The Network: Towards Unity for Health

The
Network
towards unity for health
VOLUME 27 | Number 01 | JULY 2008
NEWSLETTER
Networking
within our organisation and linking with
other organisations is of great importance to The Network: TUFH. We can
learn from each other, and also be of
help to each other. For example, since the
90’s of the last century, three Network:
TUFH institutions have been supporting
another member: Moi University, Kenia
(see page 4). Another example of cooperation within our organisation:
Maastricht students performing research
at other Network: TUFH universities (see
pages 24 and 25). As Jan de Maeseneer
states in his Foreword: “More is needed:
not only networking within the organisation but also links with other organisations/networks are important. For
example, The Network: TUFH is engaged
in the 15by2015 campaign, together with
other important organisations, such as
the world organisation of Family Doctors
(Wonca), Global Health through
Education Training and Service (GHETS),
and the European Forum for Primary
Care (EFPC)”. Read more about the
15by2015 campaign in the Foreword,
and on page 27.
Marion Stijnen and
Pauline Vluggen
Editors
In the Newsletter we refer to
The Network: Towards Unity for Health as
The Network: TUFH.
In this issue, among others:
The Present and Future of
the Family Doctor 12
Policy and Advocacy
Integration into Training 15
Grassroots Partnership
in Vietnam 20
Community Mental Health
Education in Nigeria 23
15by2015: Quality
Healthcare for All 27
07
08
contents
03 Foreword
Networking and Linking
04 The Network: TUFH in Action
04 Annual International Conference
‘South-North’ Collaboration: Friends of Moi University | A Cow for a Women’s Prison in Uganda | The Conference in
Colombia in Brief
06 Book Review
Effective IPE: Development, Delivery and Evaluation
07 Position Paper
Interprofessional Education and Practice
09 Improving Health
09 Health Authorities
What Would I Change if I Were Minister of Health?
10 Women’s Health
HIV/AIDS in Sudan | Nutritional Status of Children of Women Sugar-Cane Farm Workers | Female Genital Mutilation
12 Health Professions
The Present and Future of the Family Doctor
14 Indigenous Health
American Indians and Alaska Natives in Health Careers
14 Occupational Health
Noise Pollution in Pakistan
15 Integrating Medicine and Public Health
Policy and Advocacy Integration into Training
16 Community Action
16 Community Interview
Community at the Heart | New Brochure Education for Health
17 International Health Professions Education
17 Medical Education
Teaching for Learning, Learning for Health | Prevention Education Resource Centre
18 Interprofessional Education
Collaborating Across Borders | Interprofessional Education: A Personal Perspective
20 Yellow Papers
Grassroots Partnership in Vietnam | Embedding Indigenous Perspectives in Health Curriculum
22 International Diary
22 Diary 2008-2009
23 Students’ Column
23 Students’ Speakers Corner
Community Mental Health Education in Nigeria | Network: TUFH Institutions Welcome Maastricht Students
26 Member and Organisational News
26 Messages from the Executive Committee
EC Intelligence: Ian Cameron | 15by2015: Quality Healthcare for All | Tribute to…
28 Taskforces
Mini-Grants Supporting Women and Health Learning Package | New Taskforce: Social Accountability and Accreditation | Projects Related to Care for the Elderly
30 Represented at International Meetings/Conferences
Frontline Medicine: From Natural Disasters to Daily Care
31 About our Members
A Passion for… | Interesting Internet Sites | Moving On: Changes in Institutional Leadership | New Members |
Re-Assessing Full Members
FOREWORD
Networking
and Linking
paign (see page 27), together with other
important organisations: the world
organisation of Family Doctors (Wonca),
Global Health through Education
Training and Service (GHETS), and the
European Forum for Primary Care (EFPC).
In developing this action, the co-operation with GHETS has been utmost important. GHETS provided a lot of support in
the press-communication strategy.
Dr. Jan de Maeseneer
N U M B E R
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The 15by2015 initiative also gives a direction to our organisation: linking with
other organisations and networks - as
pointed out by De Maeseneer - but also
to focus on primary care as the most distinctive of our educational origins characteristic in 1978. The reorganisation of
the educational process was recognised
then as a necessity if we were to focus on
community-oriented primary care. Tradi-
N E W S L E T T E R
Dr. Fernando Mora
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Jan de Maeseneer | Secretary General
Email: jan.demaeseneer@ugent.be
J U LY
According to Goodwin (2004) a network
is “any moderately stable pattern of ties
or links between organisations or
between organisations and individuals,
where those ties represent some form of
recognisable accountability (however
weak and often overridden), whether
formal or informal in character, whether
weak or strong, loose or tight, bounded
or unbounded”.
The Network: TUFH exists already
decades and is connecting similar-minded people globally to share ideas, form
links and work together. In order to
strengthen these links, yearly conferences are organised, this Newsletter and
Education for Health are written and we
have the taskforces, which are interacting more and more through listservs. The
most recent initiative in this field has
been a listserv in relation to Social
Accountability and Accreditation. It
would be interesting to exchange our
views - for example at the coming
Conference in September 2008 - on how
weak or strong, loose or tight, bounded
or unbounded our links are.. Though,
apart from conferences and taskforces,
more is needed: not only networking
within the organisation but also links
with other organisations/networks are
important. For example, The Network:
TUFH is engaged in the 15by2015 cam-
Reference
GOODWIN, N., PERRI, G., PEIK, E. et al.
(2004). Managing Across Diverse Networks of Care: Lessons from Other
Sectors Report to the National Coordinating Centre for NHS Service
Delivery and Organisation. NHS. www.sdo.lshtm.ac.uk/files/adhoc/
39-policy-report.pdf
tional organisation of the curriculum based on
disciplines - with basic sciences at the beginning,
emphasis on teaching rather than learning, and
in individual performance over team learning were clearly insufficient, faced with the challenges that primary care poses. Thus innovation in
health professions education became a key concept of our institution. Many are the products of
our efforts, from problem-based learning to the
relevance of linking with all those concerned with
the health of individuals and communities, and
to the ethical principle of social accountability, to
mention just a few. But we have to recognise that
this process is so complex that no matter what
we do, or how successful we have been, there is
always more to do. I would like to point to two
areas of interest. Experiences in primary care and
linking with service providers and communities
have been interesting and relevant in many of
the less developed nations, like India, Brazil or
Uganda. There should be a more concerted effort to enhance linking of people working in
these areas that go beyond our annual conference. This is one of the central purposes of
GHETS. It would also be interesting to analyse
how much community work and educational innovation have impacted on health professions
education world-wide. I think that conceptually
there is a large impact, but this has to be reflected on the educational practices. Perhaps we have
been limited in our outward reach, in our educational mission, and this is reflected on how
some large organisations and groups
(like the Global Health Workforce Alliance:
www.who.int/workforcealliance/en/) are now
where we were many years ago: recounting educational experiences in communities. This calls
for increasing and strengthening of our links with
our educational counterparts.
At this moment, when the spirit of Alma-Ata is
riding again in the world, we have a golden opportunity to regain relevance.
Fernando Mora | Global Health through
Education Training and Service (GHETS)
Email: fmora5@yahoo.com
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THE NETWORK: TUFH IN ACTION
ANNUAL INTERNATIONAL CONFERENCE
Every year The Network: TUFH organises an international scientific and networking conference.
The Conference 2008 will be held in Chía-Bogota, Colombia, from September 27 – October 2.
N E W S L E T T E R
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‘South-North’ Collaboration: Friends of Moi University
Establishing and sustaining medical schools
in developing countries can be challenging.
Some collaborations between medical schools
in developing countries and one or more medical schools in developed countries have been
helpful. However, medical schools in developing countries can be vulnerable to the sudden
withdrawal of funds (particularly if they have
only one partner). In order to effectively shield
themselves from withdrawal of support, medical schools in developing countries often participate in a number of parallel independent
twinning relationships. This approach poses
its own challenges, including the potential for
lack of coordination, overlap and duplication
of efforts, and conflicting advice.
Consortium of Moi Supporters
In 1989, Moi University Faculty of Science
(‘Moi’) was established in Eldoret, Kenya,
under the direction of the Founding Dean,
Haroun Mengech. Mengech helped to ensure
that the medical school had a strong community focus and used problem-based learning
methods (Westberg, 1999). During the planning phase, Mengech and others approached
and received support from three medical schools: Maastricht University Faculty
of Health Sciences (‘Maastricht’) in the
Netherlands, Linköping University Faculty of
Health Sciences (‘Linköping’) in Sweden, and
Ben-Gurion University of the Negev Faculty
of Health Sciences (‘Ben-Gurion’) in Israel. All
three schools belonged to The Network.
Representatives from Maastricht and
Linköping first became aware of the support
from the other universities during a chance
meeting in Eldoret. Wanting to complement
and not conflict with each other’s support of
Moi, they decided to meet with representatives of Ben-Gurion at the Network’s next
annual Conference (Majoor, 1991).
Around the same time, a group of doctors
from Indiana University (‘Indiana’) in the US
4
who were interested in international health
approached Moi to establish an ongoing
working relationship (Voelker, 2004). Upon
learning about the institutions in The Network
which were working with Moi, the Indiana
doctors made contact with Maastricht and
agreed to communicate regularly with all
the Network partners about activities. This
‘Consortium of Moi Supporters’ has become
known as ‘Friends of Moi’ (or ‘Friends’).
Friends of Moi Work Together
Since 1991, the Friends of Moi have met every
year during the annual Conferences of what
is now called The Network: TUFH. The group
reviews the activities of all partners during
the previous year, and they plan for activities for the upcoming year, paying particular
attention to complementing the activities of
their partners and avoiding overlaps.
The success of the Friends collaboration has
required open communication and effort on
all sides. The successive Deans at Moi have
nurtured the individual partnerships and
coordinated the activities of the Friends.
Each donor has developed its own area of
focus, based on its own expertise but balanced by the need to complement the activities of the other schools. This strategy has
not only allowed these areas to strengthen
at Moi, but has also led to the development
of expertise in the Moi staff.
The universities of Linköping and Maastricht
have both focused on preclinical education. To deal with this overlap, Maastricht
and Linköping have run workshops jointly.
Indiana’s contributions to the clinical education programme appear to have complemented Linköping’s and Maastricht’s contributions to the preclinical programme. This
suggests that institutions with different
approaches and affiliations can take part
successfully in a Friends model.
Conclusion
The Friends see their consortium as one of
mutual benefit, flowing in many directions,
rather than simply as one of donor and recipient
institutions. All of the schools have benefited
from joint research projects, joint application
for funds, student and staff exchanges and an
international perspective. While many of these
successes might take place through one-onone partnerships, the benefits were multiplied
by the inclusion of different schools.
We have found that the Friends model can
include institutions offering broad-based support as well as individuals with limited resources. We have also learned that the contributions
are most likely to be successful if they focus on
the developing school’s expressed needs and
complement the activities of other partners.
References
MAJOOR, G. (1991). Collaboration Among
Institutions Supporting a New School. Newsletter: Network of Community-Oriented
Educational Institutions for Health Sciences,
16, 10.
VOELKER, R. (2004). Conquering HIV and
Stigma in Kenya. Journal of the American
Medical Association, 292(2), 157-159.
WESTBERG, J. (1999). Making a Difference: An
interview of Dr. Haroun K. Arap Mengech.
Education for Health, 12(1), 108-110.
The unabridged version of this article hasbeen published in Education for Health,
Volume 20, Issue 1 (May 2007).
Kimberly Oman (James Cook University,
Australia), Barasa Khwa-Otsyula (Moi
University, Kenya), Gerard Majoor
(Maastricht University, the Netherlands),
Robert Einterz (Indiana University, USA),
Åke Wasteson (Linköping University,
Sweden)
Email: kimberly.oman@jcu.edu.au
A Cow
for a Women’s Prison in Uganda
After attending the Network: TUFH 2007
Conference, I remained in Kampala, staying at Hospice Uganda, a non-residential
palliative care organisation. Through the
Hospice, I met a young English lawyer, Alexander Mclean. Alexander has spent the
holidays of his law degree in sub-Saharan
Africa, mainly Kenya and Uganda, setting
up clinic wings and libraries in prisons. He
offered to take me to the women’s prison,
Luzira, and I gladly accepted. Having seen
prisons in Australia, I was interested to explore conditions in Uganda.
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When I returned home to Australia, I told
my mother - a Legal Aid lawyer in Newcastle - about the conditions in Luzira. She
and her colleagues decided that they
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Around halfway through the service, a
baby started crying in the arms of one of
the prisoners. Alexander explained to me
that the women who entered the prison
More information on Alexander Mclean
and his organisation, the African Prisons
Project, can be found at
www.africanprisons.com
N U M B E R
I enquired how the children were fed, and
Alexander told me the babies were breastfed, but that their diet was so poor that it
was very difficult for them to lactate. He
explained that the cow was there so that
the women had some calcium in their diet.
There was not enough milk for all the women, but at least it helped some.
In June of 2007, a major storm had hit
Newcastle, and a coal carrier had been
grounded off Nobby’s Beach. The ship remained just off the beach for the next few
weeks, until finally being pulled off the
reef by four tug boats. It was called the
Pasha Bulker. The new Luzira cow was
finally named Pasha Bulcow by the lawyers, and is currently providing milk to the
mothers of Luzira prison.
N E W S L E T T E R
As it was Sunday, the women were awaiting church. Soon, a Catholic group and an
Anglican group of outsiders arrived to give
the services. The women broke into the appropriate groups and the services began in
two large sheds. I attended the Anglican
service, which was full of beautiful music
and dance, and was so unlike any other
church service I have ever seen.
should get in touch with Alexander to help
fund another cow for the prison. Over a few
months, they raised the money from the
criminal defence lawyers of Newcastle, and
sent it off to Alexander as a cheque. They
held a vote to decide on a name for the
new cow.
2 0 0 8
pregnant delivered there, and the children
remained with their mothers until the
mother was released, or in some cases, executed. As the mother in this case clearly
wanted to remain in the service, I offered
to take the baby outside and quieten her.
I held the baby girl for almost thirty minutes, and she barely moved in that time.
She whimpered a few times, and tried to
open her eyes, but she was very listless and
non-responsive. When the service ended,
her mother came outside to me. She was
19 years old, and had been in prison for
four months. She did not know when she
would be released, and she had no family
to care for her or the child. She begged me
to take her baby with me back to Australia,
to look after her and give her opportunities. I did not know what to say.
J U LY
On a Sunday morning, I met Alexander and
his father at the prison, and after being
given clearance, we entered the prison
grounds. It was very different than what I
had expected. Both prisoners and guards
were all women, but there were many children around the prison as well. The grounds
were not, as I had anticipated, a Victorianstyle block of concrete, but rather long dormitory blocks with corrugated tin roofing,
and a few other buildings in a similar style
(including a kitchen which had a roof but
was otherwise mostly open to the elements). Between the buildings was gravel
and grass, and prisoners seemed to be
sitting around in groups unless they had
specific duties. There was also a cow
wandering the grounds.
Pasha Bulcow being officially handed over to Luzira prison
Barbara Cameron | Student, Faculty of
Medicine, University of New South Wales,
Australia
Email: barbasha@gmail.com
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THE NETWORK: TUFH IN ACTION
ANNUAL INTERNATIONAL CONFERENCE
BOOK REVIEW
N E W S L E T T E R
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Effective IPE: Development,
Delivery and Evaluation
6
The Conference in Colombia in Brief
• When: September 27 - October 2, 2008.
• Where: Chía-Bogota, Colombia (in collaboration
with the Facultad de Medicina, Universidad de
La Sabana).
• Theme: Adapting Health Services and Health
Professions Education to Local Needs: Partnerships, Priorities, and Passions.
• Goal: To analyse and discuss how health
systems, services and health professions
education adapt and readapt to the local needs
of populations according to the historical,
political and cultural influences they receive
over time.
• Tracks throughout the Conference: educational track, research track, and Spanish track.
• Key-note speakers:
- Dawn Forman, United Kingdom and Betsy
VanLeit, United States of America - Strategic
Leadership in Interprofessional Education:
Perspective from around the World.
- Valda Ford, United States of America - The Role
of Cultural Competency in Developing and
Sustaining Partnerships, Priorities and Passions.
- Wim Van Lerberghe, Belgium - Primary
Healthcare since Alma Ata.
- German Zuluaga, Colombia – topic still to be
announced.
• Post-Conference Excursions:
- Visit the Arhuaco native groups at the village
of Nabusímake in the Sierra Nevada de Santa
Marta. During this three-day trip participants
will have the chance to receive the message
from the Arhuaco about their ecologically
sustainable perspective of health, integrated to
their traditional cultural practices and their
effort to link it to the national health system
organisation.
- Visit the village of Agua de Dios during a oneday trip, where participants will have the chance
to experience how the country has evolved
overtime in its socially organised response to
patients with Hansen disease.
• Conference website:
www.the-networktufh.org/conference
Book Review of: Effective Interprofessional Education:
Development, Delivery and Evaluation
Authors: Della Freeth, Marilyn Hammick, Scott Reeves,
Ivan Koppel & Hugh Barr
ISBN-13: 978-14051-1653-4, 206 pp.
The major objective of the book Effective Interprofessional Education is to discuss and
illustrate the development, delivery and evaluation of effective interprofessional education in both the healthcare and social service arenas. This book is written by authors
who are well-respected in interprofessional education, including Hugh Barr from Britain.
Although the authors state that they intend to reach a diverse audience that includes
teachers, practitioners, administrators and funders, the book is probably best targeted
for health professions educators whether in the academic or community setting.
The book is divided into three sections with multiple chapters in each section. Section
I includes a discussion of the fundamentals of interprofessional education and a definition of ‘effectiveness’. Section II focuses on the development and delivery of interprofessional education, while Section III concentrates on evaluation. Throughout the book
there are practical real world examples and case studies from a variety of healthcare
and social service settings. Although the authors are from Britain, they have attempted
to use case studies from other parts of the world. The authors’ treatment of the subject
matter is comprehensive. The multiple case studies are useful for illustrating the content of the text. The information is up-to-date with references to current peer-reviewed
literature and important textbooks on interprofessional education. In the Foreword of
the book, John Gilbert from Canada characterises the book as a ‘workbook’ for anyone
involved in collaborative learning. Section III on evaluation will be particularly helpful
for educators and practitioners who wish to evaluate their interprofessional educational initiatives. The section on evaluation also includes a brief discussion of the issues associated with measurement reliability and validity.
Effective Interprofessional Education is well written and easy to read. The organisation
of the book into three sections helps the reader navigate through the content. The information is logically presented, beginning with the definition of interprofessional education, followed by a discussion of the development and delivery of interprofessional
education and ending with the important topic of evaluation. Although there are multiple contributors, the book reads in a very coherent manner.
If educators, administrators or practitioners are looking for a ‘how-to’ practical book,
this will serve their purpose. It will aid healthcare and social service professionals in the
development, delivery and evaluation of interprofessional educational strategies.
This review has been published before in Education for Health, Volume 20, no. 1,
2007.
Wendy Rheault | Dean, College of Health Professions,
Rosalind Franklin University of Medicine and Science, USA
Email: wendy.rheault@rosalindfranklin.edu
POSITION PAPER
The Network: TUFH Executive Committee decided to undertake the writing of a series of ‘Position Papers’ on issues that are
closely related to the aims and objectives of our organisation. They must be seen as starting points for further discussion.
You may contribute by submitting a letter to secretariat@network.unimaas.nl, by participating in sessions on these issues at
Network: TUFH Conferences, or responding to the electronic versions of these Position Papers at the Network: TUFH’s website
(www.the-networktufh.org/publications_resources/positionpapers.asp).
Interprofessional
Education and Practice
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The Service User
While the IPE taskforce has a specific focus,
there are substantial overlaps of interest with
other taskforces focused on particular groups
of service users e.g Care of the Elderly, and
Women’s Health. In addition, the delivery
of integrated service is an issue for the IPE
taskforce and for specific areas of health
e.g. Public Health, and Primary Care. For
this reason this taskforce is interested in collaboration with other areas of The Network:
TUFH in order to encourage and enable im-
Implementation of Interprofessional
Education / Community and Work-Based
Education
A variety of learning and teaching approaches are relevant here, amongst them
problem-based learning, collaborative enquiry, and continuous quality improvements
(Barr, 2003) and also case-based learning
(Lindquist et al., 2005). “Practice-based
learning is seen as essential and can take
many forms; observational study, shadowing,
cross professional placements and experience
on training wards” (Barr, 2003). The timing
of interprofessional education continues to
be a topic of discussion as is the issue of the
importance of embedding or not embedding
uniprofessional identity before engaging
with interprofessional learning.
N U M B E R
The importance of multiprofessional (now
seen as interprofessional) learning and education for health professionals was emphasized
in 1988 by the World Health Organization
(WHO, 1988) in their statement Learning
Together to Work Together for Health and this
Evaluation of studies which focus on such
interprofessional learning experience have
been gathered by Freeth et al. (2002), Barr et
al. (2005) and Hammick et al. (2007). Much
of the interprofessional education discussed
within these studies is carried out within the
workplace and is not accredited by a college
or university. The benefit of explicit relevance
to practice can also be gained through placement experience within a multiprofessional
team and also through a joint placement
experience within a programme leading to
professional registration.
The increased involvement of service users
and carers in the design and implementation of education programmes for health
professionals is a feature of interprofessional
education in the UK and has been addressed
in the recent UK Department of Health project Creating an Interprofessional Workforce.
N E W S L E T T E R
Learning Together to Work Together
The necessity for collaboration between
health and social care professions and health
and welfare/social care agencies arises from
the multiple needs of specific groups of service users, the variety of required service responses to these and the need for effective
information exchange and discussion with
regards to care planning and delivery. The
lack of operation of functional links between
agencies has led to a failure of service and
increased risk to service users. The inability of
multiprofessional teams to communicate has
also led to a failure to respond to the needs
of service users effectively (Conway & Macmillan, 2003).
The link between multiprofessional and interprofessional learning experiences and
enhanced collaborative ability within a multiprofessional team or between agencies has
yet to be fully evidenced, but examples have
been identified which indicate a change in
practice which is sustainable following structured interprofessional learning experience
within a multiprofessional student population e.g. (Dickinson & Carpenter, 2005).
provement in service design and provision,
through improvements in interprofessional
learning and improved integration of services
and care provision.
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Mission of IPE Taskforce
To enhance the quality of interprofessional
education, learning and practice by drawing
together experience(s) from the international
context.
drive has been repeated by other legislative
and policy requirements in several different
countries.
J U LY
The taskforce Interprofessional Education
(IPE) changed its title from multiprofessional
to interprofessional in order to emphasize
the importance of structured learning with,
from and about different professions, by
comparison with simply sharing a learning
environment.
The term ‘multiprofessional’ is used in the
paper to denote a team, training ward or
student group which contains representation
from a number of professions.
The international context in which the IPE
taskforce functions recognises a number of
different models of community and workbased education, ranging from a joint placement between, for example, social work
and community nursing students as part of
pre-registration education to a uniprofessional community-based experience within a
medical education programme. There is an op7
THE NETWORK: TUFH IN ACTION
POSITION PAPER
portunity here for Network: TUFH members
to learn from each other about the advantages of these different models and to enable an
expansion of joint placement and work-based
learning where appropriate to the development of uniprofessional and interprofessional
skills, competencies and understanding.
N E W S L E T T E R
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The strengths of a joint placement experience
have been recognised as having an impact on
both students and supervisory staff, who gain
cross/interprofessional understanding. Community service learning is acknowledged to
be a valuable extension of community-based
education for health professionals (Mpofu,
et al., 2004)
Enabling Students to Work Interprofessionally
Part of the above depends on the interprofessional learning ethos being seamless across
university contexts and during the practice
learning experience. A synergy should ideally
be achieved between the interprofessional
experience in the practice learning environment and in the campus/university context.
Effective interprofessional learning (IPL)
depends on clinicians and educators being
adequately prepared for their role as facilitators during classroom and practice learning
opportunities (Reeves, 2002; Ponzer et al.,
2004). Within the UK, practice teacher preparation is influenced by professional bodies,
is often delivered uniprofessionally and does
not necessarily address interprofessional
learning and teaching. Many courses do not
provide follow-up support. This arrangement
reinforces professional boundaries, fails to
prepare practice teachers to support practice-based IPL and does little to alleviate the
isolation staff may feel. What is now needed
are some role models to encourage IPE development.
Clinical teacher preparation is similar in
Australia. In most courses there is little collaboration between professions or acknowledgement that students from different professional groups are learning in the same
8
environments, but advances are being made
to change this. However, there are some examples of good practice. There is a commitment to interprofessional practice by the professional bodies in many universities in New
Zealand. Therefore where interprofessional
learning exists, collaborative education occurs and professionals learn together as well
as focus on speciality practice.
Modelling of collaborative practice by practitioners from different professions is also an
excellent positive driver for student interprofessional development as is the delivery of
key curricular and skills areas by members of
a different profession e.g. delivery of clinical
skills teaching to medical students by nurses.
The multiprofessional training wards run in
both the UK and in Sweden enable students
from different professional programmes to be
guided by professions other than their own
(Fallsberg & Wijma, 1999; Fallsberg & Hammar, 2000).
You can read the unabridged version of this
Position Paper at www.the-networktufh.org/
publications_resources/positionpapers.asp
References
BARR, H., KOPPEL, I., REEVES, R., HAMMICK,
M. & FREETH, D. (2005). Effective
Interprofessional Education: Argument,
Assumption & Evidence. Oxford: Blackwell.
BARR, H. (2003). Unpacking
Interprofessional Education in
Interprofessional Collaboration. Ed A.
Leathard Brunner-Routledge.
CONWAY, J. & MACMILLAN, M. (2003).
Quality Health Care Delivery: Implications
for Multiprofessional Learning. The Network
International Conference. Towards Equity
in Education, Training and Health Care Delivery. October 2003, Newcastle,
Australia.
DICKINSON, C. & CARPENTER, J. (2005).
Contact Is Not Enough: An Intergroup Perspective on Stereotypes and Stereotype
Change in Interprofessional Education.
The Theory-Practice Relationship in
Interprofessional Education. Occasional
paper 7. The HE Academy Health Sciences
and Practice subject centre. Ed Colyer,
Helme and Jones.
FALLSBERG, M.B. & WIJMA, K. (1999).
Student Attitudes Towards the Goals of an
Interprofessional Training Ward. Medical
Teacher, vol 21: 6, 576-81.
FALLSBERG, M.B. & HAMMAR, M. (2000).
Strategies and Focus at an Integrated,
Interprofessional Training Ward. Journal of
Interprofessional Care, vol. 14:4, p 337-51.
FREETH, D., HAMMICK, M., KOPPEL, I.,
REEVES, S. & BARR, H. (2002). A Critical
Review of Evaluations of Interprofessional
Education. UK Learning and Teaching
Support Network (LTSN) Centre for Health
Sciences and Practice, Occasional paper 2.
HAMMICK, M., FREETH, D., KOPPEL,
I., REEVES, S. & BARR, H. (2007). A
Best Evidence Systematic Review of
Interprofessional Education. www.bemecollaboration.org/beme/pages/
reviews/hammick.html
LINDQUIST, S., DUNCAN, A., SHEPSTONE, L.,
WATTS, F & PEARCE, S. (2005). Case-Based
Learning in Cross-Professional Groups - The
Design, Implementation and Evaluation of a
Pre-Registration Interprofessional Learning
Programme. Journal of Interprofessional
Care, 19(5) 509-520.
MPOFU, R., DANIELS, P. & ADONIS, T.A.
(2004). Student Perceptions of Community
Service Learning Experiences in Community
Health Services. The Network International
conference Overcoming Health Disparities:
Global Experiences from Partnerships
between Communities, Health Services and
Health Professional Schools. October 2004
Atlanta US.
World Health Organization (1988). Learning
Together to Work Together for Health. Report
of a WHO Study Group on Multiprofessional
Education for Health Personnel. The Team
Approach Technical Report Series 769.
Geneva: WHO.
Dawn Forman, Jill Thistlethwaite, Katie
Cuthbert, Isabel Jones, Marion Jones |
On behalf of the IPE taskforce
Email: dawn.forman@btinternet.com
IMPROVING HEALTH
HEALTH AUTHORITIES
What Would I Change
if I Were Minister of Health?
This column took me a while to write. The
truth is, the US healthcare system is unique,
brilliant, and fundamentally flawed all at the
same time. If you are wealthy and have a
heart attack, you probably could count yourself lucky to have it in any major US city.
However, if you are an average citizen trying
to meet the basic health needs of your family,
and maybe even prevent a heart attack,
there are better places to be. I should point
out that we technically do not have a
‘Minister of Health’ in the USA, so this column will assume I was the US equivalent.
satisfied patients and better health indicators (Macinko et al., 2003). Additionally,
states within the USA that have a greater
supply of primary care physicians, but not
specialists, have lower mortality rates (Shi et
al., 2003).
N U M B E R
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How would I try to increase the nationwide
percentage of primary care providers? This is
a question not easily answered. I would start
by creating rewards for medical schools that
produce higher percentages of primary care
physicians, and support the expansion of
state run physician-assistant and nursepractitioner programmes. I would also ask
states to set up taskforces that would
creatively encourage the recruitment and
development of future primary care providers, in ways that worked for their state.
Continued attempts at tinkering with
References
MACINKO, J. et al. (2003). The Contribution
of Primary Care Systems to the Health Outcomes within Organization for
Economic Cooperation and Development (OECD) countries, 1970-1998. Health
Services Research, 38:831.
SHI, L. et al. (2003). The Relationship
between Primary Care, Income Inequality, and Mortality in the United States, 19801995. Journal of the American Board of
Family Practice, 16:412.
N E W S L E T T E R
Perhaps my father summed it up best, when
he said “If you go to a shoe store, they sell
you shoes”. Well, the USA’s healthcare system is structured to promote and utilise specialty care. Even the training of residents, the
post-graduate level physicians in the USA,
promotes the training of specialists. Medicare,
a public funding source, pays hospitals to
help subsidise the training of physicians, and
the subsidy is linked to the hospital’s level
of inpatient, but not outpatient service.
Reimbursement for work done by medical
providers also heavily favours invasive procedures.
I do not think simply increasing the number
of primary care providers in our country
would magically solve all our healthcare
challenges, but it would strategically change
the debate. A provider workforce more based
in the viewpoint of primary care would serve
as a stronger voice against those with purely
financial interests, specifically the insurance
and pharmaceutical industries. Perhaps then,
the USA would be ready for a rethinking of
the priorities of its healthcare system. In the
meantime, there would be more stewards to
pursue the multitude of possible communitybased solutions.
Who knows, maybe the newly powerful alliance of primary care providers would find
they did not have that much to change that
their increase in numbers did not already
take care of.
2 0 0 8
At the time of writing this, the leading
Democratic hopefuls for the 2008 presidential election are playing with ideas that keep
private insurances in the loop for any comprehensive healthcare overhaul, while many
Republican opinion leaders are responding by
stoking Cold War era fears of ‘communism’
and ‘socialism’. In this environment, what
could I do that would make a fundamental
difference? I have an idea, but its implementation would be a work in progress: I would
make it my number one priority to increase
the number of primary care providers.
The USA has a lower percentage of primary
care physicians (about 35%) than other
Western nations and Canada, where the percentage usually hovers around 50%. The
number of primary care providers has some
interesting correlates. Nations with higher
primary care orientation tend to have more
Dr. Daniel Waldman
J U LY
We all know that the USA is alone in being
the only industrialised Western nation without a national health insurance programme a safety net that ensures basic healthcare
needs are met. The US also has health indicators such as infant mortality and life expectancy that trail countries that are nowhere
near as wealthy. Why is this? That is a complex question, for a different day. It is important though, to understand that there are
many parties with vested interests in the
direction of the healthcare debate.
Medicaid and Medicare reimbursement to
reward quality primary care might serve as a
competitive incentive for private insurances
to keep pace. Finally, I would start a major
information campaign to educate the public,
in hopes that future caps on the numbers of
specialist training spots would receive public
support.
Daniel Waldman | Staff Physician,
Department of Family and Community
Medicine, School of Medicine, University
of New Mexico, USA
Email: dpwaldman@salud.unm.edu
9
IMPROVING HEALTH
WOMEN’S HEALTH
HIV/AIDS
in Sudan
N E W S L E T T E R
N U M B E R
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J U LY
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The lower status of women in society, especially in the developing world, makes them
socially vulnerable and an easier target for
the spread of HIV/AIDS. The product of
this vulnerability is the disregard of the
possible different prevention methods provided and acknowledged by the Government
and the people. It is clear that women need
various options when it comes to these
methods; the current ones are insufficient.
10
Women in Sudan have less access to education, with almost half illiterate, or have
completed only basic or primary learning.
This reality has changed over the past
years, and more women are now enrolling
in different educational institutes. Generally
speaking, women in Sudan are bound to
their homes, and they experience a lower
social status in their marriages. They are
not involved in policy making and they lack
economical dependence, relying on their
spouses financially. The concept of gender
has a direct relationship with HIV/AIDS.
Men have more power and more rights than
women. They have more access to education and employment to make money.
Socially, they can go out, have more access
to information and are more decisive on
issues regarding sexual activities. This ideology of false power holding needs to be
changed in order for both sexes to equally
prevent themselves against HIV/AIDS.
I carried out a study in Khartoum, Sudan, in
three regions, each containing numerous
women who differ in thinking, behaviour,
education and lifestyle. My main objective
was to find out how much they knew on
HIV/AIDS: what the disease is, how it is
transmitted and what are the various prevention methods. Secondly, I wanted to
know their perspectives on the current
HIV/AIDS policy and whether it is suitable
or should be changed. I also interviewed
policy makers from the Government and
NGOs, seeking their ideas on this issue.
I wanted an explanation on why there was
a rapid increase in HIV/AIDS statistics.
The Sudanese women involved in the
research are aware of the existence of HIV/
AIDS. However, their knowledge regarding
related aspects is rather low. Respectively,
41% and 37% of the women did not know
any symptom of STDs and HIV/AIDS. Main
modes of transmission were identified correctly, although still 10% think a mosquito
bite can transmit HIV. As a means of prevention, most women mentioned the use of
clean needles. The most important mode
was unprotected sexual intercourse, which
was mentioned by just 32%. Only 79
women knew about the male condom and
most of them believed it was a contraceptive method more than it was a prevention
method for HIV/AIDS and other sexually
transmitted diseases. The best ways to
inform women according to the respondents are seminars, lectures and videos.
Secondly, the influence of the Islam is
shown here; religious awareness and good
morals are the second best way!
As for policy implementation, it seems that
the Government shows a lack of funding
and the HIV/AIDS issue is not on top of the
list, since the Government already has to
deal with the conflicts in the south and in
Darfur. The other problem is programme
implementation and the unclear Government structure. There needs to be a better
co-operation among all players on the field
to yield a better outcome. The Sudanese
NGOs need to formulise their implementation structure and harmonise with the other
organisations so as to know what each is
doing.
Different changes are necessary for the
short and long term. The identification of
the needs compared with current policy
showed that the current one is not sufficient for women. The interviews with women
showed a lack of knowledge, and conversations with policy makers showed that more
structure is needed. Women need more
empowerment in defending their rights in
the different prevention methods and the
concept of stigmatisation should be
changed to help people understand that
HIV/AIDS does not affect ‘bad people’
only.
In conclusion, I would like to repeat what a
wise man said to me concerning transformations that needed to occur in Sudan: “The
lower you come, the higher the changes”.
Selma Ali El Sadig | Student, Faculty of
Medicine, Ahfad University for Women,
Sudan
Email: selma667@hotmail.com
Women need more
empowerment
in defending their
rights in the
different prevention methods
and the concept
of stigmatisation
should be
changed to help
people understand
that HIV/AIDS
does not affect
‘bad people’ only.
Nutritional Status of Children of
Women Sugar-Cane Farm Workers
Under-five malnutrition is high in the Siaya
District, Kenya: stunting (47%); underweight
(30%), and wasted (7%) (Bloss et al., 2004).
Early cessation of breastfeeding in a resourcepoor environment leads to chronic malnutrition, morbidity and mortality (Coutsoudis
and Bentley, 2004). Maternal incomegenerating activities add to household
income, but often decrease mother’s time for
child-caring, leaving care-giving to relatives
(Pierre-Louis, 2007).
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Throughout a decade, Amany Refaat
(Professor, Community Medicine, Suez
Canal University, Egypt, arefaat@
ismailia.ie-eg.com / a.refaat@scuegypt.
edu.eg) fought the medicalisation of
FGC using different interventions.
Recently Prof. Refaat has published a
report on this work: Combating the
Medicalisation of Female Genital Cutting
in Egypt: Steps on the Long Road for Its
Eradication.
N U M B E R
Rosebella Onyango / School of Public
Health and Community Development,
Maseno University, Kenya
Email: rosebella.onyango@googlemail.com
Female Genital Cutting (FGC) in
Egypt
FGC is a harmful banned cultural practice
in Egypt, which showed increased medicalisation of its practice in the last decades. Meanwhile, the prevalence of the
practice had declined from an estimated
88% of daughters in 1995 to 70% by
2005 according to consequent EDHS reports. However, medicalisation increased
from 55% to 75% for the same period.
N E W S L E T T E R
References
BLOSS, E., WAINAINA, F. & BAILEY, R.C.
(2004). Prevalence and Predictors of Underweight, Stunting, and Wasting
among Children Aged 5 and Under in Western Kenya. Journal of Tropical
Pediatrics, 50(5):260-270; Oxford University Press.
COUTSOUDIS, A. & BENTLEY, J. (2004).
Infant Feeding: In. (Eds. Michael JG, Margetts, BM Kearney, JM. and Arab, L.).
Public Health Nutrition, Chapter 16: 264282. Blackwell Publishing Company
Oxford UK.
PIERRE-LOUIS, J.N. (2007). Maternal
Income-Generating Activities, Child Care,
and Child Nutrition in Mali. Food and
Nutrition Bulletin, 28(1):67-75.
The theme for this year’s celebration was
Partnering with the media to reach Zero
Tolerance to FGM. IAC partners with the
media because the media reach a wider
segment of the population with powerful
and lasting messages. Therefore their involvement in the campaign would likely
accelerate reaching the goal of eliminating FGM.
2 0 0 8
Results
The women worked daily for 10 hours without leave, resulting in early cessation of
breastfeeding. They earned 80 shillings per
day; inadequate to purchase nutritious
replacement feeds. Children <6 months were
fed on diluted porridge, while those aged 624 months ate mashed adult foods. Most
children (70%) were fed twice a day, while
30% were fed thrice a day. Nutritional status
of the children was poor with 44% underweight, 36% stunted, and 20% wasted.
Many children (56%) had diarrhoea.
Prolonged maternal absence resulted in early
cessation of breastfeeding and introduction
of inadequate replacement feeds. The children had poorer nutritional status than Siaya
District levels.
By ‘Zero Tolerance to FGM’, IAC means
that FGM should not be tolerated for any
reason, at any time, place or on anybody.
FGM has been recognised as violence
against women and girls and coupled
with other medical, social, psycho-sexual
and economic consequences; the practice
should not be allowed to continue under
the guise of tradition or religion.
J U LY
Cross-Sectional Study
Women sugar-cane farm workers in Kenya
work for long hours that deprive them of
quality time for child-caring. Women-specific
issues such as maternity leave, proper daycare centres, equal pay-for-work, and regular
medical checks are not addressed by their
employers. Occupational health and safety
are major issues compromising their health
during pregnancy. To determine the duration
of breastfeeding among sugar-cane farm
workers, and to assess the nutritional status
of their children, a cross-sectional study was
implemented to determine the feeding patterns of 128 children, aged 3 to 24 months,
whose mothers work in sugar-cane farms.
Mothers were interviewed on breastfeeding
duration and infant-feeding practices.
Children’s weights and lengths were measured on Salter’s weighing scales and studio
meters respectively. Anthropometric parameters of weight-for-age, length-for-age and
weight-for-length were used to assess nutritional status.
A 29-year sugar-cane farm worker
carrying her nine month-old baby girl.
Standing are boys aged 14 and 24
months. All these children have proteinenergy malnutrition
Female Genital Mutilation
International Day on Zero Tolerance
to Female Genital Mutilation (FGM)
The Inter-African Committee on Traditional Practices (IAC) with its National
Committees in 28 African countries and
the Group Sections, in 16 countries outside of Africa, observes February 6, 2008
as the 5th anniversary of the International Day on Zero Tolerance to FGM.
11
IMPROVING HEALTH
HEALTH PROFESSIONS
The Present and Future
of the Family Doctor
N E W S L E T T E R
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To a large extent, Huxley’s Brave New
World has become reality. With economic,
technical and IT developments, and with
increases in numbers, the individuals of
the human species have become kind of
registered product. These so-called ‘human
resources’ are administrated by more or
less anonymous authorities and institutions, which are often not compatible with
traditional patterns of healthcare.
The traditional family doctor can be trusted to give advice, protect and support the
individual patients in their struggle for life
and health.
Europe’s social history founded political
systems based on social welfare and
Health for All. These ideas have been
spread by organisations acting globally,
like UN, WHO or Wonca.
Administrating these ‘human resources’
- ready to use and productive with high
efficiency - requires structures like the
medical services, that guarantee availability at minimal cost for application and
capacities of maintenance.
The role of the family doctor has changed
accordingly to a functioning instrument in
a complex social construction. To detect
the conflicts of interest that arise, one
needs to analyse these phenomena from
various view points.
Example One: Survival of the Species
The doctor is no longer the highly educated specialist in matters of health, called
by the suffering individual patients in their
socio-economic micro cosmos, the family.
The doctor is obliged to come, contracted
by nothing more than the professional
maintenance role within the new socioeconomic system of public healthcare.
Also, the role of the family has changed:
the responsibility for health and welfare
of its members has been delegated to ‘the
12
public’; mankind forgot about prospective
behaviour as one parameter out of several
precautionary principles of survival strategy. However, in our ‘developed world’,
dissolving patterns of family corporate
identity (FCI) and family financed support
for family members in need are still to be
found in immigrant families with Hispanic,
Arabian or Asian background.
Example Two: Economy
Welfare and Health for All submitted to
public responsibility causes expenses for
the society. Private equity is needed, the
use of which will be controlled by the
donors. Consequently, the following questions will arise:
• Will a reduced cost of maintenance of
the human resources also reduce follow
up costs?
• Do we need those people over age X, who
have outgrown the productive period of
their lifespan statistically calculated?
• Do we still need all these people consuming health and social services?
• To which extend can we influence the
servicing staff, their technical resources
and their education to reduce cost?
Example Three: Advocate for Deprived
Individuals
Individuals are left to themselves fighting
loss of mental or physical capacities, their
diseases, their pain. What they wish for
and need was an independent solicitor
(a family doctor), making a stand for their
individual needs and achieve the necessary support.
Confronted with today’s reality, we thus
have to ask:
• Under these circumstances, can family
doctors do their job properly and meet
the challenges of either side?
• Are education and training focussing on
the knowledge, skills and attitude necessary to meet the upcoming challenges
in doctor’s professional lives?
The various national health systems have
different approaches towards an eco-political solution, but they fail to solve conflicts
of interest. We, general practitioners or
family doctors, have to find ways to minimise the burden of individual suffering of
patients and disabled people. We have to
make the best under the economic pressure
and with restricted resources left for the
social and health sector by economic and
politics.
The seed you
invest today
will be the base
of a sustainable
social and
healthcare
system in the
future.
Austrian Family Doctors
Let me give you an example of a working
generalist group practice in the middle of
a European city. Following the tradition of
Austrian GP/FM doctors since World War II,
these family doctors have been educated
as ‘solicitors’ for their patients, as ‘freelancers in causa health’ for individuals.
They never lost linkage to basic medical
science, and followed up on research and
newly designed technical developments.
Another basic strategy has been to work
together in a group, and to implement
as many skills as possible into the medical services offered at primary care level.
This has led to long time results as: a low
rate of hospitalising of patients; a low
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The multidisciplinary trained family doctor
will be the effective service provider to
cope with the future challenges of health
systems. High standards of primary care
with highly educated and well trained
generalist physicians (‘family doctors’) will
create a flexible and stress resistant structure. This may be the only effective and
efficient instrument to preserve the traditional European socio-cultural advantages
- the European Way - to respect individuality, personal freedom and privacy.
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Equation
The following equation will illustrate this
concept in a simple way: sustainability is a
product and a main parameter to measure
efficiency and stability of processes in an
In other words: sustainability means strategic thinking and planning in a time frame
for generations: generations of experts
produced by the education and training
system and generations of implementation of services run by those experts. The
seed you invest today will be the base of a
sustainable social and healthcare system
in the future.
N U M B E R
Well educated and trained staff will be
in a much better and independent position, defending erosion of the right on
individualism of their patients and to withstand the pressure coming from politics,
economy or patients claims. These fam-
rate of unnecessary co-treatment, double
diagnostics and multiple level treatment;
a low decrease of capita per month treated, despite increasing numbers of service
providers in the area concerned.
N E W S L E T T E R
These family
doctors will
be able to
decide and act
independently
to stand up
for the needs
of their
patients;
they can be
a partner to
the top small
scaled
specialists.
Science x Practice = Sustainability
Graz, Austria
2 0 0 8
environment of complex systems not well
known or well described. Biological interactive systems are as complex as socioeconomical and cultural systems are. The
parameter sustainability gains importance
with the system’s increasing complexity
and reflects the ability to resist stressors
and/or the ability to use the resources
available within the system’s life cycle. If
one factor decreases, in consequence the
system’s benefit for all is also reduced.
J U LY
Active Conclusions
It is wise not to forget the roots and the
history - if there is no history there will
not be any future. The contemplative view
of the facts can lead to reflected active
conclusions and open an outlook into the
family doctors’ future:
• A medical education programme, well
based on profound scientific knowledge
(including various disciplines as physics,
chemistry, anatomy, histology, pathology), will overrule so-called holistic education programmes.
• Intensive practical training has to be
added to the theoretical education this could be a paid job with increasing
taking of responsibility (practical knowledge is supervised learning by doing).
• Specialising in top small scaled fields
shows a high dependency on technical equipment (financial investment)
and homogenously performed skills.
Therefore, the time spent on specialisations could be decreased dramatically,
but the basic practical education should
be prolonged and obligatory for all
trainees. It should be the basic outfit
before further small scaled specialisation and acting bedside in own responsibility is possible.
ily doctors will be able to decide and act
independently to stand up for the needs of
their patients; they can be a partner to the
top small scaled specialists; and specialists will be able to understand their and
their patients needs because they have
the same roots of basic education.
Communication will become easier, losses
in transfer of information will be reduced,
and misunderstanding caused by emotional level feelings will be minimised.
Ilse Hellemann | General Practitioner,
Medical University of Graz, Steirische
Akademie für Allgemeinmedizin, Austria
Email: ilse.hellemann-geschwinder@
meduni-graz.at
13
IMPROVING HEALTH
INDIGENOUS HEALTH
N E W S L E T T E R
N U M B E R
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American Indians and Alaska Natives
in Health Careers
In many parts of the world indigenous people do
not receive high quality healthcare. This is certainly
the situation in the US, where American Indians
and Alaska Natives and other minorities receive
less and lower quality healthcare than the rest of
the population. Consequently, American Indians
and Alaska Natives have the lowest life expectancies in the US or any nation in the Western Hemisphere, except Haiti. Compared to other Americans,
the death rates for American Indian are 400-700
percent higher for diabetes, tuberculosis and other
chronic diseases.
One of the reasons that American Indians and Alaska Natives have poor healthcare outcomes is because they are underrepresented in the healthcare
work force. Minority physicians, dentists and nurses
are more likely to serve minority and medically underserved populations, yet there continues to be a
severe shortage of minority health professions.
The American Indians and Alaska Natives in Health
Careers website http://aianhealthcareers.org/ is
designed to encourage indigenous people to consider a career in the health professions and to provide them with information that can help them explore careers in 11 different healthcare fields. For
each of the 11 health careers, the following information is provided on the website:
• An overview of the profession and healthcare
needs that are addressed by the profession.
• Steps that students need to take in order to enter
the profession as well as descriptions of schools
and programmes that provide special support for
indigenous students.
• Profiles of indigenous students and health professionals, including advice from these people
regarding entering their profession.
• Links to resources, such as national health professions organisations, indigenous organisations
in healthcare and the health professions, sources
of scholarships, and student organisations.
Jane Westberg | Clinical Professor, Family
Medicine, University of Colorado, USA
Email: jwestberg@mac.com
14
OCCUPATIONAL HEALTH
Noise Pollution
in Pakistan
Noise pollution or sound pollution actually means a sound which irritates or
annoys the individual. In other words, it
exceeds the standard normal decibel of
hearing threshold which leads to stressful sound, thereby damaging the ears
and subsequently causing stress factors
which lead to elevated blood pressure and
irritability. In terms of audiology, sound is
measured by a unit called the decibel. The
normal speech varies between 60-65 decibels. An increase of three decibel doubles
the sound. Heavy traffic sound reaches 90
decibels. A sound wave measuring more
than 100 to 120 decibels is equal to a
bomb blast sound.
Karachi
Karachi is a cosmopolitan city in Pakistan;
no less than two million cars, buses, scooters, motorcycles and rickshaws have led to
environmental pollution, noise pollution
and street congestion during working
hours. There are about 300,000 rickshaws
in the city without silencers, which cause
tremendous noise pollution, both from
noise and also carbon and sulphur fumes
emitted from the silencer. Loud taperecorders in the coaches will add to noise
pollution and cause damage to hearing. Noise pollution is also contributed
by the sound of factories, trucks, heavy
machines, aircraft sound (the airport is
within the premises of the city), fire crackers, loud music, headphones; they can all
damage the cochlea.
Impact
Noise pollution causes significant health
problems, leading to the damage of the
hair cells of the cochlea, which can result
in irritability, stress and tension. It can
even lead to heart problems and high
blood pressure. People get tired and have
difficulty concentrating. The working
potential of the individual is decreased.
Hearing loss occurs in places where sound
is unavoidable. It includes construction
workers, farmers, police personnel, fire
fighters and musicians. The International
Labour Organisation (ILO) does not permit
workers working an eight hour shift for
more than six months above 100 decibel
noise exposure. ILO advices a change of
job or place to avoid noise pollution.
The Federal Aviation Administration (FAA)
monitors control of noise from airplanes.
They advise airports to be built eight
kilometres away from the populated area.
The World Health Organization does not
permit constant exposure of 120 decibel
for workers.
Control and Recommendations
• Noise pollution is not a necessary price
to pay for living in an industrialised society. We must reduce industrial noise. We
must avoid constant exposure of workers
to a noisy environment.
• Training programmes to create awareness
through media, seminars and charts.
• Government and private sector to cooperate to conduct awareness programmes.
• Vehicles inspection and fitness teams
comprising of private and public sector
to allow the vehicle on the road after
complete fitness.
• Awareness of school children and college students regarding hazards of loud
music and use of headphones.
• Singers and music entertainers should
be informed about hearing problems
caused by loud music.
Kaleemullah Thahim | Assistant
Professor, Consultant Ear Nose Throat
Surgeon, Karachi, Pakistan
Email: kaleems92@hotmail.com
INTEGRATING MEDICINE AND PUBLIC HEALTH
Policy and Advocacy Integration We must also
into Training
train residents
As we write this article, the resounding an active investigation of current policies. to see what
words of one of my Network: TUFH (African) The policies may be structured within the
colleagues is triggered. He asked, “What framework of an organisation, agency, clin- aspects of the
do you mean when you say ‘Integration ic, hospital, and/or within the local, state,
patients’ lives
of Public Health and Medicine’?”. As we or federal Government.
proceeded to explain to him the current
might hinder
movement to integrate the concepts and Competencies
principles of public health in undergradu- The American College of Graduate Medical
their ability to
ate and graduate medical curriculum, he Education has restructured the paradigm
politely stopped us by asking the simple of residency education to focus on compe- comply with
question “Don’t all doctors do that?”. His tencies and outcomes (www.acgme.org/
question informed us that medicine has outcome/comp/GeneralCompetenciesStan the physicians’
once again come full circle, within a system dards21307.pdf, retrieved June 10, 2008).
of care, to affect population outcomes and The Systems Based Practice competency treatment plan.
N U M B E R
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Advocacy for Expanded Social Services
Delayed discharges and subsequent overcrowding of the emergency department
Conclusion
The far-reaching impact of resident involvement in advocacy and policy extends beyond
the individual patient or the focused clinical
experience. The population of people whose
healthcare options are negatively impacted
by a particular policy may now be positively
affected at new levels by physicians. At
the academic level, residents who engage
in policy development and advocacy, role
model their behaviour for medical students
to emulate. Physicians are empowered to
liberate themselves from the confines of the
office and impact policy that may contribute
to the well being of not only their patients,
but large populations at one time.
N E W S L E T T E R
Projects
Expanded Pharmacy Hours
Patients were frequently admitted to the hospital because their access to medications was
limited by restricted hours of the University
Pharmacy. After meeting with the pharmacy
staff and investigating other indigent pharmacy systems, the residents presented a
report to the administration that resulted in
the expansion of pharmacy hours.
has a broad impact on hospital function.
By gathering data and learning about the
pertinent management issues, residents
were able to develop a collaborative effort
with the Social Services Department, which
resulted in the recommendation to allocate
funding to new social worker positions
which would help alleviate this situation.
2 0 0 8
Advocacy Efforts
FM residents in the University of New
Mexico’s (UNM) Department of Family and
Community Medicine (DFCM) are engaged
in an effort to affect healthcare outcomes,
not only at the individual level, but at the
community level. The FM residents recently
began their advocacy efforts under the tutelage of Sally Bachofer and Arthur Kaufman.
Daily, FM residents interact with patients
afflicted with ailments and diseases that
are associated with or triggered by ecological factors or determinants of health. While
generally, we expect that the residents will
be skilled in treating or positively affecting the bio-medical aspects of the patient,
we recognise that the residents’ education
is equally fuelled by training to create
change through advocacy and/or policy
development. It is not enough to say that
the patient is non-compliant or is not following the treatment protocol. We must
also train residents to see what aspects of
the patients’ lives might hinder their ability
to comply with the physicians’ treatment
plan. One approach to engaging the FM
residents in community change is through
includes two elements that apply to advocacy and policy development: “participate in
identifying system errors and implementing
potential system solutions”, and “advocate
for quality patient care and optimal patient
care systems”. The UNM residents have
been involved in several initiatives to gain
skills and knowledge aimed at fulfilling
these competencies. Residents may elect
to incorporate the Department of Family
and Community Medicine’s Public Health
Certificate programme into their curriculum.
Residents are involved directly in policy
and advocacy activities during their clinical experiences, both in the hospital and
through their continuity clinics. A couple of
policy and advocacy projects in which the
residents were engaged are outlined below.
J U LY
not just individual patients. The simple act
of engaging Family Medicine (FM) residents
in policy and advocacy is a testament of
how we are now revisiting what once was a
norm for healers throughout the world.
Sally Bachofer, Lily Velarde, Vanessa
Jacobsohn, Amy Clithero, Arthur Kaufman
| Department of Family and Community
Medicine, School of Medicine, University
of New Mexico, USA
Email: livelarde@salud.unm.edu
15
COMMUNITY ACTION
COMMUNITY INTERVIEW
Community
at the Heart
What was your experience with community members, and with which community
members was that?
I went for my COBES training to a small village in the south western part of Uganda,
called Rugazi. I mostly interacted with
mothers, because I was more into children. They were very welcoming, because
they acknowledged that they have community problems that they have to solve.
The people who were there before did not
give them feedback, so they asked us if
we were different. Another problem were
the local leaders; they were aware of, but
not interested in our meetings. The locals
wanted to listen, but the chief felt he
heard enough of it. It is difficult to keep
the community together when their leader
disagrees.
N E W S L E T T E R
N U M B E R
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J U LY
2 0 0 8
This interview was conducted with Lydia
Nanjula, a medical student at the Mbarara
University of Science and Technology in
Uganda.
16
Were there also students of other disciplines working there, and were there ways
to collaborate with them?
Yes, there were. It was a pilot study by our
university to do a multidisciplinary elective
placement. I was the only medical student
in the group. There were two development
studies students, a teacher, and me. We
were able to collaborate and work on the
factors influencing children’s health in
that area, giving a broader understanding
of the issues in the eyes of a development
worker, a teacher, a medical student, to
finally come up with a report.
We first chose a topic, then shared roles
among the four of us. So if today we were
to give a public health talk, and I am in
charge, I would be the one to get the community together, prepare the topic and
research.
Sometimes students do research in a community. Do you know of an example in
which the outcomes of that research had
positive results for your community?
Yes, I do. There was a research initiative in
that same area. The needs of that particular community were assessed. There was
an effort to establish the community component in primary healthcare, and then
let the people of the community know
that they can better their own health. The
community was told to choose their volunteers. These trained workers went back
and they taught them to make a tap/jerry
can, for hand washing after using the
latrine. They also taught them how to conserve firewood.
If you were in a leadership position, would
there be anything that you would change
concerning the position of students in the
community?
I would try to facilitate the students more,
to give them food, upkeep money, and
transportation (some areas are so far, that
you have to exclude them). And to give
them a briefing and a workshop before the
community placement, so that they know
what they are actually up for.
Imagine that you had to choose between
community-based and hospital-based.
What choice would you make and why?
I think I would choose community-based.
Because if you tackle health at the community level, you prevent people from
getting to the hospital level. If I worked
at hospital level, and nothing was done
at community level, I would always have
a high patient load. But if I went to the
villages and told people to just wash their
hands; this is something very basic, but it
solves a lot when you just prevent diseases
through health education.
New brochure Education for Health
Education for Health (EfH) seeks/publishes
manuscripts that:
• address community-based education of
health professionals,
• address community-based healthcare
delivery,
• describe and evaluate collaborations
between academia and health service organisations designed to promote community
health,
• address multi- and interdisciplinary
approaches to health professions education
and service delivery,
• address models and systems of education,
research, and service delivery that link developing and developed countries.
EfH informs clinical and
public health practitioners, educators and
policy makers about
global approaches to
integrating health professions education and
health systems. The
journal hosts an online
forum to debate best
ways to ensure equity,
quality, relevance and
cost effectiveness of healthcare in the developing and developed world, and optimal ways for
training health professionals.
EfH publishes original full-length research
manuscripts as well as communications on programmes and policy perspectives related to:
• community-based education of health
professionals,
• integration of medicine and public health in
practice and medical education,
• global health workforce,
• multidisciplinary health professions
education,
• partnerships between health system stakeholders for disease prevention and control.
Submission information:
www.educationforhealth.net
INTERNATIONAL HEALTH PROFESSIONS EDUCATION
MEDICAL EDUCATION
Teaching for Learning,
Learning for Health
GOFAR is a comprehensive faculty development resource for all teachers and
learners in the health professions. The
letters in GOFAR refer to Goals and the
broad purposes of medical education;
Objectives and the specific desired outcomes that learners should achieve;
Framework refers to the structuring of
learning experiences to support students
in successfully achieving learning goals;
Assessment asks to what extent were
learning experience and teacher effective; Review poses the question, what
should be done differently next time?
N U M B E R
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Stewart Mennin | Professor Emeritus,
Department of Cell Biology and
Physiology, School of Medicine,
University of New Mexico, USA;
Mennin Consultoria em Saude Ltda,
Brazil
Email: smennin@gmail.com
Reference
ALLAN, J., BARWICK, T.A., CASHMAN, S., et
al. (2004). Clinical Prevention and Population Health, Curriculum Framework for Health
Professions. American Journal of Preventive
Medicine, 2004;27(5):471–76.
N E W S L E T T E R
You can find GOFAR at www.the-networktufh.org > Publications/Resources >
Further reading > Teaching for Learning:
Learning for Health - Quick Reference
Guides for Planning, Implementing, and
Assessing Learning Experiences
Please, if you are interested in education of
health sciences, in teaching methods and in
the integration of education and practice, consider participating actively in this exciting collaborative effort by either submitting materials
to PERC, or by downloading approved materials
from the PERC site that have been reviewed and
posted to the site.
2 0 0 8
GOFAR was written and compiled by
Stewart Mennin, former Assistant Dean
for Educational Development and
Research and Professor Emeritus,
Department of Cell Biology and
Physiology, and by Deana Richter,
Director of the Office of Teacher and
Educational Development at the
University of New Mexico School of
Medicine. The website for the Office of
Teacher and Educational Development
(http://hsc.unm.edu/som/TED) has a
wealth of faculty development materials,
GOFAR is also available in Farsi, generously translated by Marzieh Moattari
from Shiraz University of Medical
Sciences Faculty of Nursing and
Midwifery, Shiraz-Islamic Republic of
Iran. If you are interested in translating
GOFAR into your language, please contact either me (smennin@gmail.com) or
Deana Richter (tdevelopment@salud.
unm.edu). It is free and meant to be
shared. Let us know what you find most
useful and what would make it better.
GOFAR it!
J U LY
GOFAR represents a synthesis of 25
years of work in health professions education by the Office of Teacher and
Educational Development at the
University of New Mexico, School of
Medicine. It contains practical resources
about how people learn, the development and effective use of performance
objectives, community-based/ambulatory teaching/precepting, hospitalbased teaching, problem-based learning,
lecturing and making presentations,
giving feedback, assessing learners and
using questions effectively. It contains
guides and strategies for assessment
and feedback. GOFAR has resources for
teachers working in large classrooms,
small groups, and one-to-one.
resources, presentations, et cetera. There
is a section on the Medical Education
Scholars Programme designed to help
secure the succession of leadership and
innovation in health professions education at the University of New Mexico and
a section on residents as teachers.
Prevention Education
Resource Centre
The Prevention Education Resource Centre (PERC,
www.teachprevention.org) is a web-based repository of educational materials related to clinical
prevention and population health. PERC is supported by the Association for Prevention Teaching
and Research (APTR). The site promotes collaboration across healthcare disciplines, professions,
and institutions by facilitating the exchange of
teaching resources and connecting educators.
PERC is envisioned to fulfill the identification of
accessible relevant syllabi, teaching materials,
examination materials, and curriculum evaluation
approaches that may be used to teach each of the
19 domains identified in the Clinical Prevention
and Population Health Curriculum Framework
(Allan et al., 2004) as well as curriculum frameworks developed for introductory undergraduate
(college level) public health courses like Global
Health, Public Health and Epidemiology. Expected outcomes for PERC include the provision of a
searchable web site allowing the user world-wide
to identify materials that are relevant to particular
domains of the Curriculum Framework, applicable
to particular clinical health professions, and allow for utilisation of particular types of teaching
methods. The Network: TUFH promotes the Clinical Prevention and Population Health Curriculum
Framework as a conceptual and comprehensive
source for a systematic analysis of its adaptation
to different realities world-wide in underdeveloped and developed countries.
Jaime Gofin | Associate Editor PERC; Director
Community-Oriented Primary Care, School Public
Health & Health Services, George Washington
University, USA
Email: sphjxg@gwumc.edu
17
International health professions education
INTERPROFESSIONAL EDUCATION
N E W S L E T T E R
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Collaborating
Across Borders
In October 2007, the University of Minnesota
convened Collaborating Across Borders:
An American-Canadian Dialogue on Interprofessional Health Education, the first
American-Canadian conference of its kind.
The conference drew 300 people from the
US, Canada, UK, and New Zealand for a
three-day meeting focused on bridging knowledge, awareness and best practices in interprofessional education (IPE). The University
of Minnesota partnered with the Canadian
Interprofessional Health Collaborative (CIHC)
to design the conference. Conference goals
included: showcasing American and Canadian
work in IPE; documenting what is and is not
working in IPE; making recommendations for
policies that facilitate interprofessional collaboration; setting an agenda to promote
future continued collaboration.
From among the more than 120 abstracts that
were submitted for consideration, conference
planners designed seven tracks that paired
American and Canadian presenters in order
to provide parallel stories of IPE development
and outcomes in the two countries. Highlights
include:
Track 1: Cutting Edge Innovations in
Curriculum and Instruction
IPE shares the broad goals of building teams
of healthcare professionals: increased knowledge of professional roles, communication
skills, and learning how to work in teams.
A common concern was addressing ‘education
to practice’; the fact that some students do
not find interprofessional teams once they are
in practice.
Track 2: 21st Century Technology-Enhanced
IPE
Showcased were a range of innovative learning opportunities, including a web-based
learning module that employs educational
games, Team Objective Structured Clinical
Examinations (TOSCEs), an online case study
resembling real-life experiences, and traditional face-to-face courses that integrate an
18
e-learning component. Many presenters noted
that flexibility - both in curriculum development and course planning - is key to developing new, interprofessional programmes.
Track 3: Through the Eyes of Students
Students have been successful in designing IPE
models that have been adopted into the curricula, as well as service-learning experiences
outside the curriculum. Examples include: student run clinics, interprofessional policy and
case analysis, and pre-health interprofessional
courses. Students recommended peer education; progressive curriculum development; support for informal learning; opportunities for
research; identifying student leaders; creating
IPE clinical experiences; and creating an IPE
office that provides support and creates the
link to legitimacy, authority, and power.
Track 4: Faculty|Teaching Skills Development
Presenters discussed faculty development literature, which shows that clinical faculty serve
as role models for trainees and play a key role
in the IPE learning environment. The literature also confirms that collaborative practice
requires skilled, knowledgeable, interprofessional teachers. However, presenters noted
there is little research about the effectiveness of IPE, or about a best practice model for
educating clinical faculty about IPE.
Track 5: Transformation|Change|Leadership
Presenters discussed the merging of
technology and learning platforms, such as
‘hybrid’ or blended learning, which blends
online and face-to-face instruction. Presenters
noted a trend toward devices that are smaller,
faster, cheaper and more mobile. They discussed the use of portals to manage, customise, personalise, and make information
transportable.
Track 6: Addressing Barriers through Policy
Development
Several presenters identified the need for
further research on IPE’s impact and data that
could be used to communicate that impact to
policymakers. Research questions may focus
on the association between teamwork and
quality of care, essential knowledge, skills,
and attitudes for teamwork and collaboration, promotion of IPE through accreditation
standards, and the best time in the curriculum
to introduce IPE.
Track 7: New Models of Care|Communities of
Practice
Emerging research in new models of care is
demonstrating improved patient outcomes,
shorter patient stays and improved communication and learning among health professionals and students. The core themes supporting
the development and successful implementation of new models of care include:
•o
rienting new partners and giving them
a voice;
• designing an atmosphere of respect and
informality;
• supporting team development by articulating roles, expectations and power;
• providing flexibility for students through
their learning experiences.
Moving Forward
The University of Minnesota has continued its
collaboration with Canadian University partners to foster interprofessional health education across its borders. Current efforts include
the Journal for Research in Interprofessional
Education, expected to launch late 2008.
Collaborating Across Borders II will be held in
Halifax, Nova Scotia, May 20-22, 2009.
For more information about the 2007
Collaborating Across Borders conference,
please visit www.ipe.umn.edu and click the
‘Collaborating Across Borders’ logo.
Barbara Brandt | Assistant Vice President
for Education, University of Minnesota
Academic Health Center, USA
Email: brandt@umn.edu
Interprofessional Education:
A Personal Perspective
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For all professions to learn together for the
benefit of the clients and communities they
serve, changes have to be made at curricula
and professional attitude level. Finally, the
willingness to analyse and participate in
this process no matter what profession one
comes from is the key to the success of IPE.
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More recently, the definitions of interprofessional practice and collaborative practice
have been addressed by the WHO Working
Groups, of which I am a member. However,
Those who have attempted interprofessional education will agree that challenges
include finding a common depth of knowledge, synchronising curricula and timetabling difficulties as well as developing
common method of assessment of learning
outcomes.
N U M B E R
For IPE to succeed, there should be an
understanding of why professionals should
learn together. Sharing an anatomy class
may be cost effective, but may not produce
interprofessional collaboration. The students from different professions have to
critically review why they should sit in one
class, learn the same material or attend to
the same client. In trying to answer these
questions, students may discover the
amount of overlapping knowledge, both
theoretical and practical, coupled with the
strength of each professional expertise
which they will require to practice collaboratively. In most cases, this overlap of knowledge has kept professionals apart, emanating into professional and protective professional acts, which in some cases do not
allow for interprofesional practice. The professional boards often set learning outcomes and competences in line with their
international partners without reference to
the growing interprofessional practice needed for comprehensive healthcare in underdeveloped countries.
My personal experience is that for IPE to
succeed the following should be taken into
consideration: development of core courses
combining theoretical and practical knowledge; designation of sites for collaborative
practice with generic educators or supervisors; the involvement of lay persons, e.g.
communities in developing the curricula
and student supervision; a generic assessment system for students; analytical teaching methods allowing for sharing of ideas
among the different profession.
N E W S L E T T E R
Attempts to train generic workers have had
little success, and more recently, IPE has
been seen as an acceptable alternative
since it does not challenge professional
identity. IPE requires several approaches,
such as more than one profession learning
together using the same learning materials,
tutors and time tables with the aim of
achieving the same goals. The assumption
is that there is generic knowledge and skills
which each profession should have, without
losing professional identity. Further, a
common site for interprofessional clinical
practice or a service learning module has to
be developed since objectives are seen to
overlap more in practice than in theory.
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In Africa and other underdeveloped countries, lack of qualified personnel, limited
professional programmes, sparse health
facilities, increase of pandemics such as
HIV/AIDS and the continuing challenges of
poverty as well as political struggles, have
forced professionals to work together and to
be multi-skilled. Healthcare professions in
developing countries have no luxury of specialisation. In most cases, the only available
healthcare practitioner may be a nurse who
is expected to know about all health needs
of clients. The challenge therefore is to
equip one health practitioner with all skills
required for care of not only one individual,
but also of eradicating preventable diseases
in partnership with other professionals and
lay persons.
Professor Ratie Mpofu
only minority educators have dared to
engage in IPE while the rest still wallow in
their singular, isolated professional practice. The majority ridicule those who try to
look for answers of complex healthcare from
a broader interprofessional perspective.
Consequently, the general consensus among
those who have accepted IPE as a future
reality is that it is still far from solving the
real challenges of complex healthcare issues
such as mental health, HIV/AIDS pandemic
and health promotion in general.
J U LY
Interprofessional education (IPE) has been
described in as many ways as there are
attempts to implement it. The most recognised definitions, particularly for European
and Western countries, have been summarised in a report by Della Freeth et al. on
A critical review of the evaluation of
Interprofessional Education commissioned
by learning and teaching Support Network
Health Sciences and Practice from the
Interprofessional Education Joint Evaluation
published in May, 2002. It emphasises
shared problem solving and collaborative
decision making particularly in complex
health problems.
Ratie Mpofu | Dean, Faculty of Community
and Health Sciences, The University of the
Western Cape, South Africa
Email: rmpofu@uwc.ac.za
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International health professions education
YELLOW PAPERS
Between those outstanding publications that were already published in leading journals, and some preliminary notes scribbled
on the last page of an agenda, there are also papers or reports that belong to the in-between (‘grey area’) category. Papers that,
for whatever reason, have not been published before. Within this ocean of ‘grey’ papers, there are some which by content are most
relevant to the Network: TUFH’s mission and aims. We will pick those pieces of gold from the ‘grey’ ocean, change their status to
‘yellow’ (because we can’t print in gold) and publish these in this section. Here you will find two of such yellow papers.
N E W S L E T T E R
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Grassroots
Partnership in Vietnam
This article describes a model of a community collaboration in which young teaching
staff at the Faculty of Public Health, Hanoi
Medical University (HMU) learned how to
work with grassroots health workers. The
objectives of the programme were to build
both capacity of teaching staff for working
with communities, and capacity of local
health workers and volunteers to identify
and address local health problems related
to social changes.
Courses
HMU worked with three communes in a
densely-populated, urbanising area near
Hanoi, to build a model that supported
health staff and volunteers at grassroots
level in solving local health problems.
A pool of trainers taught and supervised
six staff of the commune health centres
and 27 village health workers (VHW). The
VHW were the final target for capacity
building as well as the link with community members during community diagnosis. The commune staff and VHW learned
to identify problems and to collect data
(existing and new), to describe and prioritise the problems, and then to look
for solutions. They learned by doing in a
series of courses alternating with practice
periods, in two phases.
During the first course, the VHW collected evidence to identify health problems
in their communes, then prioritised and
selected topics for action research. During
the second course, the trainees developed
research plans and quantitative and qualitative data collection tools. They analysed
the collected during the third course, when
they also wrote reports, including proposed
20
interventions. Stakeholder meetings gave
opportunities for community members to
contribute their ideas to the plans.
In the second phase the same groups
planned one intervention each, using an
evidence-based approach and the first
phase results. During the six-month implementation period, the HMU teachers and
district staff provided supervision, not only
to support the VHW and commune health
staff but also for their own learning.
Discussion
Village health workers in Vietnam are not
staff in the health system, but volunteers,
although many are retired health staff
and all have had training in programmes
lasting from three months to two years.
With health staff at the commune health
station, VHW constitute a network for
primary healthcare activities, both preventive and curative. VHW are in a position to
know about health and health problems
in their areas, so they should be involved
actively in evidence-based planning and
management (Moazzem et al., 2004). The
history of top-down planning left both
commune health staff and VHW passive
in problem-solving, even in their own villages. Recent rapid development results
in new health problems, so it is important
to involve local health staff and VHW to
identify local problems and find appropriate and feasible solutions to them. The
programme followed the systemic capacity-building model developed by Potter and
Brough (2004), based on their experience
in the Indian health sector, with support to
the four elements of the capacity pyramid:
structures, staff, skills and tools.
The other side of the problem was in the
medical schools; their teaching staff had
little experience of health problems at
village level and of how the rapid social
changes affect them. The teachers bring
students to the community and need to
know how to work in a participatory
way with the local people responsible for
health. To involve the local health staff
and volunteers, an appropriate approach
and way of working is essential. Key lessons that teachers learned from this pilot
programme included the importance of:
using participatory methods to create an
enabling environment for learning and
sharing; understanding differences and
similarities between professional and lay
definitions and perceptions and exchange
of lay and expert knowledge and perception; joint supervision and evaluation
between health service, university and
community as key tools for empowerment
and capacity building on both sides.
References
MOAZZEM HOSSAIN, S.M., BHUIYA,
A., KHAN, A.R. & UHAA, I. (2004).
Community Development and its Impact
on Health: South Asian Experience.
British Medical Journal, 328, 830-833.
POTTER, C. & BROUGH, R. (2004).
Systemic Capacity-Building: A Hierarchy
of Needs. Health Policy and Planning,
19, 336-345.
Dr. Luu Ngoc Hoat | Head, Biostatistics
Department, Faculty of Public Health,
Hanoi Medical University, Vietnam
Email: luungochoat@hn.vnn.vn
Embedding Indigenous
Perspective in Health Curriculum
With the health of Australia’s Indigenous
peoples amongst the worst in developed
nations, and the health disadvantage of
Indigenous Australians so devastatingly
apparent, the importance of appropriate
training for health professionals has never
been more salient.
N E W S L E T T E R
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Key elements of the strategy included the
explicit identification of expected learning
outcomes, the streamlining of content/
learning activities within selected units, the
Key elements of the programme included:
• the explicit identification of expected
learning outcomes and competencies;
• the incorporation of Indigenous content
and learning activities within a large number of selected units;
• the integration of Aboriginal and Torres
Strait Islander perspectives within assessment in theory and practicum units;
• the development of a purpose-built website and media-based learning resources
for use across the faculty and in specific
units; and
• tutorial and self assessment activities for
students to reflect on their learning.
References
CAMPINHA-BACOTE, J. (1998). The Process
of Cultural Competence in the Delivery of
Healthcare Services (3rd ed.). Cincinnati,
OH: Transcultural C.A.R.E. Associates.
CROSS, T., BAZRON, B., DENNIS, K., &
ISAACS, M. (1989). Towards a Culturally
Competent System of Care. Washington, DC:
Georgetown University Child Development Centre, CASSP Technical
Assistance Centre.
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The Yapunyah Project involved extensive
consultation and collaboration with
Indigenous staff and health experts in the
local Aboriginal and Torres Strait Islander
community, and it carefully constructed a
core curriculum and associated graduate
capabilities. The overall project involved
incorporation of Indigenous perspectives
across four major undergraduate courses in
the Faculty of Health (Nursing, Psychology
and Counselling, Public Health, and Human
Movements) and one biomedical unit offered
by the Faculty of Science. The experience has
been a challenging and positive one, and the
reforms have been supported by a sustainable framework.
This project took a ‘whole of course’
approach to the development of cultural
competency in the health disciplines, and
was implemented across first, second and
third year units within four major undergraduate courses in the Faculty of Health.
The goal was to move beyond a ‘good citizenship’ model of Indigenous knowledge to
one of professional competence in students.
A crucial feature of the Yapunyah Project
was the embedding of learning activities,
including assessment, within curricula.
Student learning has been impacted positively across 26 units at both undergraduate
and postgraduate levels, with over 7,700
students each year enrolled in the units that
have been redeveloped to include Indigenous
perspectives. The self awareness and personal development that students experience
through their engagement in the learning
activities of the programme provide a basis
for their learning outcomes beyond graduation and into their professional lives. This has
been facilitated by the integration of the
clinical/practicum environment within the
Yapunyah Project, whereby cultural competency is built into clinical units and clinical
assessments. The project has also succeeded
in enhancing the experience of Aboriginal
and Torres Strait Islander students with
respect to health courses and creating a
positive impact on all graduates’ interest in
and opportunities for employment in the
area of Indigenous health. The continued
and sustained work that has arisen from the
Yapunyah project prepares our graduates to
be proactive in working to improve the
health status of Indigenous Australians.
J U LY
The Yapunyah Project was an initiative of the
Faculty of Health at the Queensland
University of Technology, instigated as a
result of ethical, clinical, accreditation, and
regulatory imperatives to develop cultural
competence in health graduates with respect
to Aboriginal and Torres Strait Islander perspectives. The project was guided by earlier
reforms in health curricula by the Committee
of Deans of Australian Medical Schools and
the Royal Australian College of General
Practitioners, and by the cultural competence
in healthcare delivery models of CampinhaBacote (1998) and Cross, Bazron, Dennis &
Isaacs (1989). It was also informed by the
cultural safety reforms to health curricula in
New Zealand.
development of media-based learning
resources within selected units, integration
of Aboriginal and Torres Strait Islander perspectives within assessment in theory and
practicum units, and self assessment activities for students to reflect on their learning.
The Yapunyah Project reflects an explicit
strategy to systematically promote students’
understanding and appreciation of
Aboriginal and Torres Strait Islander perspectives and competence in providing culturally safe healthcare to health consumers
of Indigenous backgrounds. The project
aimed to facilitate the development of professional competencies that are fundamental to the provision of care that promotes
optimal health outcomes for Aboriginal and
Torres Strait Islander people.
Robyn Nash, Sandra Sacre and Beryl
Meiklejohn | Faculty of Health,
Queensland University of Technology,
Australia
Email: s.sacre@qut.edu.au
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INTERNATIONAL DIARY
Diary 2008
Annual International Conference of
The Network: Towards Unity for Health
27 September - 2 October, 2008,
Chía-Bogotá, Colombia
International Conference on Adapting
Health Services and Health Professions
Education to Local Needs: Partnerships,
Priorities and Passions. Organised by
The Network: TUFH and Facultad de
Medicina, Universidad de La Sabana
Further information: Network: TUFH Office,
P.O. Box 616, 6200 MD Maastricht,
the Netherlands; tel: 31-43-3885638;
fax: 31-43-3885639;
email: secretariat@network.unimaas.nl;
Internet: www.the-networktufh.org/
conference
1 - 5 October, Melbourne, Australia
2008 Wonca Asia Pacific Regional
25 - 29 October, San Diego CA, USA
APHA annual meeting. Organised by
American Public Health Association
(APHA). Further information:
email: comments@apha.org;
Internet: www.apha.org/meetings/
31 October - 5 November, 2008,
San Antonio TX, USA
AAMC annual meeting. Organised by
Association of American Medical Colleges
(AAMC). Further information: Internet:
www.aamc.org/meetings
17 - 21 November, 2008, Kampala, Uganda
Improving the Quality of Family Medicine
Training in Sub-Saharan Africa. Organised
by Primafamed. Further information:
email: primafamed@ugent.be;
Internet: www.primafamed.ugent.be
20 - 21 November, 2008, Maastricht,
the Netherlands
Visitors Workshop: A Primer on the
Maastricht Approach to Medical Education.
Organised by School of Health Professions
Education, Faculty of Health, Medicine and
Life Sciences, Maastricht University,
Maastricht, the Netherlands. Further
information: School of Health Professions
Education, P.O. Box 616, 6200 MD
Maastricht, the Netherlands;
tel: 31-43-3885626; fax: 31-43-3885639;
email: she@oifdg.unimaas.nl;
Internet: www.she.unimaas.nl
21 - 24 December, 2008, Ismailia, Egypt
10th International Workshop on Human
Resource Development in Health Management & Leadership. Organised by Center
for Research & Development in medical
education & health services, Faculty of
Medicine, Suez Canal University (FOM/
SCU), Ismailia, Egypt. Further information:
email: CRDMED@ismailia.ie-eg.com;
Internet: crdmed.tripod.com
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Post-Conference Excursions:
October 3, 2008:
Health Centre Aqua de Dios
October 3 - 5, 2008:
Valledupar - Sierra Nevada de Santa Marta
Conference - A Celebration of Diversity.
Organised by Royal Australian College of
General Practitioners and World Organization of Family Doctors (WONCA).
Further information:
email: wonca2008@meetingplanners.com.
au; Internet: www.wonca2008.com
Diary 2009
1 - 4 March, 2009, Johannesburg,
Republic of South Africa
Wonca African Regional Conference Family Medicine in the African Context.
Organised by World Organization of Family
Doctors (WONCA). Further information:
Internet: www.globalfamilydoctor.com/
conferences/conferences.asp
15 - 19 March, 2009, Ismailia, Egypt
23rd International Workshop on Community-based Education Incorporating
Problem-based Learning, Innovative
Approaches. Organised by Center for
Research & Development in medical
education & health services, Faculty of
Medicine, Suez Canal University (FOM/
22
SCU), Ismailia, Egypt. Further information:
email: CRDMED@ismailia.ie-eg.com;
Internet: crdmed.tripod.com
25 - 29 May, 2009, Washington DC, USA
Global Health Conference. Organised by
the Global Health Council. Further information: email: conference@globalhealth.org;
Internet: www.globalhealth.org/conference
5 - 8 June, 2009, Hong Kong, China
Wonca Asia Pacific Regional Conference Building Bridges. Organised by World
Organization of Family Doctors (WONCA).
Further information: Internet:
www.wonca2009.org
15 - 26 June, 2009, Maastricht,
the Netherlands
Summer Course: Expanding Horizons in
Problem-based Learning in Medicine,
Health and Behavioural Sciences. Organised by School of Health Professions
Education, Faculty of Health, Medicine and
Life Sciences, Maastricht University,
Maastricht, the Netherlands. Further
information: School of Health Professions
Education, P.O. Box 616, 6200 MD
Maastricht, the Netherlands;
tel: 31-43-3885611; fax: 31-43-3885639;
email: she@oifdg.unimaas.nl;
Internet: www.she.unimaas.nl
STUDENTS’ COLUMN
STUDENTS’ SPEAKERS CORNER
Community
Mental Health Education in Nigeria
I just concluded an insightful ten-week
posting in psychiatry. I gained a panoramic
view of mental health and some knowledge
of how the attitudes, beliefs and practices
of individuals in the local community affect
the concept of psychiatry.
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Mental Healthcare Programmes
The earliest account of community
It is important to note that community
psychiatry involves the education of people
in the community, preventive measures,
therapy, rehabilitation and support of the
mentally ill and those convalescing.
There is therefore a need to create mental
healthcare programmes and at the same
time involve individuals in the community
in its initiation. Apart from community
mental health education, the need to establish population-based treatment and care is
also very vital.
N U M B E R
This may be attributed to the poor knowledge of mental health due to inadequate
mental health education. The community
Gap
Over the years more focus has been placed
on community and family health education
with mental health education being
neglected. This reality has created a wide
gap between attitudes and practices
towards improving the general body health
and that of mental health. It is therefore
important that we scientifically educate
the community on good mental health. At
the same time they need to understand
that apart from genetic predispositions to
mental disorders, we are all predisposed to
a decline in our mental health; it should not
be attributed to cultural phenomenon and
perceived enemies in their locality. There is
hence a necessity to integrate this in various organised healthcare programmes.
psychiatry and community mental health
education in Nigeria was in 1954, when a
notable doctor, Professor Adeoye Thomas
Lambo formed a diurnal hospital system
around a psychiatric hospital, Aro-Abeokuta
(during that period they did not have the
infrastructure or manpower for the mentally
ill) where the individuals in the community
allowed patients to stay in rented rooms in
their houses where they were treated and in
exchange the villagers were given water
and free healthcare services. This initiative
was reported to have shown an effective
enhancement in the mental health of the
patients, improved prognosis and reduction
in stigmatisation.
N E W S L E T T E R
A brief story: a fellow medical student of
mine was on her way to the psychiatric
hospital when she decided to hail a cab
going via that route. She was then asked by
the cabman where specifically she wanted
to be dropped off and when she mentioned
the hospital the cabman blatantly refused
to take her there.
easily accepts issues on general body health
while matters on mental illness are treated
with rejection. The first point of call for
most of these members of the community in
the care/treatment of mental illness is
traditional/spiritual healers, due to lack of
proper understanding together with the
traditional belief that the sources of mental
health problems are spiritual. This approach
usually prevents early detection of the factors that contribute to the illness. It also
delays initiation of prompt and effective
therapy.
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Stigmatisation
The perception of psychiatry varies from
community to community. Generally, mental illness is still being perceived as being
spiritually related in developing countries
like Nigeria. It is reported that about 70%
of the population of Nigeria reside in rural
communities. Lack of understanding and
knowledge about mental health by the
community contributes largely to the stigmatisation of practitioners (psychiatrists,
other health workers, medical students in
psychiatry posting) in the field of psychiatry as well as the patients.
Queens Medical Centre
J U LY
The concept of mental health is integrated
into the WHO (1986) definition of ‘health’
or ‘wholeness’ of an individual, which states
that “Health is a state of complete physical, mental and social well being and not
merely the absence of disease or infirmity”.
Hence, when considering the general wellbeing of individuals in the community there
is no need to fragment the health of their
body from their mind, as they both constitute the total state of health of any individual.
Igwilo Ugonnaya Ugochineyre | SNO
African Representative, College of Health
Sciences, Igbinedion University, Nigeria
Email: chinyerehumphrey@yahoo.com
23
STUDENTS’ COLUMN
STUDENTS’ SPEAKERS CORNER
Network: TUFH Institutions
Welcome Maastricht Students
Why did I choose Sudan? I finished a
Master’s degree before, so I had already
done a thesis in the Netherlands. I wanted
to try to do the same in a foreign country.
Actually, I planned to go to a country like
England or another European country. But
then the university offered me an opportunity to go to Sudan. What to do? It seemed
it was not possible to go to England unless
I arranged everything myself, which would
take too long. Since three other students
were going to Sudan as well, I assumed this
was a good second option. Then the others
decided not to, so I was by myself.... I still
decided to go: off to Sudan!
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A Maastricht Student at Ahfad
University for Women, Sudan
April 2007 was an exiting month! It was
the month I would leave to Sudan to work
on a research for my Master Thesis in
Health Policy, Economics and Management.
I had also completed a Bachelor in Health
Sciences and a Master in Health Education
and Promotion, all at Maastricht University.
My study concerned a cross-sectional survey
regarding HIV/AIDS prevention policy for
Sudanese women. HIV/AIDS is increasingly
affecting girls and women world-wide. The
first case of HIV in Sudan was diagnosed
in 1986 and since this diagnosis, the prevalence in Sudan has been rapidly increasing.
It is really important to change this rising
pattern now to prevent bigger problems
from occurring in the future.
I hope my thesis helped to change this. My
problem statement was: To what extent
can the policy for HIV/AIDS prevention for
women in Sudan be improved? I formulated
short- and long-term recommendations: the
political commitment has to be improved
by emphasizing the impact of HIV/AIDS in
Sudan, testing for HIV, and using protective
measures during sex should become more
anonymous. Furthermore, the Government
24
Ms. Annemarie van der Kolk with her supervisor Dr. Mohamed Moukhyer
should involve the community to get greater
insight into their needs. In the long-term, a
climate of openness concerning sexuality
and related matters should be encouraged.
This approach might change opinions on sex
and use of condoms. Islam is an important
factor, since this religion has a big impact
on people’s beliefs and behaviour policy
making. This religion should be intertwined
with HIV/AIDS prevention.
This last recommendation on integration of
Islam is a very important one. During my
stay I got insight in this religion and the
way it impacts daily life. It was very interesting to live with a Sudanese family. I still
remember the first time I was in the room
and suddenly everyone got up, grabbed a
prayer mat and started to pray!
The research itself was quite difficult. It happened several times that I managed to make
an appointment with someone and travelled
for an hour in a bus without air-conditioning
(degrees up to 50ºC!). When I arrived at the
institution and asked for the person I would
have an appointment with they replied:
“No, he is not here, we do not know of any
appointment...”. You have to be very patient
and persistent. But although it was hard, I
did manage to write my research report.
After three months of many, many spoons
of sugar (they like sweets a lot!), busy markets, incredibly crowded bus stations, several death experiences due to crazy traffic,
interesting conversations regarding religion
and a lot of sunshine I travelled back home.
I gained many experiences and will certainly
never forget this country!
Annemarie van der Kolk | Student, Faculty
of Health, Medicine and Life Sciences,
Maastricht University, the Netherlands
Email: annevdk@hotmail.com
Geriatric Depression Care
in Rural Illinois
Because of a change in the medical curriculum at Maastricht University, the Maastricht
Faculty of Medicine (now Faculty of Health,
Medicine and Life Sciences) was in need of
more off-campus clinical and research
opportunities for their 6th year medical students.
During the Network: TUFH Conference in
Australia, we started to talk about sending
some of those students to the College of
Medicine at Rockford, University of Illinois,
USA. Our students do not have a research
requirement; in their senior year they have
several electives, so a lot of the time they
are away from Rockford. We always have a
number of research projects, but not
always a lot of students around. Therefore,
it was handy for us that Maastricht students could help us with the projects; and
we helped them gain experience.
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I think a
strength of
students
coming to
Rockford is
that it is very
easy for us to
put them in
contact with
doctors and
patients, so they
can actually go
out and collect
their own data.
N U M B E R
As a 6th year Dutch medical student, I
went all the way to Rockford, Illinois for
my research participation. My research
Lieke Vogels / Student, Faculty of Health,
Medicine and Life Sciences, Maastricht
University, the Netherlands
Email: liekevogels@hotmail.com
N E W S L E T T E R
Michael Glasser | Associate Dean,
Centre for Rural Health Professions,
College of Medicine at Rockford,
University of Illinois, USA
Email: michaelg@uic.edu
Finishing my research project was my main
goal in Rockford, but another reason to
choose for Rockford was the fact that I
always wanted to experience the American
way of life. And I certainly did! I shared my
apartment with a medical student. This
made it very easy to integrate with other
medical students and local people. I was
the only exchange student at the College
of Medicine, so everybody was really interested and willing to help. All people I met
have been very generous and I have made
some precious friendships. I have even
been a bridesmaid at a friend’s wedding!
This made my stay in the US a wonderful
experience.
Ms. Lieke Vogels
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I think a strength of students coming to
Rockford is that it is very easy for us to put
them in contact with doctors and patients,
so they can actually go out and collect
their own data. At other universities the
research might be more clinical; ours is
clinical in a way, but also social and behavioural. They actually get to know people,
and they get to know how the healthcare
system works and how it effects the people
that are using that system.
Throughout this experience, I have realised
that management of geriatric depression
in rural areas in the US remains an area of
concern, as there is poor access to mental
healthcare. Although more than 20% of
the US population lives in places defined
as rural, only 9% of all physicians practice
in these communities. Better recruitment
of psychologists and counsellors in rural
regions is needed to improve depression
care. Furthermore, the results of the study
strongly support integration of mental
healthcare in primary care practices. This
approach is quite similar to the change
you see in the Netherlands; an increasing
amount of family physicians share the
office with psychologists.
J U LY
Lieke Vogels came in October 2007, for the
18 week research participation. It is important to have 18 weeks; you need this time.
We did a project on what primary care doctors know about and how they treat
depressions in older people. Ten years
before that, a colleague and I had done a
survey of rural doctors in Illinois, to find
out how they treated depression in older
people. It would be useful to conduct a
survey on that population 10 years later.
Lieke and I are writing a paper now to
publish her study findings. We have analysed the results and now we are writing a
paper so we can submit it to a US peerreviewed journal.
project was on the assessment and treatment of depression in older adults in rural
Illinois. I grew up on a farm in a small rural
community in the Netherlands, and geriatric medicine has always drawn my attention; therefore, this project was perfect for
me. Rural medicine gets special attention
at the University of Illinois in Rockford.
There is a special programme for rural
medical students, so it was the perfect
location for this project.
25
Member and organisational News
Messages from the executive committee
To learn more about the personal beliefs, motivation and goals of our EC Members, we have invited Ian Cameron to share his
thoughts with us.
N E W S L E T T E R
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EC Intelligence:
Ian Cameron
In April 2008 the Australian Government
held a 2020 Summit. The planners invited
1000 people who were described as Australia’s brightest and best, to spend an unfunded weekend discussing what Australia
should look like in 2020, and what needed
to be done to get there. Streams included
such areas as productivity, governance, social inclusion, creativity, health, rural communities, Aboriginal and Torres Strait Islander peoples, security, and the economy.
I was honoured to be one of those selected
to attend.
In many ways it reminded me of a Network:
TUFH Conference. There were few plenaries, and those few addressed some of the
bigger issues. Our groups focussed not on
what was wrong, but what was needed.
The thoughts were diverse and often ‘out
of the square’. Like a Network: TUFH Conference, it had no defined ending, but left
participants and the Government with a
plethora of thoughts for the future. It was
fun.
One of the great strengths of The Network:
TUFH has always been this inclusion and
sharing of thoughts, without anyone pushing their thought as a single path to make
the system work. The Network: TUFH recognises and celebrates diversity. From its beginnings in academic-community partnership, it has acknowledged that health
changes will largely come from outside the
health sector, but that we all have our role
to play and to share. However, The Network: TUFH has for many years concentrated on the education side of development.
The merging of The Network with TUFH
gave exciting possibilities to the new organisation in moving beyond an academic
focus to being more inclusive of others in
26
health systems, and at all levels including
policy makers, practitioners and health organisations, as well as academics and community. I think that since the merger, we
have not taken full advantage of the opportunities offered by the inclusion of
TUFH, and we still have a chance to maximise these opportunities.
Recently I was talking with a wise and
eminent doctor about rural health workforce. He had also been involved for many
years in Aboriginal health and in general
practice education. While we talked he
asked me “where did we go wrong?” And
we have gone wrong. Our rural health
workforce throughout the world is small
and declining. Yet our education and training effort and expertise are increasing. Reflecting on his question, I think it in many
ways parallels the directions that are open
in The Network: TUFH. Our focus on education has helped to equip a potential health
workforce for their future, but we sometimes have neglected the work environment they may go into. This is where I think
a greater uptake of the TUFH elements will
add immense value.
For me the future of The Network: TUFH
combines more of the same actions with
more concentration on health systems. The
conferences are marvellous; often the
thought of the next one is what helps to
keep me going. We need to add to that the
wider partnership theme. This has already
been happening with closer ties to collegiate organisations including Wonca, the
Wonca Rural Working Party and the Wonca
Africa regional group. The recent co-signed
editorial in the British Medical Journal on
vertical health funding is a great example.
The ongoing relationship with GHETS is
another.
Dr. Ian Cameron
The Network: TUFH is widely known, but
we could be better at letting people know
how we do things. This particularly applies
to future funders of Network: TUFH activities. I think that a short published strategic plan that includes what we do, who we
do it with, how we do it and how it is funded would be of immense value in adding to
our profile.
All these strategies are framed in a context
that it is the people involved who make
The Network: TUFH what it is. We need to
continue to acknowledge the vision and
leadership, the participation and work of
all our people from Conference attendees
to the Secretariat. We need to support the
students and hopefully keep them within
the Network: TUFH community as they
graduate and move into their own work.
And we need to ensure that the Network:
TUFH community remains one that cares,
shares, develops and is enjoyable.
Ian Cameron | Executive Committee
Member; CEO NSW Rural Doctors Network
Email: icameron@nswrdn.com.au
TASKFORCES
15by2015:
Quality Healthcare for All
The Network: TUFH is one of the organisations involved in the 15by2015
campaign. The campaign has been officially launched with the publication of an editorial in the British Medical Journal on March 1, 2008 ( De
Maeseneer et al., 2008. Funding for Primary Healthcare in Developing
Countries. 336:518-519).
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Dr. Elmusharaf has been relevant to the advancement of
health in his community, in different areas including medical education, medical students’ activities, health service
delivery, health researches and community charity work. He
established and led many students and medical organisations and conducted workshops and training courses concerning leadership developing programme. He organised
and participated in more than 30 medical trips to rural areas
of Sudan, which included medical students training, charity
medical services, health education and promotion and small
projects implementation, which was of grate value.
N U M B E R
Please sign our petition in support of improving the primary healthcare
around the world: www.15by2015.org
During the General Meeting in Kampala, Uganda in September 2007 the 2nd TFA was presented to a very honoured Dr. Khalifa Elmusharaf from Sudan. Dr. Elmusharaf,
a 32-year old medical doctor, has been an active participant
and contributor at the Network: TUFH Conferences; he was
a member of the Poster Evaluation Committee; he was also
national coordinator of Sudanese participants in Australia;
in Vietnam he was a member of the Conference Evaluation
Committee, and he won the Best Poster Award; in Belgium
he organised and co-facilitated a workshop titled Practical
skills for students and young health professional to setup
community projects; he is an active member of Evaluation
Committee of the Women and Health taskforce; he presented also several posters.
N E W S L E T T E R
Primary healthcare cuts across diseases in a systemic way. Investing
in improving the quality of primary healthcare (infrastructure, human
resources and equipment) is a broad-based and sustainable investment
that should be accessible and affordable for all. For example, if good
primary healthcare were available in the 42 countries accounting for
about 90% of child deaths world-wide, 63% of these deaths could
be prevented. The most prevalent health care problems in developing
countries are respiratory illnesses, diarrhoea and complications of labour and delivery. These can and must be treated within the same primary healthcare framework that deals with diseases such as malaria,
tuberculosis and AIDS.
The TFA honours a person/organisation/institution/group
for outstanding contributions to The Network: TUFH. The
award consists, apart from a certificate, of an economy ticket to travel to a future Network: TUFH Conference (to be
filled in within three years from the year of award), space in
the Newsletter and a world-wide announcement through our
hlt-net Alert.
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The positive news is that financial support to improve healthcare in
developing countries has increased seriously in the last years, about
26% between 1997 and 2002. However, the vast majority of this aid
was allocated to disease specific projects (vertical programmes) rather
than to broad-based investments (horizontal programmes) such as primary healthcare services. Vertical programmes improve healthcare, but
only for small groups of people with specific diseases. Some people receive good care, others remain untreated because there are no doctors,
nurses or medication available.
Furthermore, salaries of healthcare providers working for donor-funded
vertical programmes are often two to four times that of equally trained
Government workers in primary healthcare. This induces an internal
brain-drain (loss of well-trained people where they are most needed)
where local healthcare workers move from their work in health centres
and hospitals to the better paid projects of donor organisations.
Tribute to…
At the occasion of the Network: TUFH’s 25th anniversary, the
Executive Committee installed the Tamas Fülöp Award (TFA).
Tamas Fülöp, who was in a leadership role at WHO Headquarters in Geneva at the time, took the initiative to establish The Network in 1979.
J U LY
15by2015 is a campaign calling for all major global health donors to
allocate 15% of all their grants towards strengthening the primary
healthcare system of the country they are working in. The target date
is the same as with the globally known and used eight millennium development goals: 2015. With 15by2015 we want to specifically target
healthcare and make you and all influencing stakeholders aware of an
adequate strategy to improve healthcare. Quality healthcare - accessible and affordable - is a right for all; most everybody agrees on this,
but the way to reach this is not always clear.
Dr. Khalifa Elmusharaf was awarded with the 2007
Tamas Fülöp Award
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Member and organisational News
TASKFORCES
Mini-Grants Supporting
Women and Health Learning Package
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Global Health through Education, Training
and Service (GHETS) awarded in 2007 a
total of $10,000 towards mini-grants (each
is no more than $3,000) to support the use
of the Women and Health Learning Package (WHLP). Each year, the grant proposals
are reviewed by the Women and Health
Taskforce. In 2007, the taskforce chose
four recipients who submitted innovative
plans for approaching women’s health topics through a variety of different avenues:
In Uganda, GHETS funded Sarah Kiguli to
increase knowledge regarding reproductive
health among undergraduate medical students, who will in turn work with women in
the surrounding areas. This project came
about from Sarah Kiguli’s observations of
the trend of pregnancy among many single
female students during their medical training along with the lack of stand-alone services for women.
Sarah Kiguli sees the need to promote preventive messages in order to decrease the
risk of unwanted pregnancies and STI’s. As
a result she plans to use a variety of media,
such as workshops and talk shows, to increase reproductive health knowledge,
while also directing skits and role-playing
in order to empower young people with the
communication skills for approaching these
issues.
Rogayah Ja’afar of Malaysia has identified a similar need to promote curricula
surrounding women’s health at health professional schools as well as NGOs.
After taking part in the drafting of a formal educational module on women’s
health at a meeting several years ago, she
hopes to incorporate the WHLP as a key
component of this curriculum and to expand its scope to the national level. These
efforts will culminate in a National Work28
shop for Promoting Women’s Health Learning for Malaysian Health Professional
Students scheduled for next year.
In South Africa’s Gauteng province, Todd
Maja has recognised the need for health
education curricula to be developed among
youth care centres in order to address the
increasing number of youth engaging in
risky behaviours.
By conducting workshops among healthcare providers and students serving as peer
educators from these health centres, Todd
Maja will help to develop learning modules
tailored to the specific health problems of
local youth.
Ultimately these modules, derived from
the WHLP, will be implemented by staff at
several different youth centres.
Lastly, in Nigeria Godwin Aja aims to use
church-based women support networks as
a means for promoting the use of the
WHLP. Churches provide opportunities for
training non-professionals on behaviour
change and promoting health among local
communities.
Godwin Aja will orchestrate a two-day
workshop that will allow for discussion of
many WHLP topics via interactive activities
such as drama features, essays, storytelling, and poster presentation. Along with
disseminating knowledge, GHETS is hopeful that this workshop will create a sense
of partnership for increased awareness on
women’s health issues among churchbased networks as well as arm individuals
with the necessary skills for facilitating
further workshops in the future.
Jessie Rothstein | Global Health through
Education, Training and Service (GHETS),
USA
Email: jdr@ghets.org
New Taskforce:
Social Accountability and
Accreditation
The new taskforce is chaired by Robert Woollard, Canada (woollard@familymed.ubc.ca),
and Charles Boelen, France (boelen.charles@
wanadoo.fr).
Its aim is promotion of social accountability
principles and methods with aims:
• to orient education, research and health
service activities of educational institutions to better respond to people’s priority
health needs; and
• to develop relevant evaluation and accreditation standards and processes.
The taskforce objectives are:
• to create awareness and interest for social
accountability in universities and health
professional schools at international level;
• to organise educational activities related
to the definition and measurement of
social accountability;
• to elaborate standards reflecting social
accountability;
• to suggest tools and mechanisms to
assess social accountability;
• to collect data on status and progress of
social accountability in universities and
health professional schools; and
• to conduct experiments in using standards, assessment tools and mechanisms
for the purpose of accreditation.
Projects
Related to Care for the Elderly
Molly Eriki from Uganda (jajjashome@
mildmay.or.ug) reported on an innovative
programme in Uganda, in which grandparents are care givers of children with AIDS.
‘Clubs for Grandparents’ were set up in 14
of the 80 districts of Uganda. NGO funding
was used to hire volunteer coordinators who
recruit volunteers identified by local healthcare centres and parish officials to run these
clubs. The clubs typically support 40 to 50
grandparents each week.
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The Network: TUFH taskforce on Elderly Care
and the Network: TUFH taskforce on Interprofessional Education will jointly plan and
run a session at the next Network: TUFH
Conference in Colombia in 2008. Elderly
Care taskforce members are invited to participate in planning the session by contacting
Larry Chambers and Dawn Forman (dawn.
forman@btinternet.com) (leader of the taskforce on Interprofessional Education).
N U M B E R
The Help Age Ghana long-term care home
and a few veteran homes are the only facilities, and therefore virtually all older adults
must stay at home when they become frail
and more dependent. As more and more city
dwellers spend time at work, they have less
time to care for their homebound parents
and/or grandparents.
Joan Basigira from Uganda (registrar@
med.mak.ac.ug) had observed that care of
the elderly is not a topic presently covered in
the undergraduate curriculum of the Makere
Medical School. Medical students now must
participate in the Community-Based Education Service (CBES) component of their programme, where they conduct a community
environmental scan focusing on prevention
and health promotion. Some exposure to
care of the elderly may arise but this is not
emphasized by the CBES. Students also are
involved in the palliative care hospice in
Kampala that includes outreach home visits.
The School of Medicine is presently conducting a review of the undergraduate medicine
curriculum. As Registrar, Joan will recom-
N E W S L E T T E R
At present, the students may be exposed
to care of the elderly in their clerkship, and
there is an opportunity in the family medicine residency programme for residents to
focus on geriatrics.
In her teaching hospital, a geriatrics clinic is
offered one day of each week. In September
2007, an outreach centre/clinic for older
adult outpatients was offered and medical
students (house surgeons/interns) participate in these clinics. The plan is to expand
these clinics to include health promotion
and disease prevention.
Larry Chambers from Canada (lchamber@
scohs.on.ca) outlined projects of the Elisabeth Bruyère Research Institute (EBRI). The
EBRI website provides brief overviews of its
research programmes that cover care of the
elderly, including the cardiovascular health
awareness programme (www.chapprogram.
ca), palliative care, CanDRIVE (a research
programme to improve clinical decision-making related to keeping older drivers driving),
primary care, and TAFETA (keeping people
independent in a friendly home environment
through the use of technology). Larry reported that the EBRI is producing and evaluating
on-line e-learning resources that focus on
interprofessional patient-centred collaborative care and palliative care through the humanities. The EBRI is a member of the newly
established Ontario Seniors Health Research
Transfer Network (SHRTN) (www.shrtn.on.ca).
Through the support of librarians, knowledge
brokers and the health and aging research
institutes/centres in Ontario, caregivers of
older adults participate in SHRTN local implementation teams, SHRTN communities of
practice, the SHRTN annual assembly to exchange ideas, connect people, and promote
use and production of research.
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Akye Essuman from Ghana (akyessuman@
yahoo.com) outlined his interest in home
care for older adults in his practice and his
desire to see care of the elderly be a learning goal for medical students in his medical
school.
Suman Gadicherla from India (sumanamogh@gmail.com) reported on Indira
Gandhi National Open University, School of
Health Sciences offering post graduate diploma courses, which is of one year duration,
for medical graduates i.e. to those who have
completed their MBBS and are practicing
medicine. This course is offered in distance
education mode and the school is one of
the study centres where the enrolled participants come for contact programmes, about
four spells of one week each.
mend that care of the elderly be part of the
undergraduate medicine curriculum.
J U LY
A number of activities are offered at the
clubs, from skills training in care of children
to poetry writing and healthcare. Healthcare
sessions at the club are followed up with
home visits by nurses, teachers, physicians,
religious leaders and social workers. Students including medical nursing and social
work students regularly have placements attached to the clubs. With the early success
of these clubs, Molly pointed out that this
programme should be offered in the other
66 districts in Uganda.
Akye plans to work with his colleagues in his
family practice to find ways to provide home
care for the older adults in their practices.
This approach will also create learning opportunities for undergraduate medical students.
Larry Chambers | Taskforce Care for the
Elderly
Email: lchamber@scohs.on.ca
29
Member and organisational News
REPRESENTED AT INTERNATIONAL MEETINGS/CONFERENCES
The Network: TUFH is being represented at meetings and conferences all over the
world. Here is a report of one of our representatives.
WONCA 8th International Rural Health
Conference, Nigeria, February 2008
Three hundred members attended - the majority from Nigeria - dynamic and ebullient
and welcoming. Sadly, rumours about security deterred visitors from outside. But Calabar appeared well ordered, organisers ensured security and there was no sense of
threat. The Organising Committee was
chaired by Ndifreke Udonwa and the Scientific Committee by Victor Inem. They and
their teams of workers overcame all challenges.
Mutually Supportive Relationship
WONCA and The Network: TUFH are seeking
a mutually supportive relationship. This
partnership was discussed by the Rural
Health Working Party, chaired by Ian Couper
from Witwatersrand University, South Africa.
I was asked to represent The Network: TUFH.
N E W S L E T T E R
N U M B E R
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Frontline Medicine:
From Natural Disasters to Daily Care
The organisations have different aims but
share common ground in rural communitybased medical education and commitments
to primary care. They are jointly seeking discussion at the World Health Assembly for:
• the HARP initiative (Health for all Rural
People), and
• the 15by2015 initiative to ensure by the
year 2015 that 15% of vertical programme
funding be allocated to strengthening integrated local primary care systems.
WONCA proposed to The Network: TUFH that
the relationship be developed as follows:
• Consultation will continue at the
Northern Ontario School of Medicine
International Conference: Community;
Medical Education in the North (ICEMEN) in Sudbury Ontario, June 8 to 14,
2008: http://normedsps.lakeheadu.ca/
icemen/default.aspx
• WONCA Rural Health members will
30
attend the Network: TUFH Conference in
Colombia for further discussion in
September: www.the-networktufh.org/
conference
• A joint workshop at the WONCA Rural
Health World Conference in Crete in
2009 (www.ruralwonca2009.org) will
plan for a joint full meeting in 2011.
Remembrance
The conference opening ceremony and celebratory dinner were marked by the remembrance of the contribution to general practice of two historic figures in the early
development of general practice in Nigeria.
The first was S.IE. Emoke, of this very region,
one of the first Nigerian trained practitioners. The second was C. Andrew Pearson of
the Wesley Guild Mission hospital, who was
a leader in establishing of this training.
Pearson’s son Bryon presented the album of
his fathers’ photographic record of those
early beginnings, to remain permanently in
Nigeria. He reminded me I had spoken about
McMaster at the 1979 launching conference. The first day of the Calabar conference
was rich with seminars, training sessions
and presentations on the main theme and
on wide ranging topics. The day closed with
an outdoor evening reception at University
of Calabar Teaching Hospital.
Okoyong
On the second day we were bussed to the
rural community of Okoyong. Here my keynote address, Lessons from Community-Based
Education in Five Continents, was held in
brilliant sunshine, the PowerPoint invisible.
Pictures were in words and action. Fifteen
graduates of Ilorin were in the audience.
Three I had taught 30 years ago! Discussion
to and fro became part of the talk, verifying
my account. Who needs technology? We
were greeted by the Paramount Chief, an
The Network: TUFH is being represented
at meetings and conferences all over the
world:
• Geneva Health Forum 2008, May
2008, Switzerland. Represented by Jan
de Maeseneer.
• Global Forum on Human Resources for
Health, March 2008, Uganda.
Represented by Sarah Kiguli.
• WONCA 8th International Rural Health
Conference, February 2008, Nigeria.
Represented by John Hamilton.
• Bellagio Conference on Expanding
Frontiers in Medical Education,
September 2008. Represented by
Abraham Joseph.
• Global Health Council’s 35th Annual
International Conference, May 2008,
USA. Represented by Jan de Maeseneer and Pertti Kekki.
anaesthetist. Then moved to the old home of
Mary Slessor, an early missionary, much revered in this area to which she brought Presbyterian ministry, healthcare and protection
for newborn twins who were believed to be
evil. And then we got down to serious exchange with the community at the village
meeting house, with speeches, music, singing and dancing. The officers of the Rural
Health Working Party and Chris van Weel
(President of WONCA) were robed and inducted as Chiefs, followed by more singing
and dancing.
The working party returned the compliments
of the elders by proposing that a fund be
raised to repair and update the clinic. A cultural evening in Calabar and a thoughtful
visit to the Museum of Slavery closed the
day.
The Network: TUFH should look forward to
working with WONCA Rural Health.
John Hamilton | Professor Emeritus,
Department of Medicine and Public
Health, Faculty of Health, The University
of Newcastle, Australia
Email: jha06187@bigpond.net.au
ABOUT OUR MEMBERS
A Passion
for...
The passion of Paul Akmajian,
Marketing and Outreach Officer,
School of Medicine, University of
New Mexico, USA:
A famous Argentine teacher of mine once
said, “You don’t find the tango. The tango
finds you.” Well, the tango found me and it
became a major passion of mine.
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It is said that to become an expert at
something (anything) requires doing it for
ten years or 10,000 hours. Looking back
over my ten-year tango journey, I can say
that I have probably become an expert,
but I also know how much more I still have
to learn. It is difficult now to conceive of
even a week going by without dancing two
or three times. Tango has taken me to unexpected places, and in the process I have
made lots of friends and become part of a
network of people all over the world who
share my passion…and speaking of that,
I have heard there is some good tango in
Bogotá!
V O L U M E
Argentine Tango itself has a fascinating
history, going back perhaps as far as 150
years, with the form we are familiar with
evolving in Argentina and Uruguay just before the beginning of the 20th century. The
very first musicians and dancers were most
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The answer is complex and mysterious, but
I think the best explanation I can give is
that it combines so many things I love into
one activity: nice music, hugs, a bit of theatricality and spontaneity with a physical
challenge. Combined with that you have a
unique opportunity to connect deeply - to
become one - with another human being
for the three minutes of a song.
As the century progressed, immigrant
dockworkers from Italy, Germany and elsewhere in Europe arrived in Argentina in
great numbers. Living in the poorer barrios
(neighbourhoods), they brought their own
music and instruments, and through mixing with the residents of the nearby black
barrios, the tango was born.
N U M B E R
So exactly what is it about the tango that
hooks people? How is it that someone
like me, who had never done any couple
dancing per se and never even thought of
myself as a good dancer, became addicted
to and adept at a dance so intricate and
complex as the Argentine Tango - that now
I am even teaching it to others?
likely Afro-Argentines and Afro-Uruguayans who originally came over as slaves.
They brought with them African rhythms
such as the candombe, and later, via Cuba,
the habanera. These two rhythms form the
earliest origins of the milonga; a dance
predecessor of the tango.
N E W S L E T T E R
Little did I know then that this was just
barely the beginning, and that it would
take years and many miles more on the
dance floor to get even close to mastering
the dance. Nor did I fully realise then how
it would change me and how far it would
take us, how many wonderful people we
would meet and wonderful times we would
have.
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At first, as we struggled through those
early classes, it was maddening and frustrating. This was social, couple dance requiring that I lead every step. Many times
I decided that this was it; I was quitting.
I just was not going to get it. Yet, something kept me coming back… Perhaps the
sweet, sad, nostalgic sounding music, the
social interaction, the wonderful feeling of
embracing your partner and moving around
the floor, or just simply moving your body
to music. Little by little, with time, I gained
confidence and finally reached a point (after more than a year!) to ‘think’ less and
‘feel’ more. As the vocabulary of the dance
became part of my body memory, I had
fewer tango ‘crises’ and I was able to relax
and enjoy it more.
‘You don’t find the tango. The tango finds you.’
J U LY
It all began rather innocently in 1998,
when my wife and I decided to try to get
out of the house more and we started taking some swing dance lessons. They were
quite fun, and one day through a casual
conversation with a friend, the idea of
branching out and trying tango lessons
came up. My initial reaction was “Tango!?”.
It seemed very old fashioned and exotic….
I knew virtually nothing about it and questioned whether or where we would ever get
the chance to dance it outside of classes.
Nevertheless, we signed up for a six-week
class series, and my amazing tango journey began.
31
Member and organisational News
The
Network
towards unity for health
ABOUT OUR MEMBERS
N E W S L E T T E R
N U M B E R
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Newsletter Volume 27 | no. 1 | July 2008
ISSN 1571-9308
Interesti ng Internet Si tes
The Network: TUFH Interactive - Recommended Internet sites
www.the-networktufh.org/publications_resources/interactive.asp
The Higher Education Academy Subject Centre for Medicine, Dentistry and Veterinary
Medicine
www.medev.ac.uk
International Physicians for the Prevention of Nuclear War, European affiliatess
www.ippnw-europe.org
American Indians and Alaska Natives in Health Careers
http://aianhealthcareers.org
International conference in UK: The Future of Primary Healthcare in Europe
www.futureofprimarycare.com/?opt=0
The International Council of Nurses (ICN) calls the world’s attention to the increasing
violence against women, particularly in areas of conflict
www.icn.ch/waa_UNambassadors.htm
Primafamed; An institutional network for the development of family medicine and
primary healthcare in Africa
www.primafamed.ugent.be/index.html
Moving On:
Changes in Institutional Leadership
The Secretariat received information about changes in leadership with the following Network: TUFH members. We have listed the names of the former and new (Vice-) Deans/
Directors for you:
• Dr. Hernando Matiz Camacho, Escuela Colombiana de Medicina, Universidad El Bosque,
Bogotá, Colombia has been replaced by Dr. Miguel Ruiz Rubiano, medicina@unbosque.
edu.co
• Dr. Jayaprakash Muliyil, Christian Medical College and Hospital, Bagayam, Vellore,
India has been replaced by Dr. Anand Job, prince@cmcvellore.ac.in
• Dr. Bernard Groosjohan, Faculty of Medicine, Catholic University of Mozambique, Beira,
Mozambique has been replaced by Dr. Josefo Ferro, josefoferro@yahoo.com.br
• Dr. Mayuree Vasinanukorn, Faculty of Medicine, Prince of Songkla University, Songkhla,
Thailand has been replaced by Dr. Somchai Suntornlohanakul, somchai.su@psu.ac.th
• Prof. Michael Olanrewaju Padonu - mopadonu@yahoo.co.uk - has been appointed to
the post of Provost of the College of Health Sciences, Igbinedion University, Nigeria
It is with pleasure that we would like to inform you that the following Full Members
have been awarded (a continuation of their) Full Membership:
Up to 2102:
Faculty of Health, The University of Newcastle, Newcastle, Australia.
Silver Full Member
Up to 2013:
School of Medicine, Moi University, Eldoret, Kenya.
Silver Full Member
32
Editors: Marion Stijnen and Pauline Vluggen
Language editor: Sandra McCollum
The Network: Towards Unity for Health
Publications
P.O. Box 616, 6200 MD Maastricht
The Netherlands
Tel: 31-43-3885633, Fax: 31-43-3885639
Email: secretariat@network.unimaas.nl
www.the-networktufh.org
Lay-out: Graphic Design Agency Emilio Perez
Print: Drukkerij Gijsemberg
New Members
Full Members
• School of Medicine and Health Sciences,
University for Development Studies, Tamale,
Ghana
• Faculty of Medicine, University of Medical
Sciences & Technology, Khartoum, Sudan
Associate Members
• Steirische Akademie für Allgemeinmedizin,
Medical University of Graz, Graz, Austria
• Health Training Institute, Alli Causai
Foundation, Ambato, Ecuador
Individual Members
• Dr. Tayyab Hassan, Hospital University
Science Malaysia, Kota Bharu, Kubang
Kerian, Malaysia
• Drs. Klaas Bart de Raad, Máxima Medical
Centre Eindhoven, Eindhoven, the Netherlands
• Ms. Ntsakisi Eustacia Furumele, Faculty of
Health Sciences, University of Limpopo,
Polokwane, Republic of South Africa
• Ms. Julie Sierra, Department of Internal
Medicine, University of New Mexico,
Albuquerque, NM, USA