Tamas Fülöp Award - 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 this issue, among others:
The Present and Future of
the Family Doctor 12
Policy and Advocacy
Integration into Training 15
07
08
Grassroots Partnership
in Vietnam 20
Community Mental Health
Education in Nigeria 23
15by2015: Quality
Healthcare for All 27
In the Newsletter we refer to
The Network: Towards Unity for Health as
The Network: TUFH.

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
tional organisation of the curriculum based on
important organisations: the world
disciplines - with basic sciences at the beginning,
organisation of Family Doctors (Wonca),
emphasis on teaching rather than learning, and
Global Health through Education
in individual performance over team learning -
Training and Service (GHETS), and the
were clearly insufficient, faced with the challeng-
European Forum for Primary Care (EFPC).
es that primary care poses. Thus innovation in
In developing this action, the co-opera-
health professions education became a key con-
tion with GHETS has been utmost impor-
cept of our institution. Many are the products of
tant. GHETS provided a lot of support in
our efforts, from problem-based learning to the
the press-communication strategy.
relevance of linking with all those concerned with
the health of individuals and communities, and
Reference
to the ethical principle of social accountability, to
Dr. Jan de Maeseneer
GOODWIN, N., PERRI, G., PEIK, E. et al.
mention just a few. But we have to recognise that
(2004). Managing Across Diverse
this process is so complex that no matter what
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
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
Jan de Maeseneer | Secretary General
Email: jan.demaeseneer@ugent.be
Dr. Fernando Mora
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
J U L Y 2 0 0 8 N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
views - for example at the coming
The 15by2015 initiative also gives a di-
for increasing and strengthening of our links with
Conference in September 2008 - on how
rection to our organisation: linking with
our educational counterparts.
weak or strong, loose or tight, bounded
other organisations and networks - as
or unbounded our links are.. Though,
pointed out by De Maeseneer - but also
At this moment, when the spirit of Alma-Ata is
apart from conferences and taskforces,
to focus on primary care as the most dis-
riding again in the world, we have a golden op-
more is needed: not only networking
tinctive of our educational origins char-
portunity to regain relevance.
within the organisation but also links
acteristic in 1978. The reorganisation of
with other organisations/networks are
the educational process was recognised
Fernando Mora | Global Health through
important. For example, The Network:
then as a necessity if we were to focus on
Education Training and Service (GHETS)
TUFH is engaged in the 15by2015 cam-
community-oriented primary care. Tradi-
Email: fmora5@yahoo.com
3

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.
‘South-North’ Collaboration: Friends of Moi University
Establishing and sustaining medical schools
who were interested in international health
Conclusion
in developing countries can be challenging.
approached Moi to establish an ongoing
The Friends see their consortium as one of
Some collaborations between medical schools
working relationship (Voelker, 2004). Upon
mutual benefit, flowing in many directions,
in developing countries and one or more med-
learning about the institutions in The Network
rather than simply as one of donor and recipient
ical schools in developed countries have been
which were working with Moi, the Indiana
institutions. All of the schools have benefited
helpful. However, medical schools in develop-
doctors made contact with Maastricht and
from joint research projects, joint application
ing countries can be vulnerable to the sudden
agreed to communicate regularly with all
for funds, student and staff exchanges and an
withdrawal of funds (particularly if they have
the Network partners about activities. This
international perspective. While many of these
only one partner). In order to effectively shield
‘Consortium of Moi Supporters’ has become
successes might take place through one-on-
themselves from withdrawal of support, medi-
known as ‘Friends of Moi’ (or ‘Friends’).
one partnerships, the benefits were multiplied
cal schools in developing countries often par-
by the inclusion of different schools.
ticipate in a number of parallel independent
Friends of Moi Work Together
twinning relationships. This approach poses
Since 1991, the Friends of Moi have met every
We have found that the Friends model can
J U L Y 2 0 0 8
its own challenges, including the potential for
lack of coordination, overlap and duplication
of efforts, and conflicting advice.
Consortium of Moi Supporters
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
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
N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
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
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 educa-
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).
Linköping first became aware of the support
tion. To deal with this overlap, Maastricht
from the other universities during a chance
and Linköping have run workshops jointly.
Kimberly Oman (James Cook University,
meeting in Eldoret. Wanting to complement
Indiana’s contributions to the clinical edu-
Australia), Barasa Khwa-Otsyula (Moi
and not conflict with each other’s support of
cation programme appear to have comple-
University, Kenya), Gerard Majoor
Moi, they decided to meet with representa-
mented Linköping’s and Maastricht’s contri-
(Maastricht University, the Netherlands),
tives of Ben-Gurion at the Network’s next
butions to the preclinical programme. This
Robert Einterz (Indiana University, USA),
annual Conference (Majoor, 1991).
suggests that institutions with different
Åke Wasteson (Linköping University,
approaches and affiliations can take part
Sweden)
Around the same time, a group of doctors
successfully in a Friends model.
Email: kimberly.oman@jcu.edu.au
from Indiana University (‘Indiana’) in the US
4

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.
Pasha Bulcow being officially handed over to Luzira prison
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.
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 ap-
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.
I enquired how the children were fed, and
Alexander told me the babies were breastfed,
but that their diet was so poor that it
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.
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.
More information on Alexander Mclean
and his organisation, the African Prisons
Project, can be found at
www.africanprisons.com
J U L Y 2 0 0 8 N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
propriate groups and the services began in
was very difficult for them to lactate. He
two large sheds. I attended the Anglican
explained that the cow was there so that
service, which was full of beautiful music
the women had some calcium in their diet.
Barbara Cameron | Student, Faculty of
and dance, and was so unlike any other
There was not enough milk for all the wom-
Medicine, University of New South Wales,
church service I have ever seen.
en, but at least it helped some.
Australia
Email: barbasha@gmail.com
Around halfway through the service, a
When I returned home to Australia, I told
baby started crying in the arms of one of
my mother - a Legal Aid lawyer in Newcas-
the prisoners. Alexander explained to me
tle - about the conditions in Luzira. She
that the women who entered the prison
and her colleagues decided that they
5

THE NETWORK: TUFH IN ACTION
ANNUAL INTERNATIONAL CONFERENCE
BOOK REVIEW
Effective IPE: Development,
Delivery and Evaluation
J U L Y 2 0 0 8
N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
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
The taskforce Interprofessional Education
drive has been repeated by other legislative
provement in service design and provision,
(IPE) changed its title from multiprofessional
and policy requirements in several different
through improvements in interprofessional
to interprofessional in order to emphasize
countries.
learning and improved integration of services
the importance of structured learning with,
and care provision.
from and about different professions, by
The link between multiprofessional and in-
comparison with simply sharing a learning
terprofessional learning experiences and
The increased involvement of service users
environment.
enhanced collaborative ability within a mul-
and carers in the design and implementa-
The term ‘multiprofessional’ is used in the
tiprofessional team or between agencies has
tion of education programmes for health
paper to denote a team, training ward or
student group which contains representation
from a number of professions.
Mission of IPE Taskforce
To enhance the quality of interprofessional
education, learning and practice by drawing
together experience(s) from the international
context.
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
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).
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 Service User
While the IPE taskforce has a specific focus,
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.
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.
J U L Y 2 0 0 8 N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
also led to a failure to respond to the needs
there are substantial overlaps of interest with
of service users effectively (Conway & Mac-
other taskforces focused on particular groups
The international context in which the IPE
millan, 2003).
of service users e.g Care of the Elderly, and
taskforce functions recognises a number of
Women’s Health. In addition, the delivery
different models of community and work-
The importance of multiprofessional (now
of integrated service is an issue for the IPE
based education, ranging from a joint place-
seen as interprofessional) learning and educa-
taskforce and for specific areas of health
ment between, for example, social work
tion for health professionals was emphasized
e.g. Public Health, and Primary Care. For
and community nursing students as part of
in 1988 by the World Health Organization
this reason this taskforce is interested in col-
pre-registration education to a uniprofes-
(WHO, 1988) in their statement Learning
laboration with other areas of The Network:
sional community-based experience within a
Together to Work Together for Health and this
TUFH in order to encourage and enable im-
medical education programme. There is an op-
7

THE NETWORK: TUFH IN ACTION
POSITION PAPER
portunity here for Network: TUFH members
environments, but advances are being made
paper 7. The HE Academy Health Sciences
to learn from each other about the advantag-
to change this. However, there are some ex-
and Practice subject centre. Ed Colyer,
es of these different models and to enable an
amples of good practice. There is a commit-
Helme and Jones.
expansion of joint placement and work-based
ment to interprofessional practice by the pro-
FALLSBERG, M.B. & WIJMA, K. (1999).
learning where appropriate to the develop-
fessional bodies in many universities in New
Student Attitudes Towards the Goals of an
ment of uniprofessional and interprofessional
Zealand. Therefore where interprofessional
Interprofessional Training Ward. Medical
skills, competencies and understanding.
learning exists, collaborative education oc-
Teacher, vol 21: 6, 576-81.
curs and professionals learn together as well
FALLSBERG, M.B. & HAMMAR, M. (2000).
The strengths of a joint placement experience
as focus on speciality practice.
Strategies and Focus at an Integrated,
have been recognised as having an impact on
Interprofessional Training Ward. Journal of
both students and supervisory staff, who gain
Modelling of collaborative practice by practi-
Interprofessional Care, vol. 14:4, p 337-51.
cross/interprofessional understanding. Com-
tioners from different professions is also an
FREETH, D., HAMMICK, M., KOPPEL, I.,
munity service learning is acknowledged to
excellent positive driver for student interpro-
REEVES, S. & BARR, H. (2002). A Critical
be a valuable extension of community-based
fessional development as is the delivery of
Review of Evaluations of Interprofessional
education for health professionals (Mpofu,
key curricular and skills areas by members of
Education. UK Learning and Teaching
et al., 2004)
a different profession e.g. delivery of clinical
Support Network (LTSN) Centre for Health
skills teaching to medical students by nurses.
Sciences and Practice, Occasional paper 2.
J U L Y 2 0 0 8
Enabling Students to Work Interprofessionally
Part of the above depends on the interprofessional
learning ethos being seamless across
university contexts and during the practice
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 & Ham-
HAMMICK, M., FREETH, D., KOPPEL,
I., REEVES, S. & BARR, H. (2007). A
Best Evidence Systematic Review of
Interprofessional Education.
www.bemecollaboration.org/beme/pages/
N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
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 prac-
mar, 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
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
tice-based IPL and does little to alleviate the
International Conference. Towards Equity
Together to Work Together for Health. Report
isolation staff may feel. What is now needed
in Education, Training and Health Care
of a WHO Study Group on Multiprofessional
are some role models to encourage IPE de-
Delivery. October 2003, Newcastle,
Education for Health Personnel. The Team
velopment.
Australia.
Approach Technical Report Series 769.
DICKINSON, C. & CARPENTER, J. (2005).
Geneva: WHO.
Clinical teacher preparation is similar in
Contact Is Not Enough: An Intergroup
Australia. In most courses there is little col-
Perspective on Stereotypes and Stereotype
Dawn Forman, Jill Thistlethwaite, Katie
laboration between professions or acknowl-
Change in Interprofessional Education.
Cuthbert, Isabel Jones, Marion Jones |
edgement that students from different pro-
The Theory-Practice Relationship in
On behalf of the IPE taskforce
fessional groups are learning in the same
Interprofessional Education. Occasional
Email: dawn.forman@btinternet.com
8

IMPROVING HEALTH
HEALTH AUTHORITIES
What Would I Change
if I Were Minister of Health
This column took me a while to write. The
Medicaid and Medicare reimbursement to
truth is, the US healthcare system is unique,
reward quality primary care might serve as a
brilliant, and fundamentally flawed all at the
competitive incentive for private insurances
same time. If you are wealthy and have a
to keep pace. Finally, I would start a major
heart attack, you probably could count your-
information campaign to educate the public,
self lucky to have it in any major US city.
in hopes that future caps on the numbers of
However, if you are an average citizen trying
specialist training spots would receive public
to meet the basic health needs of your family,
support.
and maybe even prevent a heart attack,
there are better places to be. I should point
I do not think simply increasing the number
out that we technically do not have a
Dr. Daniel Waldman
of primary care providers in our country
‘Minister of Health’ in the USA, so this col-
would magically solve all our healthcare
umn will assume I was the US equivalent.
satisfied patients and better health indica-
challenges, but it would strategically change
tors (Macinko et al., 2003). Additionally,
the debate. A provider workforce more based
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 indica-
states within the USA that have a greater
supply of primary care physicians, but not
specialists, have lower mortality rates (Shi et
al., 2003).
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
J U L Y 2 0 0 8
tors 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.
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 implemen-
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.
How would I try to increase the nationwide
percentage of primary care providers This is
a question not easily answered. I would start
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.
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
N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
tation would be a work in progress: I would
by creating rewards for medical schools that
between Primary Care, Income Inequality,
make it my number one priority to increase
produce higher percentages of primary care
and Mortality in the United States, 1980-
the number of primary care providers.
physicians, and support the expansion of
1995. Journal of the American Board of
The USA has a lower percentage of primary
state run physician-assistant and nurse-
Family Practice, 16:412.
care physicians (about 35%) than other
practitioner programmes. I would also ask
Western nations and Canada, where the per-
states to set up taskforces that would
Daniel Waldman | Staff Physician,
centage usually hovers around 50%. The
creatively encourage the recruitment and
Department of Family and Community
number of primary care providers has some
development of future primary care provid-
Medicine, School of Medicine, University
interesting correlates. Nations with higher
ers, in ways that worked for their state.
of New Mexico, USA
primary care orientation tend to have more
Continued attempts at tinkering with
Email: dpwaldman@salud.unm.edu
9

IMPROVING HEALTH
WOMEN’S HEALTH
HIV/AIDS
in Sudan
The lower status of women in society, espe-
I wanted an explanation on why there was
showed a lack of knowledge, and conversa-
cially in the developing world, makes them
a rapid increase in HIV/AIDS statistics.
tions with policy makers showed that more
socially vulnerable and an easier target for
structure is needed. Women need more
the spread of HIV/AIDS. The product of
The Sudanese women involved in the
empowerment in defending their rights in
this vulnerability is the disregard of the
research are aware of the existence of HIV/
the different prevention methods and the
possible different prevention methods pro-
AIDS. However, their knowledge regarding
concept of stigmatisation should be
vided and acknowledged by the Government
related aspects is rather low. Respectively,
changed to help people understand that
and the people. It is clear that women need
41% and 37% of the women did not know
HIV/AIDS does not affect ‘bad people’
various options when it comes to these
any symptom of STDs and HIV/AIDS. Main
only.
methods; the current ones are insufficient.
modes of transmission were identified cor-
In conclusion, I would like to repeat what a
rectly, although still 10% think a mosquito
wise man said to me concerning transforma-
Women in Sudan have less access to educa-
bite can transmit HIV. As a means of pre-
tions that needed to occur in Sudan: “The
tion, with almost half illiterate, or have
vention, most women mentioned the use of
lower you come, the higher the changes”.
completed only basic or primary learning.
clean needles. The most important mode
J U L Y 2 0 0 8
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
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
Selma Ali El Sadig | Student, Faculty of
Medicine, Ahfad University for Women,
Sudan
Email: selma667@hotmail.com
N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
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.
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
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.
10

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 income-
generating activities add to household
income, but often decrease mother’s time for
child-caring, leaving care-giving to relatives
(Pierre-Louis, 2007).
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.
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

IMPROVING HEALTH
HEALTH PROFESSIONS
The Present and Future
of the Family Doctor
To a large extent, Huxley’s Brave New
public’; mankind forgot about prospective
The various national health systems have
World has become reality. With economic,
behaviour as one parameter out of several
different approaches towards an eco-politi-
technical and IT developments, and with
precautionary principles of survival strat-
cal solution, but they fail to solve conflicts
increases in numbers, the individuals of
egy. However, in our ‘developed world’,
of interest. We, general practitioners or
the human species have become kind of
dissolving patterns of family corporate
family doctors, have to find ways to mini-
registered product. These so-called ‘human
identity (FCI) and family financed support
mise the burden of individual suffering of
resources’ are administrated by more or
for family members in need are still to be
patients and disabled people. We have to
less anonymous authorities and institu-
found in immigrant families with Hispanic,
make the best under the economic pressure
tions, which are often not compatible with
Arabian or Asian background.
and with restricted resources left for the
traditional patterns of healthcare.
social and health sector by economic and
Example Two: Economy
politics.
The traditional family doctor can be trust-
Welfare and Health for All submitted to
J U L Y 2 0 0 8
N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
ed 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
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 neces-
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.
by the suffering individual patients in their
sary support.
They never lost linkage to basic medical
socio-economic micro cosmos, the family.
Confronted with today’s reality, we thus
science, and followed up on research and
The doctor is obliged to come, contracted
have to ask:
newly designed technical developments.
by nothing more than the professional
• Under these circumstances, can family
maintenance role within the new socio-
doctors do their job properly and meet
Another basic strategy has been to work
economic system of public healthcare.
the challenges of either side
together in a group, and to implement
• Are education and training focussing on
as many skills as possible into the medi-
Also, the role of the family has changed:
the knowledge, skills and attitude nec-
cal services offered at primary care level.
the responsibility for health and welfare
essary to meet the upcoming challenges
This has led to long time results as: a low
of its members has been delegated to ‘the
in doctor’s professional lives
rate of hospitalising of patients; a low
12

ily doctors will be able to decide and act
environment of complex systems not well
independently to stand up for the needs of
known or well described. Biological inter-
Graz, Austria
their patients; they can be a partner to the
active systems are as complex as socio-
top small scaled specialists; and special-
economical and cultural systems are. The
rate of unnecessary co-treatment, double
ists will be able to understand their and
parameter sustainability gains importance
diagnostics and multiple level treatment;
their patients needs because they have
with the system’s increasing complexity
a low decrease of capita per month treat-
the same roots of basic education.
and reflects the ability to resist stressors
ed, despite increasing numbers of service
Communication will become easier, losses
and/or the ability to use the resources
providers in the area concerned.
in transfer of information will be reduced,
available within the system’s life cycle. If
and misunderstanding caused by emo-
one factor decreases, in consequence the
Active Conclusions
tional level feelings will be minimised.
system’s benefit for all is also reduced.
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.
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
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.
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.
Ilse Hellemann | General Practitioner,
Medical University of Graz, Steirische
Akademie für Allgemeinmedizin, Austria
Email: ilse.hellemann-geschwinder@
J U L Y 2 0 0 8
N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
Well educated and trained staff will be
meduni-graz.at
in a much better and independent posi-
Equation
tion, defending erosion of the right on
The following equation will illustrate this
individualism of their patients and to with-
concept in a simple way: sustainability is a
stand the pressure coming from politics,
product and a main parameter to measure
economy or patients claims. These fam-
efficiency and stability of processes in an
13

IMPROVING HEALTH
INDIGENOUS HEALTH
OCCUPATIONAL HEALTH
American Indians and Alaska Natives
in Health Careers
In many parts of the world indigenous people do
Noise Pollution
in Pakistan
not receive high quality healthcare. This is certainly
Noise pollution or sound pollution actu-
the situation in the US, where American Indians
ally means a sound which irritates or
and Alaska Natives and other minorities receive
annoys the individual. In other words, it
less and lower quality healthcare than the rest of
exceeds the standard normal decibel of
the population. Consequently, American Indians
hearing threshold which leads to stress-
and Alaska Natives have the lowest life expectan-
ful sound, thereby damaging the ears
is unavoidable. It includes construction
cies in the US or any nation in the Western Hemi-
and subsequently causing stress factors
workers, farmers, police personnel, fire
sphere, except Haiti. Compared to other Americans,
which lead to elevated blood pressure and
fighters and musicians. The International
the death rates for American Indian are 400-700
irritability. In terms of audiology, sound is
Labour Organisation (ILO) does not permit
percent higher for diabetes, tuberculosis and other
measured by a unit called the decibel. The
workers working an eight hour shift for
chronic diseases.
normal speech varies between 60-65 deci-
more than six months above 100 decibel
bels. An increase of three decibel doubles
noise exposure. ILO advices a change of
One of the reasons that American Indians and Alas-
the sound. Heavy traffic sound reaches 90
job or place to avoid noise pollution.
ka Natives have poor healthcare outcomes is be-
decibels. A sound wave measuring more
The Federal Aviation Administration (FAA)
J U L Y 2 0 0 8
cause 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.
than 100 to 120 decibels is equal to a
bomb blast sound.
Karachi
Karachi is a cosmopolitan city in Pakistan;
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
N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
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.
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.
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 col-
• Links to resources, such as national health pro-
Impact
lege students regarding hazards of loud
fessions organisations, indigenous organisations
Noise pollution causes significant health
music and use of headphones.
in healthcare and the health professions, sources
problems, leading to the damage of the
• Singers and music entertainers should
of scholarships, and student organisations.
hair cells of the cochlea, which can result
be informed about hearing problems
in irritability, stress and tension. It can
caused by loud music.
Jane Westberg | Clinical Professor, Family
even lead to heart problems and high
Medicine, University of Colorado, USA
blood pressure. People get tired and have
Kaleemullah Thahim | Assistant
Email: jwestberg@mac.com
difficulty concentrating. The working
Professor, Consultant Ear Nose Throat
potential of the individual is decreased.
Surgeon, Karachi, Pakistan
Hearing loss occurs in places where sound
Email: kaleems92@hotmail.com
14

INTEGRATING MEDICINE AND PUBLIC HEALTH
Policy and Advocacy Integration
into Training
As we write this article, the resounding
words of one of my Network: TUFH (African)
colleagues is triggered. He asked, “What
do you mean when you say ‘Integration
of Public Health and Medicine’”. As we
proceeded to explain to him the current
movement to integrate the concepts and
principles of public health in undergraduate
and graduate medical curriculum, he
politely stopped us by asking the simple
question “Don’t all doctors do that”. His
question informed us that medicine has
once again come full circle, within a system
of care, to affect population outcomes and
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.
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
an active investigation of current policies.
The policies may be structured within the
framework of an organisation, agency, clinic,
hospital, and/or within the local, state,
or federal Government.
Competencies
The American College of Graduate Medical
Education has restructured the paradigm
of residency education to focus on competencies
and outcomes (www.acgme.org/
outcome/comp/GeneralCompetenciesStan
dards21307.pdf, retrieved June 10, 2008).
The Systems Based Practice competency
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.
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.
Advocacy for Expanded Social Services
Delayed discharges and subsequent overcrowding
of the emergency department
We must also
train residents
to see what
aspects of the
patients’ lives
might hinder
their ability to
comply with
the physicians’
treatment plan.
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.
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.
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
J U L Y 2 0 0 8
N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
15

COMMUNITY ACTION
COMMUNITY INTERVIEW
Community
at the Heart
New brochure Education for Health
Education for Health (EfH) seeks/publishes
manuscripts that:
This interview was conducted with Lydia
Sometimes students do research in a com-
• address community-based education of
Nanjula, a medical student at the Mbarara
munity. Do you know of an example in
health professionals,
University of Science and Technology in
which the outcomes of that research had
• address community-based healthcare
Uganda.
positive results for your community
delivery,
Yes, I do. There was a research initiative in
• describe and evaluate collaborations
What was your experience with commu-
that same area. The needs of that particu-
between academia and health service or-
nity members, and with which community
lar community were assessed. There was
ganisations designed to promote community
members was that
an effort to establish the community com-
health,
I went for my COBES training to a small vil-
ponent in primary healthcare, and then
• address multi- and interdisciplinary
lage in the south western part of Uganda,
let the people of the community know
approaches to health professions education
called Rugazi. I mostly interacted with
that they can better their own health. The
and service delivery,
mothers, because I was more into chil-
community was told to choose their vol-
• address models and systems of education,
dren. They were very welcoming, because
unteers. These trained workers went back
research, and service delivery that link devel-
they acknowledged that they have com-
and they taught them to make a tap/jerry
oping and developed countries.
J U L Y 2 0 0 8
munity 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
can, for hand washing after using the
latrine. They also taught them how to conserve
firewood.
If you were in a leadership position, would
EfH informs clinical and
public health practitioners,
educators and
policy makers about
N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
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.
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
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
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
worker, a teacher, a medical student, to
at hospital level, and nothing was done
practice and medical education,
finally come up with a report.
at community level, I would always have
• global health workforce,
We first chose a topic, then shared roles
a high patient load. But if I went to the
• multidisciplinary health professions
among the four of us. So if today we were
villages and told people to just wash their
education,
to give a public health talk, and I am in
hands; this is something very basic, but it
• partnerships between health system stake-
charge, I would be the one to get the com-
solves a lot when you just prevent diseases
holders for disease prevention and control.
munity together, prepare the topic and
through health education.
research.
Submission information:
www.educationforhealth.net
16

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
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.
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,
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.
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!
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
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
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.
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.
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.
Jaime Gofin | Associate Editor PERC; Director
Community-Oriented Primary Care, School Public
Health & Health Services, George Washington
University, USA
Email: sphjxg@gwumc.edu
J U L Y 2 0 0 8 N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
17

International health professions education
INTERPROFESSIONAL EDUCATION
Collaborating
Across Borders
In October 2007, the University of Minnesota
e-learning component. Many presenters noted
could be used to communicate that impact to
convened Collaborating Across Borders:
that flexibility - both in curriculum develop-
policymakers. Research questions may focus
An American-Canadian Dialogue on Inter-
ment and course planning - is key to develop-
on the association between teamwork and
professional Health Education, the first
ing new, interprofessional programmes.
quality of care, essential knowledge, skills,
American-Canadian conference of its kind.
and attitudes for teamwork and collabora-
The conference drew 300 people from the
Track 3: Through the Eyes of Students
tion, promotion of IPE through accreditation
US, Canada, UK, and New Zealand for a
Students have been successful in designing IPE
standards, and the best time in the curriculum
three-day meeting focused on bridging knowl-
models that have been adopted into the cur-
to introduce IPE.
edge, awareness and best practices in inter-
ricula, as well as service-learning experiences
professional education (IPE). The University
outside the curriculum. Examples include: stu-
Track 7: New Models of Care|Communities of
of Minnesota partnered with the Canadian
dent run clinics, interprofessional policy and
Practice
Interprofessional Health Collaborative (CIHC)
case analysis, and pre-health interprofessional
Emerging research in new models of care is
to design the conference. Conference goals
courses. Students recommended peer educa-
demonstrating improved patient outcomes,
included: showcasing American and Canadian
tion; progressive curriculum development; sup-
shorter patient stays and improved communi-
J U L Y 2 0 0 8
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.
port 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.
cation and learning among health professionals
and students. The core themes supporting
the development and successful implementation
of new models of care include:
• orienting new partners and giving them
N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
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 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
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.
noted a trend toward devices that are smaller,
Track 2: 21 st Century Technology-Enhanced
faster, cheaper and more mobile. They dis-
For more information about the 2007
IPE
cussed the use of portals to manage, cus-
Collaborating Across Borders conference,
Showcased were a range of innovative learn-
tomise, personalise, and make information
please visit www.ipe.umn.edu and click the
ing opportunities, including a web-based
transportable.
‘Collaborating Across Borders’ logo.
learning module that employs educational
games, Team Objective Structured Clinical
Track 6: Addressing Barriers through Policy
Barbara Brandt | Assistant Vice President
Examinations (TOSCEs), an online case study
Development
for Education, University of Minnesota
resembling real-life experiences, and tradi-
Several presenters identified the need for
Academic Health Center, USA
tional face-to-face courses that integrate an
further research on IPE’s impact and data that
Email: brandt@umn.edu
18

Interprofessional Education:
A Personal Perspective
Interprofessional education (IPE) has been
only minority educators have dared to
described in as many ways as there are
engage in IPE while the rest still wallow in
attempts to implement it. The most recog-
their singular, isolated professional prac-
nised definitions, particularly for European
tice. The majority ridicule those who try to
and Western countries, have been sum-
look for answers of complex healthcare from
marised in a report by Della Freeth et al. on
a broader interprofessional perspective.
A critical review of the evaluation of
Consequently, the general consensus among
Interprofessional Education commissioned
those who have accepted IPE as a future
by learning and teaching Support Network
reality is that it is still far from solving the
Health Sciences and Practice from the
real challenges of complex healthcare issues
Interprofessional Education Joint Evaluation
Professor Ratie Mpofu
such as mental health, HIV/AIDS pandemic
published in May, 2002. It emphasises
and health promotion in general.
shared problem solving and collaborative
common site for interprofessional clinical
decision making particularly in complex
practice or a service learning module has to
My personal experience is that for IPE to
health problems.
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.
Attempts to train generic workers have had
little success, and more recently, IPE has
be developed since objectives are seen to
overlap more in practice than in theory.
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 out-
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.
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.
For all professions to learn together for the
benefit of the clients and communities they
serve, changes have to be made at curricula
J U L Y 2 0 0 8 N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
been seen as an acceptable alternative
comes and competences in line with their
and professional attitude level. Finally, the
since it does not challenge professional
international partners without reference to
willingness to analyse and participate in
identity. IPE requires several approaches,
the growing interprofessional practice need-
this process no matter what profession one
such as more than one profession learning
ed for comprehensive healthcare in under-
comes from is the key to the success of IPE.
together using the same learning materials,
developed countries.
tutors and time tables with the aim of
Ratie Mpofu | Dean, Faculty of Community
achieving the same goals. The assumption
More recently, the definitions of interprofes-
and Health Sciences, The University of the
is that there is generic knowledge and skills
sional practice and collaborative practice
Western Cape, South Africa
which each profession should have, without
have been addressed by the WHO Working
Email: rmpofu@uwc.ac.za
losing professional identity. Further, a
Groups, of which I am a member. However,
19

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.
Grassroots
Partnership in Vietnam
This article describes a model of a commu-
interventions. Stakeholder meetings gave
The other side of the problem was in the
nity collaboration in which young teaching
opportunities for community members to
medical schools; their teaching staff had
staff at the Faculty of Public Health, Hanoi
contribute their ideas to the plans.
little experience of health problems at
Medical University (HMU) learned how to
village level and of how the rapid social
work with grassroots health workers. The
In the second phase the same groups
changes affect them. The teachers bring
objectives of the programme were to build
planned one intervention each, using an
students to the community and need to
both capacity of teaching staff for working
evidence-based approach and the first
know how to work in a participatory
with communities, and capacity of local
phase results. During the six-month imple-
way with the local people responsible for
health workers and volunteers to identify
mentation period, the HMU teachers and
health. To involve the local health staff
J U L Y 2 0 0 8
and address local health problems related
to social changes.
Courses
HMU worked with three communes in a
district staff provided supervision, not only
to support the VHW and commune health
staff but also for their own learning.
Discussion
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
N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
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.
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
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
to involve local health staff and VHW to
of Needs. Health Policy and Planning,
During the first course, the VHW collect-
identify local problems and find appropri-
19, 336-345.
ed evidence to identify health problems
ate and feasible solutions to them. The
in their communes, then prioritised and
programme followed the systemic capaci-
Dr. Luu Ngoc Hoat | Head, Biostatistics
selected topics for action research. During
ty-building model developed by Potter and
Department, Faculty of Public Health,
the second course, the trainees developed
Brough (2004), based on their experience
Hanoi Medical University, Vietnam
research plans and quantitative and quali-
in the Indian health sector, with support to
Email: luungochoat@hn.vnn.vn
tative data collection tools. They analysed
the four elements of the capacity pyramid:
the collected during the third course, when
structures, staff, skills and tools.
they also wrote reports, including proposed
20

Embedding Indigenous
Perspective in Health Curriculum
With the health of Australia’s Indigenous
development of media-based learning
peoples amongst the worst in developed
resources within selected units, integration
nations, and the health disadvantage of
of Aboriginal and Torres Strait Islander per-
Student learning has been impacted posi-
Indigenous Australians so devastatingly
spectives within assessment in theory and
tively across 26 units at both undergraduate
apparent, the importance of appropriate
practicum units, and self assessment activi-
and postgraduate levels, with over 7,700
training for health professionals has never
ties for students to reflect on their learning.
students each year enrolled in the units that
been more salient.
The Yapunyah Project reflects an explicit
have been redeveloped to include Indigenous
strategy to systematically promote students’
perspectives. The self awareness and per-
The Yapunyah Project was an initiative of the
understanding and appreciation of
sonal development that students experience
Faculty of Health at the Queensland
Aboriginal and Torres Strait Islander per-
through their engagement in the learning
University of Technology, instigated as a
spectives and competence in providing cul-
activities of the programme provide a basis
result of ethical, clinical, accreditation, and
turally safe healthcare to health consumers
for their learning outcomes beyond gradua-
regulatory imperatives to develop cultural
of Indigenous backgrounds. The project
tion and into their professional lives. This has
competence in health graduates with respect
aimed to facilitate the development of pro-
been facilitated by the integration of the
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 Campinha-
Bacote (1998) and Cross, Bazron, Dennis &
Isaacs (1989). It was also informed by the
cultural safety reforms to health curricula in
New Zealand.
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
fessional competencies that are fundamental
to the provision of care that promotes
optimal health outcomes for Aboriginal and
Torres Strait Islander people.
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.
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 num-
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.
References
CAMPINHA-BACOTE, J. (1998). The Process
of Cultural Competence in the Delivery of
Healthcare Services (3 rd 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:
J U L Y 2 0 0 8 N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
Movements) and one biomedical unit offered
ber of selected units;
Georgetown University Child
by the Faculty of Science. The experience has
• the integration of Aboriginal and Torres
Development Centre, CASSP Technical
been a challenging and positive one, and the
Strait Islander perspectives within assess-
Assistance Centre.
reforms have been supported by a sustain-
ment in theory and practicum units;
able framework.
• the development of a purpose-built web-
Robyn Nash, Sandra Sacre and Beryl
site and media-based learning resources
Meiklejohn | Faculty of Health,
Key elements of the strategy included the
for use across the faculty and in specific
Queensland University of Technology,
explicit identification of expected learning
units; and
Australia
outcomes, the streamlining of content/
• tutorial and self assessment activities for
Email: s.sacre@qut.edu.au
learning activities within selected units, the
students to reflect on their learning.
21

INTERNATIONAL DIARY
Diary 2008
Annual International Conference of
Conference - A Celebration of Diversity.
Internet: www.primafamed.ugent.be
The Network: Towards Unity for Health
Organised by Royal Australian College of
27 September - 2 October, 2008,
General Practitioners and World Organiza-
20 - 21 November, 2008, Maastricht,
Chía-Bogotá, Colombia
tion of Family Doctors (WONCA).
the Netherlands
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:
email: wonca2008@meetingplanners.com.
au; Internet: www.wonca2008.com
25 - 29 October, San Diego CA, USA
APHA annual meeting. Organised by
American Public Health Association
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
Post-Conference Excursions:
(APHA). Further information:
Education, P.O. Box 616, 6200 MD
October 3, 2008:
email: comments@apha.org;
Maastricht, the Netherlands;
Health Centre Aqua de Dios
Internet: www.apha.org/meetings/
tel: 31-43-3885626; fax: 31-43-3885639;
October 3 - 5, 2008:
email: she@oifdg.unimaas.nl;
Valledupar - Sierra Nevada de Santa Marta
31 October - 5 November, 2008,
Internet: www.she.unimaas.nl
J U L Y 2 0 0 8
Further information: Network: TUFH Office,
P.O. Box 616, 6200 MD Maastricht,
the Netherlands; tel: 31-43-3885638;
fax: 31-43-3885639;
San Antonio TX, USA
AAMC annual meeting. Organised by
Association of American Medical Colleges
(AAMC). Further information: Internet:
www.aamc.org/meetings
21 - 24 December, 2008, Ismailia, Egypt
10 th International Workshop on Human
Resource Development in Health Management
& Leadership. Organised by Center
N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
email: secretariat@network.unimaas.nl;
Internet: www.the-networktufh.org/
conference
1 - 5 October, Melbourne, Australia
2008 Wonca Asia Pacific Regional
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/
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;
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 informa-
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
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
conferences/conferences.asp
tion: email: conference@globalhealth.org;
Life Sciences, Maastricht University,
Internet: www.globalhealth.org/conference
Maastricht, the Netherlands. Further
15 - 19 March, 2009, Ismailia, Egypt
information: School of Health Professions
23 rd International Workshop on Commu-
5 - 8 June, 2009, Hong Kong, China
Education, P.O. Box 616, 6200 MD
nity-based Education Incorporating
Wonca Asia Pacific Regional Conference -
Maastricht, the Netherlands;
Problem-based Learning, Innovative
Building Bridges. Organised by World
tel: 31-43-3885611; fax: 31-43-3885639;
Approaches. Organised by Center for
Organization of Family Doctors (WONCA).
email: she@oifdg.unimaas.nl;
Research & Development in medical
Further information: Internet:
Internet: www.she.unimaas.nl
education & health services, Faculty of
www.wonca2009.org
Medicine, Suez Canal University (FOM/
22

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.
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 physi-
Queens Medical Centre
cal, mental and social well being and not
merely the absence of disease or infirmity”.
easily accepts issues on general body health
psychiatry and community mental health
Hence, when considering the general well-
while matters on mental illness are treated
education in Nigeria was in 1954, when a
being 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.
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.
A brief story: a fellow medical student of
mine was on her way to the psychiatric
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.
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
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.
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
J U L Y 2 0 0 8 N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
hospital when she decided to hail a cab
that apart from genetic predispositions to
in its initiation. Apart from community
going via that route. She was then asked by
mental disorders, we are all predisposed to
mental health education, the need to estab-
the cabman where specifically she wanted
a decline in our mental health; it should not
lish population-based treatment and care is
to be dropped off and when she mentioned
be attributed to cultural phenomenon and
also very vital.
the hospital the cabman blatantly refused
perceived enemies in their locality. There is
to take her there.
hence a necessity to integrate this in vari-
Igwilo Ugonnaya Ugochineyre | SNO
ous organised healthcare programmes.
African Representative, College of Health
This may be attributed to the poor knowl-
Sciences, Igbinedion University, Nigeria
edge of mental health due to inadequate
Mental Healthcare Programmes
Email: chinyerehumphrey@yahoo.com
mental health education. The community
The earliest account of community
23

STUDENTS’ COLUMN
STUDENTS’ SPEAKERS CORNER
Network: TUFH Institutions
Welcome Maastricht Students
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.
J U L Y 2 0 0 8
N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
24
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!
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
Ms. Annemarie van der Kolk with her supervisor Dr. Mohamed Moukhyer
should involve the community to get greater After three months of many, many spoons
insight into their needs. In the long-term, a of sugar (they like sweets a lot!), busy markets,
climate of openness concerning sexuality
incredibly crowded bus stations, sev-
and related matters should be encouraged. eral death experiences due to crazy traffic,
This approach might change opinions on sex interesting conversations regarding religion
and use of condoms. Islam is an important and a lot of sunshine I travelled back home.
factor, since this religion has a big impact I gained many experiences and will certainly
on people’s beliefs and behaviour policy never forget this country!
making. This religion should be intertwined
with HIV/AIDS prevention.
Annemarie van der Kolk | Student, Faculty
of Health, Medicine and Life Sciences,
This last recommendation on integration of Maastricht University, the Netherlands
Islam is a very important one. During my Email: annevdk@hotmail.com
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 Geriatric Depression Care
remember the first time I was in the room in Rural Illinois
and suddenly everyone got up, grabbed a Because of a change in the medical curriculum
prayer mat and started to pray!
at Maastricht University, the Maastricht
Faculty of Medicine (now Faculty of Health,
The research itself was quite difficult. It happened
Medicine and Life Sciences) was in need of
several times that I managed to make more off-campus clinical and research
an appointment with someone and travelled opportunities for their 6 th year medical students.
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 During the Network: TUFH Conference in
have an appointment with they replied: Australia, we started to talk about sending
“No, he is not here, we do not know of any some of those students to the College of
appointment...”. You have to be very patient Medicine at Rockford, University of Illinois,
and persistent. But although it was hard, I USA. Our students do not have a research
did manage to write my research report. requirement; in their senior year they have

several electives, so a lot of the time they
project was on the assessment and treat-
are away from Rockford. We always have a
ment of depression in older adults in rural
number of research projects, but not
Illinois. I grew up on a farm in a small rural
always a lot of students around. Therefore,
community in the Netherlands, and geriat-
it was handy for us that Maastricht stu-
ric medicine has always drawn my atten-
dents could help us with the projects; and
tion; therefore, this project was perfect for
we helped them gain experience.
me. Rural medicine gets special attention
at the University of Illinois in Rockford.
Lieke Vogels came in October 2007, for the
There is a special programme for rural
18 week research participation. It is impor-
medical students, so it was the perfect
tant to have 18 weeks; you need this time.
location for this project.
We did a project on what primary care doctors
know about and how they treat
Throughout this experience, I have realised
depressions in older people. Ten years
that management of geriatric depression
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.
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.
Michael Glasser | Associate Dean,
Centre for Rural Health Professions,
College of Medicine at Rockford,
University of Illinois, USA
Email: michaelg@uic.edu
As a 6 th year Dutch medical student, I
went all the way to Rockford, Illinois for
my research participation. My research
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.
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
Lieke Vogels / Student, Faculty of Health,
Medicine and Life Sciences, Maastricht
University, the Netherlands
Email: liekevogels@hotmail.com
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.
J U L Y 2 0 0 8 N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
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.
EC Intelligence:
Ian Cameron
In April 2008 the Australian Government
health systems, and at all levels including
held a 2020 Summit. The planners invited
policy makers, practitioners and health or-
1000 people who were described as Aus-
ganisations, as well as academics and com-
tralia’s brightest and best, to spend an un-
munity. I think that since the merger, we
funded weekend discussing what Australia
have not taken full advantage of the op-
should look like in 2020, and what needed
portunities offered by the inclusion of
to be done to get there. Streams included
TUFH, and we still have a chance to maxi-
such areas as productivity, governance, so-
mise these opportunities.
cial inclusion, creativity, health, rural communities,
Aboriginal and Torres Strait Is-
Recently I was talking with a wise and
lander peoples, security, and the economy.
eminent doctor about rural health work-
J U L Y 2 0 0 8
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 plena-
force. 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
Dr. Ian Cameron
The Network: TUFH is widely known, but
we could be better at letting people know
N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
ries, 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
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
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.
changes will largely come from outside the
keep me going. We need to add to that the
And we need to ensure that the Network:
health sector, but that we all have our role
wider partnership theme. This has already
TUFH community remains one that cares,
to play and to share. However, The Net-
been happening with closer ties to colle-
shares, develops and is enjoyable.
work: TUFH has for many years concentrat-
giate organisations including Wonca, the
ed on the education side of development.
Wonca Rural Working Party and the Wonca
Ian Cameron | Executive Committee
Africa regional group. The recent co-signed
Member; CEO NSW Rural Doctors Network
The merging of The Network with TUFH
editorial in the British Medical Journal on
Email: icameron@nswrdn.com.au
gave exciting possibilities to the new or-
vertical health funding is a great example.
ganisation in moving beyond an academic
The ongoing relationship with GHETS is
focus to being more inclusive of others in
another.
26

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).
Dr. Khalifa Elmusharaf was awarded with the 2007
Tamas Fülöp Award
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.
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.
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.
Please sign our petition in support of improving the primary healthcare
around the world: www.15by2015.org
Tribute to…
At the occasion of the Network: TUFH’s 25 th 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.
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.
During the General Meeting in Kampala, Uganda in September
2007 the 2 nd 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.
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.
J U L Y 2 0 0 8 N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
27

Member and organisational News
TASKFORCES
Mini-Grants Supporting
Women and Health Learning Package
Global Health through Education, Training
shop for Promoting Women’s Health Learn-
New Taskforce:
and Service (GHETS) awarded in 2007 a
ing for Malaysian Health Professional
Social Accountability and
total of $10,000 towards mini-grants (each
Students scheduled for next year.
Accreditation
is no more than $3,000) to support the use
The new taskforce is chaired by Robert Wool-
of the Women and Health Learning Pack-
In South Africa’s Gauteng province, Todd
lard, Canada (woollard@familymed.ubc.ca),
age (WHLP). Each year, the grant proposals
Maja has recognised the need for health
and Charles Boelen, France (boelen.charles@
are reviewed by the Women and Health
education curricula to be developed among
wanadoo.fr).
Taskforce. In 2007, the taskforce chose
youth care centres in order to address the
four recipients who submitted innovative
increasing number of youth engaging in
Its aim is promotion of social accountability
plans for approaching women’s health top-
risky behaviours.
principles and methods with aims:
ics through a variety of different avenues:
• to orient education, research and health
By conducting workshops among health-
service activities of educational institu-
In Uganda, GHETS funded Sarah Kiguli to
care providers and students serving as peer
tions to better respond to people’s priority
J U L Y 2 0 0 8
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
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
health needs; and
• to develop relevant evaluation and accreditation
standards and processes.
The taskforce objectives are:
N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
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
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
• 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.
surrounding women’s health at health pro-
of partnership for increased awareness on
fessional schools as well as NGOs.
women’s health issues among churchbased
networks as well as arm individuals
After taking part in the drafting of a for-
with the necessary skills for facilitating
mal educational module on women’s
further workshops in the future.
health at a meeting several years ago, she
hopes to incorporate the WHLP as a key
Jessie Rothstein | Global Health through
component of this curriculum and to ex-
Education, Training and Service (GHETS),
pand its scope to the national level. These
USA
efforts will culminate in a National Work-
Email: jdr@ghets.org
28

Projects
Related to Care for the Elderly
Molly Eriki from Uganda (jajjashome@
Akye plans to work with his colleagues in his
mend that care of the elderly be part of the
mildmay.or.ug) reported on an innovative
family practice to find ways to provide home
undergraduate medicine curriculum.
programme in Uganda, in which grandpar-
care for the older adults in their practices.
ents are care givers of children with AIDS.
This approach will also create learning op-
Larry Chambers from Canada (lchamber@
‘Clubs for Grandparents’ were set up in 14
portunities for undergraduate medical stu-
scohs.on.ca) outlined projects of the Elisa-
of the 80 districts of Uganda. NGO funding
dents.
beth Bruyère Research Institute (EBRI). The
was used to hire volunteer coordinators who
EBRI website provides brief overviews of its
recruit volunteers identified by local health-
Suman Gadicherla from India (suma-
research programmes that cover care of the
care centres and parish officials to run these
namogh@gmail.com) reported on Indira
elderly, including the cardiovascular health
clubs. The clubs typically support 40 to 50
Gandhi National Open University, School of
awareness programme (www.chapprogram.
grandparents each week.
Health Sciences offering post graduate di-
ca), palliative care, CanDRIVE (a research
ploma courses, which is of one year duration,
programme to improve clinical decision-mak-
A number of activities are offered at the
for medical graduates i.e. to those who have
ing related to keeping older drivers driving),
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 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.
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
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.
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.
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 pro-
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.
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
J U L Y 2 0 0 8 N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
focus on geriatrics.
gramme, where they conduct a community
Conference in Colombia in 2008. Elderly
environmental scan focusing on prevention
Care taskforce members are invited to partic-
The Help Age Ghana long-term care home
and health promotion. Some exposure to
ipate in planning the session by contacting
and a few veteran homes are the only facili-
care of the elderly may arise but this is not
Larry Chambers and Dawn Forman (dawn.
ties, and therefore virtually all older adults
emphasized by the CBES. Students also are
forman@btinternet.com) (leader of the task-
must stay at home when they become frail
involved in the palliative care hospice in
force on Interprofessional Education).
and more dependent. As more and more city
Kampala that includes outreach home visits.
dwellers spend time at work, they have less
The School of Medicine is presently conduct-
Larry Chambers | Taskforce Care for the
time to care for their homebound parents
ing a review of the undergraduate medicine
Elderly
and/or grandparents.
curriculum. As Registrar, Joan will recom-
Email: lchamber@scohs.on.ca
29

Member and organisational News
REPRESENTED AT INTERNATIONAL MEETINGS/CONFERENCES
J U L Y 2 0 0 8
N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
30
The Network: TUFH is being represented at meetings and conferences all over the
world. Here is a report of one of our representatives.
Frontline Medicine:
From Natural Disasters to Daily Care
WONCA 8 th 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.
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 (ICE-
MEN) in Sudbury Ontario, June 8 to 14,
2008: http://normedsps.lakeheadu.ca/
icemen/default.aspx
• WONCA Rural Health members will
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 8 th 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 35 th 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.
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.
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.
Little did I know then that this was just
barely the beginning, and that it would
take years and many miles more on the
‘You don’t find the tango. The tango finds you.’
dance floor to get even close to mastering likely Afro-Argentines and Afro-Uruguayans
who originally came over as slaves.
the dance. Nor did I fully realise then how
it would change me and how far it would They brought with them African rhythms
take us, how many wonderful people we such as the candombe, and later, via Cuba,
would meet and wonderful times we would the habanera. These two rhythms form the
have.
earliest origins of the milonga; a dance
predecessor of the tango.
So exactly what is it about the tango that
hooks people How is it that someone As the century progressed, immigrant
like me, who had never done any couple dockworkers from Italy, Germany and elsewhere
in Europe arrived in Argentina in
dancing per se and never even thought of
myself as a good dancer, became addicted great numbers. Living in the poorer barrios
to and adept at a dance so intricate and (neighbourhoods), they brought their own
complex as the Argentine Tango - that now music and instruments, and through mixing
with the residents of the nearby black
I am even teaching it to others
barrios, the tango was born.
The answer is complex and mysterious, but
I think the best explanation I can give is It is said that to become an expert at
that it combines so many things I love into something (anything) requires doing it for
one activity: nice music, hugs, a bit of theatricality
and spontaneity with a physical over my ten-year tango journey, I can say
ten years or 10,000 hours. Looking back
challenge. Combined with that you have a that I have probably become an expert,
unique opportunity to connect deeply - to but I also know how much more I still have
become one - with another human being to learn. It is difficult now to conceive of
for the three minutes of a song.
even a week going by without dancing two
or three times. Tango has taken me to unexpected
places, and in the process I have
Argentine Tango itself has a fascinating
history, going back perhaps as far as 150 made lots of friends and become part of a
years, with the form we are familiar with network of people all over the world who
evolving in Argentina and Uruguay just before
the beginning of the 20 th century. The I have heard there is some good tango in
share my passion…and speaking of that,
very first musicians and dancers were most Bogotá!
J U L Y 2 0 0 8 N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
31

Member and organisational News
ABOUT OUR MEMBERS
The Network
towards unity for health
J U L Y 2 0 0 8
Interesting Internet Sites
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
Newsletter Volume 27 | no. 1 | July 2008
ISSN 1571-9308
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
N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
32
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
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