouldbe influenced, leading to better integration of FamilyMedicineintohealthcarepolicies
Hosting the WONCA SAR conference in India isnotjustamatterofprestige,butastrategic imperative. It will spotlight the country's commitment to strengthening primary care andprovideanopportunitytoshowcasethe advancements being made in Family Medicine Moreover,itwillserveasacatalyst for policy change, encouraging the governmentandhealthinstitutionstoinvest moreinthiscrucialspecialty.
In conclusion, the WONCA SAR Family Medicine Conference 2025 in India is poised to be a landmark event. It will not only reinforce the importance of Family Medicine intheregionbutalsocontributesignificantly to the global discourse on primary care By bringing together experts from across South Asia,thisconferencewillhelpchartacourse for a more robust, resilient, and equitable healthcaresysteminIndiaandbeyond.
Organising Secretary WONCA South Asia Region Conference 2025
GERIATRICS TRAINING PROGRAM
WONCA AGEING & HEALTH SIG
The need for improved training and skills developmentincareofourolderpatientshas been identified as one of the goals of the WONCAAgeing&HealthSIG Globally,within medical schools, training at both undergraduate and postgraduate levels in geriatrics is significantly lacking due to competing needs with other disciplines We arehappytoinformyouthatwearenowable to offer an internationally accredited and certifiede-learningprogramingeriatrics
WONCA has entered into an agreement with the International Association of Gerontology and Geriatrics (IAGG) & Federation of Geriatric Education (FGE), who have for a numberofyearsbeenofferingthee-TRIGGER program The online “E-TRaining In Gerontology & GERiatrics” (IAGG-FGEorg) is conducted over 12 months The course is accredited by the European Accreditation Council for CME for 60 CEUs. The Health ProfessionalsCouncilofSouthAfrica,viathe South African Academy of Family Physicians (the South African WONCA member organisation), has awarded the course 60 hoursofCMEcredits Itishopedthatinother regions of the world, where accredited training is needed to maintain registration, thecreditswillberecognised.
Fees for the course, as a member of the WONCA Ageing and Health SIG, have been substantially discounted with costs ranging from CHF 30 for doctors practicing in lowincomecountries,CHF60forthosepracticing inmiddle-incomecountries,andCHF120for thosefromhigh-incomecountries Residents, registrars, and trainees will be entitled to a further 50% discount on these fees, and a certainnumberofscholarshipsareavailable. These fees are available to the first 10 applicants from the Ageing & Health SIG To join the Ageing & Health SIG, please click here
Thecourseswillbedevelopedforthreemain regions of the world; however, anyone from anywhere can participate in any course as the content is available for offline learning WONCA’s association with the IAGG FGE will allowustoprovidesubstantialinputintothe topics to be presented, and for those of us who are experts in a particular field to be presenters, as well as opportunities for trainees or early-career doctors to present cases
Thefirstcourse,whichisintheAfrica,Middle East & Europe Region, will commence on 26 September from 2PM – 5PM Paris time. Below is an outline of the topics to be presented:
Newgenerationofadults:September26, 2024
Cardiovascular diseases: October 24, 2024
Neurology:November21,2024
Nutrition and metabolic disorders: December19,2024
Dementia:January23,2025
Mobilitydisorders:February20,2025
Longtermcare:March20,2025
MentalHealth:April20,2025
Pulmonarydiseases:May22,2025
Teamworkingeriatricmedicine:June20, 2025
End-of-lifeissues:July24,2025
Aging in a changing world: August 21, 2025
To register for the course, pleaseclickhere.
If you would like to apply for a scholarship or make further enquiries, please send an email to contact iagg@hsetorg, informing them that you are a memberofWONCA
