The network - Towards Unity For Health

CONTENTS03ForewordPrimary Healthcare: Now More than Ever04 The Network: TUFH in Action04 Annual International Conference“This Group Represents a Support System like No Other” | Winning Posters | Jumping into the Deep for a Trial by Fire |Bogotá Briefing on Primary Healthcare | No Teachers or Students, Just Participants | The 2009 Conference07 Book ReviewAwakening Hippocrates08 Position PaperReview Position Paper on Interprofessional Education and Practice09 International Health Professions Education09 Leadership ColumnCreating a New Style of Medical Doctor10 Problem-Based Learning and Community-Based EducationEnhancing Medical Education and Scholarship in Uganda11 New Institutions and ProgrammesLast Year of the Maastricht Medical Curriculum: HELP and SCIP12 Yellow PapersAttitudes towards Computer Education in Medical Curriculum | Soft Skills Training in Malaysia14 Social AccountabilityPajarito Mesa: How a ‘Little Bird’ Took Flight15 The Like-Minded Working TogetherGlobal Health Education Consortium16 Medical EducationConsortium for Longitudinal Integrated Curricula | JMHPE: Third Group of Graduates17 Improving Health17 Health AuthoritiesWhat Would I Change if I Were Minister of Health? | Health Reform in Colombia19 Women’s HealthPreventing Paediatric HIV in Rural South Africa20 Indigenous HealthTraditional Medicine Mapped21 Health PromotionOral Health Promotion in South Africa22 Students’ Column22 Out of the SNO PenHow to Become an Effective Leader of Change22 Students’ Speakers CorneWelcome Back Kenya23 Student InterviewThe Big Five24 Member and Organisational News24 About our MembersExperiences in the Eastern Mediterranean Region | Re-Assessing Full Members | New Members | InterestingInternet Sites | Family Medicine and Primary Healthcare in Africa27 TaskforcesInterprofessional Education Taskforce: An Update | Taskforce Care for the Elderly Gets New Chair | Introducingthe Taskforce Social Accountability and Accreditation29 Represented at International Meetings/ConferencesExpanding Horizons in Medical Education30 Introducing MembersNorthern Ontario School of Medicine31 International DiaryDiary 200932 About our MembersTribute to... | Moving On: Changes in Institutional Leadership

THE NETWORK: TUFH IN ACTIONANNUAL INTERNATIONAL CONFERENCENo Teachers or Students,Just ParticipantsD E C E M B E R 2 0 0 8N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 76Paulo Marcondes Carvalho surrounded by students during the Dinner & DanceIn the past I had the opportunity to attend Mayor, always kind and supportive in theirthe Network: TUFH Conferences in New yellow jackets. The visit to University of LaMexico and in Londrina. This year I was Sabana showed us an audacious university,invited by FAIMER; I was very happy with this fully prepared to face new millennium needs,invitation, because attending previous but settled and in respect of their tradition.Network: TUFH Conferences had been highly My group also visited the health facilities ofvaluable to my career as a medical educator; Ciudad Bolivar, a large place with a lot ofI am still using several skills and insights poverty and problems, but also with manyacquired there, mainly when I am part of an people who are concerned with helping eachorganising scientific committee (for example, other and meeting local health needs.the poster session that we included recently The parties, dinners and reception offeredat the Brazilian Medical Education Congress). delicious food and were a lot of fun. Here wecould strengthen our friendships.I participated in a pre-conference workshop.There were few participants, but still it was At the Bogotá Conference I met many oldan amazing day! Because it lasted a whole friends, but I also interacted with many newday, we had the opportunity to discuss and people from all around the world. I also gotexplore the topic in-depth. And I made to know students, in my role as a mentor orfriends with whom I interacted during the just through casual conversation. It seems towhole Conference.me that this Conference knows no teachers orstudents, just participants. There is no hierarchyand all connections are made easily.In essence, the Network: TUFH Conferenceprogramme is intense and mixed. It coversmany key topics of the health sciences curricula,such as medical education, project cussed how to increase participation ofDuring the Latin-American meeting we dis-management, partnership, et cetera. Collectivediscussions and reflection moments are I think we must fight together to increaseschools from this region in a structural way.privileged; this is one of the few conferences Latin-American participation into Thethat I attended where concepts of active Network: TUFH. Let’s hope that many of uslearning are being used in practice. All participantsare responsible for the sessions, notcan be in Amman in 2009, including myself!only facilitators and key-note speakers.Paulo Marcondes Carvalho Junior |Other very strong key points this year were Marilia Medical School, Marilia, Brazilthe site visits and parties. All site visits were Email: paulo@famema.brsupported by the youth service of BogotáTHE 2009 CONFERENCEDuring October 10-15, 2009 The Network:TUFH will organise its annual Conference incollaboration with the Faculty of Medicine,University of Jordan. This Conference will beheld in Amman, Jordan.The theme of the Conference is Achieving Qualityin Health Care: Challenges for Education,Research and Service Delivery.After the Conference (October 16, 2009) youcan participate in the following Post-ConferenceExcursion: Mu’tah University, Karak, Jordan.Available from early 2009:Conference site:www.the-networktufh.org/conferencePreliminary programme:www.the-networktufh.org/conference/programme.aspRegistration:www.the-networktufh.org/conference/registration.aspAbstract submission (for Thematic PosterSessions):www.the-networktufh.org/conference/abstractchoice.aspProposal submission (for Mini-workshops orDidactic Sessions):www.the-networktufh.org/conference/abstractchoice.asp

BOOK REVIEWAwakeningHippocratesBook review of: Awakening Hippocrates:population growth, environmental events,A Primer on Health, Poverty and Globalethics, religion, and human rights.ServiceAuthor: Edward O’Neil, JrFollowing this display of information, thereISBN 1-57947-772-0, 502 pp.is then a shift of focus to give the readerexamples of physicians who have worked in“Never underestimate the ability of a smallparts of the world with the greatest healthgroup of committed individuals to changedisparities. O’Neil uses these vignettes tothe world. Indeed, they are the only onesdemonstrate the ‘power of direct action’.who ever have”.Some of these individuals are iconic fig-- Margaret Meadures for most health professionals: AlbertThis essentially describes the thesis of EdwardO’Neil’s book. His desire is to makethe case that as health professionals weshould all engage in a global work forceto improve health in the parts of the worldwhere others are less fortunate than we are.EngagementIn his first chapter O’Neil discusses theforces of disparity which propagate illness.He tells us that the greatest enemiesof good health are poverty and structuralviolence. O’Neil wants his readers and allhealth professionals to engage in not onlyunderstanding the disparities in health,but in becoming part of the solution. Hethen goes on to lay out the case for thecurrent state of health in the developingworld. He tells us there are three simpleobservations: the first is that most wealthycountries have “a large cadre of healthcareproviders whose healing powers now reachunprecedented levels”; the next, that ourprofession concentrates our knowledgeand skills for those who can afford them;Schweitzer, Tom Dooley, Paul Farmer. Allof their stories remind us that as individualswe can do something to improve thehealth of others.Primary CareFrom cover to cover, Awakening Hippocratesdoes stir up the reader’s emo-tions about the state of health and thetremendous disparities that exist aroundthe world. To that end, Edward O’Neil hasbeen successful. However, through his verydetailed and careful navigation of thesewaters he does neglect an important opportunity.There is no mention of the valueof primary care in improving health. BarbaraStarfield and other authors have repeatedlydemonstrated that evidence showsthat primary care helps prevent illnessand death, and that it is associated witha more equitable distribution of health inpopulations. This is a finding that holds inboth cross-national and within-nationalstudies. In addition, the means by whichprimary care improves health have beenidentified (Starfield, 2005).O’Neil. However, when one looks at theMillennium Development Goals, perhapsthe best opportunity to achieve them liesin the training of a primary care workforceof healthcare providers, to allow access tohigh quality care.O’Neil’s book is a wonderful compendiumof back ground information and inspirationalstories that should encourage healthprofessionals to work globally. Let us hopethat it will also serve as a catalyst for discussionsby policy makers about what hasworked, and what has not, to achieve quality,accessible healthcare for all.ReferenceSTARFIELD, B., SHI, L., & MACINKO, J.(2005). Contribution of Primary Care toHealth Systems and Health. TheMilbank Quarterly83 (3), 457–502.This review has been published before inEducation for Health, Volume 20, no. 3,2007.D E C E M B E R 2 0 0 8 N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 7and finally, that “there is an ethical imperativethat compels us to care for all whoSo although we must support the eradica-Alain J. Montegut | Department of Familyneed us”.tion of poverty and of structural violence,Medicine, Boston University Medicalwe must also work to truly strive for theCentre, United States of AmericaO’Neil reports to us about how we haveaccessibility of quality primary care for all.Email: jgravdalmd@gmail.comtried to improve health in the world throughThe funding that goes towards the verticalagencies such as the United Nations andpublic health programmes for disease con-many non-governmental organisations.trol - such as the fight to prevent malariaHe also examines the forces of disparityand tuberculosis - are having some impactlooking at e.g. trade, racism, governance,on health indicators as documented by7

THE NETWORK: TUFH IN ACTIONPOSITION PAPERThe Network: TUFH Executive Committee decided to undertake the writing of a series of ‘Position Papers’ on issues that areclosely 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 atNetwork: 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).Review Position Paperon Interprofessional Education and PracticeFrom my position as a practising nursefurnish themselves with the key attributesD E C E M B E R 2 0 0 8N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 7and visiting lecturer, I commend this paperfor its clarity of the current standing ofInterprofessional Education (IPE) and itsprovision in today’s academic and practicemarket place.Significant strides have been made andsolid foundations set on which to buildfurther great developments. Through theformation of student networks, focusgroups and taskforces, hand in hand withthe nurturing of strong collaborative links,IPE has been granted a valuable place onagendas in many significant boardrooms,both in the academic arena as in publicand private practice. Now is the timeto build further on these exciting andvaluable developments and to empowerstudents and those who work closely withthem to take charge and ownership, drivingthe strategy forward for the next generationof learners and workers.I echo the call for clinicians and practiceeducators, together with their students,to be prepared to embrace and learn fromeffective IPE experiences, and to expect tobuild them into programmes of academicstudy.I commend students who have gonethe extra mile to take charge of theirlearning through memberships of magnificentorganisations such as CAIPE andEIPEN, and initiatives such as the UKInterprofessional Student Network. What Iwould like to see is for this to be taken forwardto the next stage, where students notonly comply and expect to encounter IPE,required of professionals working togethereffectively toward a common aim.This aim is increasingly being underpinnedand rolled out through real life tangiblecase studies where students and academicstaff engage in learning from, with andabout each other and the subject mattersimultaneously. One such medium beingthe use of simulation to allow situationsto unfold and play out to various endingsachieved and determined by howthe learners interact and plan together toachieve a common goal.I commit my support to initiatives suchas this and to the valuable work beingundertaken by all parties and bodies inincorporating IPE in real terms into theacademic curriculum, and to practice educators,mentors and preceptors who ensureits incorporation into everyday workingpractice.I believe there is still a great deal moreto be achieved and it is essential that thecorrect people are empowered to drivethe initiative forward. I believe the futurerelating to IPE and this Position Paper issubstantial and inspiring.Nicholas Gee | Founding Member UKInterprofessional Student Network;Registered Nurse - Child; VisitingLecturer, Centre for Excellence inTeaching and Learning, BirminghamCity University; Senior Nurse, IntegratedDisabled Children’s Service, Derby CityPrimary Care Trust, United KingdomTHROUGH THEFORMATION OFSTUDENT NETWORKS,FOCUS GROUPSAND TASKFORCES,HAND IN HANDWITH THE NURTURINGOF STRONG COLLAB-ORATIVE LINKS,IPE HAS BEENGRANTED AVALUABLE PLACEON AGENDAS INMANY SIGNIFICANTBOARDROOMS, BOTHIN THE ACADEMICARENA AS IN PUBLICAND PRIVATEPRACTICE.but where they shape and plan it, relat-Email: nicholas.gee@bcu.ac.uking to their academic studies in order to8

INTERNATIONAL HEALTH PROFESSIONS EDUCATIONLEADERSHIP COLUMNCreating a New Styleof Medical DoctorThis article was based on an interview thatWhat is the curriculum like?Jane Westberg held with Camilo OsorioWe have a classical structure, but we areBarker (Dean of the Faculty of Medicine ofworking to integrate the basic sciencesthe Universidad de La Sabana in Chia,and clinical medicine. We have a compe-Colombia|camilo.osorio@unisabana.edu.co)tency-based programme that is sevenat the Network: TUFH Conference inyears long, including the internship. MostUganda as well as follow-up email com-schools in Colombia are only six yearsmunications. A longer version of the inter-long, but we want students to have time toview was published in Education for Healthdevelop a humanistic perspective.Volume 21, issue 2.Currently we are in the process of a cur-What was your pathway?ricular reform. Until one year ago, fourth-In 1978, when I was 17 years old, I beganstudying medicine at the UniversidadPontificia Bolivariana in Medellín(Colombia). After the internship, I had tospend a year in a rural practice. I went to asmall hospital in the rural mountains in myregion, where I became the director. Thenext year the governor asked me to direct abigger hospital, Santa Sofia de Fredonia.After working two years, I went back to myAlma Mater for four years as the first-evergeneral surgical resident. This was a verystressful, unpleasant time. It was very hierarchical.This made it difficult to have afriendly atmosphere in which to work as ateam. Since that experience, in every placethat I have worked, I have tried to create amore collaborative atmosphere. Now, atthe Universidad de la Sabana, I’m trying tocreate a collaborative atmosphere with thehelp of the faculty and staff.In 1993 I began working to create a universityhospital. I worked for seven yearson that project and was involved in allphases of the hospital, from its conceptu-Dr. Camilo Osorio BarkerThe general idea was to create leaders ofchange; a new style of medical doctor whothinks of patients as whole people. Therewas an attempt to understand humanbeings not only from a scientific point ofview but also from an anthropologicalpoint of view.My three goals were: to get accredited, toget the rest of our funding, and to consolidatethe academic programme, whichmeant developing graduate programmes.Accreditation is voluntary but we felt itwas very important. There are more than50 schools in Colombia, but only 13 areaccredited. When we were only 10 yearsold we became the youngest school ofmedicine in Colombia to be accredited.Now we have re-accreditation for six moreyears.year students who had just completed thethree years of basic science, had a wholesemester dedicated to family and communitymedicine. We still have such a semester,but now students will have this experiencein their twelfth semester. Studentswill be given opportunities to work in theschools, but they will also be able tochoose to work in other community settings.We think that if students have hadtime to develop basic competencies invarious clinical areas, they will be able toget more out of their community experience.At the same time, we think they willbe able to provide better services to thecommunity.What are your hopes and dreams for medicaleducation and healthcare in Colombia?Our big dream is to prepare new medicalprofessionals who have the skills and toolsto improve the health of our communitiesin our country and all of Latin America.These new medical professionals must bemedically competent, but they also needto be committed to treating people withdignity and seeing them as part of theD E C E M B E R 2 0 0 8N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 7alisation to the equipment and personnel.In 2001 I was asked to be Dean of theUniversity of La Sabana, which had beenestablished in 1994. I was reluctant toaccept the position, but saw that the universityhad an incredible programme and aclear future, so I accepted.One of the most important challenges hasbeen establishing our special identify. Wewant our graduates to be known not onlyas well educated in medicine, but as physicianswho have a special relationship withtheir patients and understand theirpatients’ problems in the context of thepatients’ family and community.family and community. Medical doctorsmust recover their historic role as positiveleaders of society.9

INTERNATIONAL HEALTH PROFESSIONS EDUCATIONPROBLEM-BASED LEARNING AND COMMUNITY-BASED EDUCATIONEnhancing Medical Educationand Scholarship in UgandaIn response to invitations from Dean Jeromeand the context of peoples’ lives. StudentsKabayenka and faculty from Mbararaspend their mornings with patients atWorking with faculty and students atUniversity of Science and Technologymaternal and child health clinics, the outpa-Mbarara University of Science and(MUST) - and with support from Globaltient department, the HIV/AIDS clinic, andTechnologyHealth through Education, Training andthe hospital unit. Afternoons are devoted toService (GHETS) - we spent eight eventfulcommunity activities which include provid-process of implementation, include obtain-weeks in Mbarara working with faculty anding health education in schools and assess-ing financial support from the Ministry ofstudents. During this time, we participateding living conditions and health hazardsHealth for residency stipends, equitablein MUST’s endeavours to train generalistduring home visits. They also visit birthsalaries, and incentives for those practicingphysicians, strengthen primary care research,attendants and other traditional healers,in rural areas, and faculty development withand provide community-based medical edu-health centres II and III, and community-emphasis on the importance of trainingcation (CBME). We focused our combinedbased nongovernmental organisations. Wegeneralist physicians to meet the needs ofD E C E M B E R 2 0 0 8experiences in public health research andfamily medicine on providing a boost tothese exemplary efforts to bridge the gapbetween the population-based approach ofcommunity health and the person-centredorientation of the generalist physician.were impressed by the students’ self initiativeand the way in which they organisedand reported these experiences.Mary Kay worked with Gad Ruzaaza, coordinatorof CBME, and Vincent Batwala onevaluation methods for the CBME experi-the communities and patients whom theywill serve. Other initiatives include sharingof resources such as curricula, educationalmodules, and research expertise throughcollaboration with the fledgling East Africanetwork of family medicine programmes;and developing decentralised training sitesN E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 7Our synergistic backgrounds converged aswe assisted five family medicine graduateswith their dissertations. Their projectsaddressed a variety of critical communityhealth problems such as: prevention ofmother to child transmission of HIV/AIDS,prevention of HIV/AIDS in adolescents, andpromotion of community involvement inplanning and implementing rural healthcareservices. Subsequently, these physicianssuccessfully defended their researchand received their Masters degrees inCommunity Practice and Family Medicine,thus increasing the pool of qualified familydoctors in southern Uganda.We also participated in CBME and COPCactivities at Rugazi Health Centre IV, 79kilometres from Mbarara. Over the pastence. They drafted educational objectiveswhich will be incorporated into the coursesyllabus and used as the basis for designingprocess and outcome evaluation instruments.Vincent gave presentations, reviewed curricula,provided mentoring, and identifiedstrengths and challenges pertaining to thefamily medicine programme at MUST. Healso spent time with Atai Omuruto andAnthony Musisi Kyayise at MakerereUniversity, reviewing curricula and the progressof the family medicine and communitypractice residency.Many of the challenges confronting thefamily medicine programme and CBMErelate to limited resources and scarce facul-in district hospitals, church supported hospitalsand level IV health centres.Throughout this profound experience, wewere inspired by the perseverance and competenceof the colleagues with whom weworked and the equanimity and dignity of thepatients with whom we interacted. Likewise,we were impressed by the academic initiativesat Mbarara and Makerere universities.These institutions provide valuable lessonsfor affluent countries as well as those withfewer material resources, as they strive toreduce the overwhelming burden of diseasethrough comprehensive primary healthcare.Vincent Hunt and Mary Kay Hunt |Professor Emeritus, Department of Familyseveral years, GHETS has provided fundingty. Family medicine also faces conceptualMedicine, Warren Alpert Medical Schoolto convert this centre into a teaching/difficulties especially when residents rotateof Brown University, USA - Adjunctpatient care facility which hopefully willthrough specialty services where objectivesProfessor, Department of Family Medicinebecome what has been termed ‘the firstfor their training may not be understood orand Community Health, University ofmodel peripheral training complex inappreciated. A significant constraint for theMinnesota Medical School, USA - ProjectUganda’. Medical and nursing studentsCBME programme is the increased cost ofManager, Wonca East Africa Initiative;from MUST and Makerere University train atliving for students and the additional drainSenior Research Scientist, Dana-Farberthis rural setting, immersed in clinical careon faculty in order to provide teaching,Cancer Institute & Harvard School ofand community health activities that eluci-guidance and supervision. Possible solu-Public Health, USAdate the close relationship between healthtions, which are being considered or in theEmail: vrhunt@comcast.net10

NEW INSTITUTIONS AND PROGRAMMESLast Year of the Maastricht Medical Curriculum:HELP and SCIPMedical students at the Faculty of Health,that students have to apply for their favou-conductor gives an advice for a grade. TheMedicine and Life Sciences of Maastrichtrite elective. The applications are transmit-final grade is determined by the Board,University follow a curriculum consistingted to the respective departments whichand is based upon an independent judg-of three pre-clinical bachelor years andare responsible for the organisation of thement of the portfolio and upon the advicethree master years of clinical training.selection procedure. A first selection isof the elective conductor.During the last year in the master phase -based upon written applications. If posi-after the required clerkships - studentsperform two electives, each of which takes18 weeks. These electives concentraterespectively upon participation in clinicalcare (HELP) and scientific research (SCIP).In the HELP, the student becomes juniordoctor, which will facilitate the transitionto the postgraduate phase. The student isresponsible for a number of patients.During the SCIP, the student participatesin the daily activities of the universityresearch institutes, and performs a selfdesignedresearch project. If appropriate,both electives can be combined to oneelective.Although the majority of the students preferelectives in the academic hospitalMaastricht or affiliated hospitals in theneighbourhood, a substantial number (onan annual base circa 50 students), selectan elective(s) in a foreign country. Whenstudents perform a clinical care elective ina foreign country, a proper knowledge ofthe native language is required.Adequate StreamingSince 2005, every year about 340 studentsfollow both electives. To allow anadequate streaming of students to theirfavourite elective, the Board of Partici-tive, students are invited for an interview.The advantage of this system is that itallows an ideal coupling of elective conductorand student. Indeed, the first canmake a proper selection out of severalcandidates; the second one is allowed torefuse a positive selection, for instancebecause (s)he prefers another offer. Ingeneral, over the last three years this systemhas worked very well. A back-up hadto be organised to mediate additionalinterviews for a limited number of studentsthat were not selected in the first round.Protocol and PortfolioBefore the start of each elective, studentshave to submit a written protocol forapproval by the Board. Students have todescribe – based upon a prior madestrength-weakness analysis – how theywill construct their elective (using theSMART principle).Regarding the competency developmentduring both electives, the Board hasadopted the seven CanMEDS domains,because they are also used in the postgraduateeducation phase. In order toevaluate this development, the junior doctoris evaluated permanently throughoutthe elective. The evaluation is based uponTHIS ORGANISA-TIONAL INSTRU-MENT IS IDEALLYEQUIPPED TOALLOW PROFES-SIONAL TRAININGOF STUDENTSIN THE TRANSI-TIONAL PHASEBETWEEN GRADU-ATE EDUCATIONAND RESIDENCY.EvaluationThroughout the last three years, all studentsand elective conductors have beenasked to evaluate this new system. Fromthis evaluation, it can be concluded thatthis organisational instrument is ideallyD E C E M B E R 2 0 0 8 N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 7pation Electives has chosen to build anseveral evaluation instruments, like shortequipped to allow professional training ofelectronic environment in which all theclinical observations (SCOs), 360º obser-students in the transitional phase betweenproposals for electives can be found. Tovations, critical appraisal of topics (CATs),graduate education and residency, respec-ascertain the quality of the offered pro-oral presentations, written reports (impor-tively post-graduation specialisation.grammes, all proposals for electives aretant for the research elective), studentscreened by the Board and have to bereflections, and reports of weekly discus-Luc Snoeckx | Chairman Board ofapproved before advertisement.sions. All this material is gathered into aParticipation Electives, Faculty of Health,portfolio, for which the student is heldMedicine and Life Sciences,The second measure taken in order toresponsible. At the end of the elective,the Netherlandsorganise adequate and fair streaming, isafter a conclusive discussion, the electiveEmail: l.snoeckx@fys.unimaas.nl11

INTERNATIONAL HEALTH PROFESSIONS EDUCATIONYELLOW PAPERSBetween those outstanding publications that were already published in leading journals, and some preliminary notes scribbled onthe last page of an agenda, there are also papers or reports that belong to the in-between (‘grey area’) category. Papers that, forwhatever reason, have not been published before. Within this ocean of ‘grey’ papers, there are some which by content are mostrelevant 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.D E C E M B E R 2 0 0 8N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 712Attitudes towardsComputer Education in Medical CurriculumIn many universities, computer education isintroduced and implemented in the medicalcurriculum. Computer utilisation is becomingessential for medical students in assistingtheir medical education, especially using theInternet as an important medical resource.Likewise, the use of computers in medicineis becoming indispensable and doctors mustbe prepared to use them.Since 1991, computers have been utilisedas part of the educational approach in theSchool of Medical Sciences (SMS), UniversitiSains Malaysia (USM), with the introductionof Computer Aided Instruction (CAI). CAIhelps medical students understand certainmedical subjects; it has also been used tosupplement or replace traditional methods,where the logistics for large student numbersare otherwise prohibitive (Ward et al.,2001). Recent curricular innovation has integratedthe electronic learning (e-learning)concept in years one to three.ResearchIn 2003, a self-administered questionnairewas issued to approximately 60 second-yearand 60 final-year medical students. Theaim was to find out what attitudes medicalstudents in year 2 and in the final year ofSMS had towards computer education, andwhether there was any significant differencebetween the two groups (it was assumedthat these two different groups may differ intheir attitude towards computer education).The data could give some input and assistthe implementation process of computereducation in the medical curriculum.The questionnaire was returned by 78%(n=47) second-year and 88% (n=53) finalyearmedical students. The study showedSubscales Year 2 Year 5Total group/mean (SD)/n Total group/mean (SD)/ntStatistic* p value*Computer education 47/20.9 (2.82)/ 44 53/19.0 (3.68)/ 50 2.88 0.005CAI lab 47/10.7 (1.98)/ 47 53/9.0 (2.38)/ 52 3.83

Soft Skills Trainingin MalaysiaThe concept of regarding patients as partnersin managing their own health is pivotalin the delivery of quality healthcare in the21 stcentury. Central to developing this part-nership is effective doctor-patient communication.However, numerous studies indicatewidespread deficits in doctor-patient communicationand interpersonal skills.Recognising the shortfall, the WorldFederation for Medical Education recommendedin 1994 that communication skillsshould be an essential component of medicaleducation.In Malaysia, one of the major weaknesses ofgraduates is the astounding lack of ‘softskills’ demanded by society and the competitivejob market (EPU, 2006). To addressthis lack, the Ministry of Higher Educationidentified seven ‘soft skills’; one of thesewas communication skills, which was alsoidentified as one of the important componentsthat lacked in the current humancapital of Malaysia (MOHE, 2006).Evidence-Based ApproachIn the bid to equip the students to face newchallenges and public expectations, theFaculty of Medicine, Universiti TeknologiMARA (UiTM) in Malaysia, took a step forwardby introducing a comprehensive, crosscurriculumcommunication skills training aspart of the ‘hybrid’, integrated and seamlessundergraduate medical curriculum. This wasto realise the Faculty’s mission to producecompetent doctors with solid scientific foundationimbued with strong humanistic valuesand soft skills.Following extensive literature reviews anddiscussions amongst the local experts, theFaculty chose the enhanced Calgary-Cambridge Guide to the Medical Interview(Kurtz et al., 2003; Silverman et al., 2005) asthe basis to formulate the cross-curriculumcommunication skills training. This enhancedguide identifies a total of more than 70 core,evidence-based communication process skillsCommunication skills teachingthat fit into the framework of tasks andobjectives. The group of researchers foundthat unless communication skills are integratedwith history taking, physical examination,and medical problem solving, learnersare unlikely to apply communication skillsthey have learned in real-life medical practice.The guide marries the ‘process’ and the‘content’ of the medical interview.The training programme was implementedfrom the academic year 2005/2006 acrossthe five-year undergraduate curriculum.Challenges and Future DirectionsAlthough great measures have been taken tostandardise the teaching framework andmethods, the greatest challenges remain inincreasing the Faculty’s teaching expertiseand inculcating positive attitudes towardscommunication skills teaching and rolemodelling.Yearly workshops are conductedto improve faculty skills.Improvement of the infrastructure, for example,building a communication skills laboratory,is well under way. There are also ongoingresearches in evaluating the effectivenessof the programme and assessing students’attitude towards communication skillslearning.ConclusionWith the current demand of quality healthcaredelivery, there is no doubt that communicationskills training should be integratedacross the continuum of the medical educationin consistent and effective ways.Research reveals that although communicationskills can be learned in medical schools,it also can be forgotten if training is not sufficientlytargeted and reinforced throughoutmedical education (Craig, 1992; Davis &Nicholaou, 1992).The experience in UiTM can provide a possiblemodel of cross-curriculum communicationskills training to be implemented in a developingcountry where resources and teachingexpertise in this field is limited.The Faculty has high hopes that it will realiseits mission to produce medical graduateswho are not only clinically competent, butwho are also imbued with strong interpersonalcommunication skills that will make adifference in the way medicine is being practicedin Malaysia.ReferencesCRAIG, J.L. (1992). Retention of interviewingskills learned by first-year medicalstudents: A longitudinal study. MedicalEducation, 26, 276-81.DAVIS, H., & NICHOLAOU, T. (1992). A comparisonof the interviewing skills of firstand final year medical students. MedicalEducation, 26, 441-7.ECONOMIC PLANNING UNIT (2006). NinthMalaysia Plan 2006-2010. The PrimeMinister’s Department, Putrajaya, 559.KURTZ, S., SILVERMAN, J., BENSON, J., &DRAPER, J. (2003). Marrying content andprocess in clinical method teaching:Enhancing the Calgary-Cambridge Guides.Academic Medicine, 78, 802-9.MINISTRY OF HIGHER EDUCATIONMALAYSIA (2006). Development of softskills module for institutions of higherlearning. Universiti Putra Malaysia.SILVERMAN, J., KURTZ, S., & DRAPER, J.(2005). Teaching and learning communicationskills in Medicine. Oxford/SanFrancisco: Radcliffe Publishing Ltd.Anis Safura Ramli | Corresponding author;Senior Lecturer & Primary Care MedicineDiscipline Coordinator, Faculty of Medicine,Universiti Teknologi MARA, MalaysiaEmail: rossanis_yuzadi@yahoo.co.ukD E C E M B E R 2 0 0 8N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 713

INTERNATIONAL HEALTH PROFESSIONS EDUCATIONSOCIAL ACCOUNTABILITYPajarito Mesa:How a ‘Little Bird’ Took FlightImagine for a moment what it would be liketo live in a community where the landscapeconsisted of miles and miles of dusty plainspeppered with humble, flat-roofed homes,and a climate too dry to support much morethan a sage bush here and there. And whatis more, imagine life there is quite challenging:no running water, no electricity, no sewage,no paved roads, no mail service and setapart from the conveniences enjoyed bypeople residing in the nearby modern city.The place I describe exists. It is the commu-Pajarito Mesa communityD E C E M B E R 2 0 0 8nity of Pajarito Mesa, a non-border colonialocated six miles south of Albuquerque(New Mexico, USA), at the rim of the maincity dump. A couple of years ago, residentsand attending physicians at the Universityof New Mexico (UNM), Department ofFamily and Community Medicine (F&CM)Mobile Clinic VanOver the course of the past couple years, ourdoctors have worked with the UNM LawSchool, the Southwest Organising Project (acommunity organisation), and with theAddressing Community NeedsA project of this magnitude has taught usmuch about the gap between the UniversityHospital setting and marginalised communities.As you may imagine, communicationN E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 7caught site of Pajarito Mesa, and found thatits health needs were as vast as its stark,dusty landscape.ColoniasNew Mexico is a unique state because over50% of the population consider themselvespart of an ethnic minority. Whereas peopleof all ethnicities generally live in harmony,there is an unfortunate, but also commonnegative view regarding undocumentedminorities. Because New Mexico is situatedalong the US-Mexico border, there are manypeople who enter the USA through NewMexico without documentation, seeking abetter life for their families. Once in theUSA, many of these people live in fear thatthey may be deported and thus oftentimesPajarito Mesa community itself to make asource of clean water a reality. At the sametime, at the request of the community, UNMalso began a project to provide healthcareto the community via a mobile clinic van.The van is staffed by UNM attending physicians,residents and students. All comers tothe mobile clinic are served on a walk-inbasis.Perhaps the most important function of theclinic is to create a trusting relationshipwith the community by providing good careand then easy follow-up at a nearby establishedclinic. This helps residents of PajaritoMesa, who may have not seen a doctor inyears, to obtain a medical home that doesnot discriminate based on documentation.with the Pajarito Mesa community has, attimes, been challenging. We are constantlyreminded we are there not to impose ourideas, but to listen and respond to theneeds expressed by the community.Unfortunately, many of New Mexico’sundocumented people face financial, politicaland emotional barriers to a way of lifeenjoyed by wealthy citizens of the USA. Aswe have heard from the Pajarito Mesacommunity, helping establish a source ofclean water, and providing healthcare viaa mobile clinic were two small, yet feasibleways a large university could use itsresources and expertise to address onecommunity’s needs. While we continuepushing for ‘healthcare for all’ with all ourlive together in clandestine communitiesmight here in the USA, we can always findcalled colonias. Pajarito Mesa is such aThe mobile clinic is free of charge, andcreative and meaningful ways of helpingcolonia and is home to approximately 1500patients may be seen for routine medicalthose who need it most. In the meantime,people, most of whom are undocumentedand gynaecologic care. In January 2009 wemy ear is to the ground!Spanish speakers.will be able to provide the community withMost in the community work, pay taxes, butfree of charge basic medications, a projectErin Corriveau | Student, School oflive in fear and poor conditions. Furthermore,which was approved quietly by the Board ofMedicine, University of New Mexico,when UNM F&CM physicians conducted aPharmacy and UNM Hospital administra-United States of Americaneeds assessment in the community, cleantion.Email: ecorriveau@salud.unm.eduwater and healthcare were top priorities!14

THE LIKE-MINDED WORKING TOGETHERGlobal HealthEducation ConsortiumThe initial ideas for launching a univer-of its website, listserv, networking groupssity consortium dedicated to promotingand conferences, GHEC then makes thesehealthcare and social equity to disadvan-resources readily available in the servicetaged populations through global healthof improved and expanded global healtheducation arose during a meeting ineducation programmes. Thus, GHEC seeksWashington in 1990. The first consulta-to serve as a catalyst for shifting the para-tive and organisational meeting, hosteddigm of medical education from a purelycollaborations with universities in lowby the University of Arizona on March 2,bio-medical curative model to one moreincome countries, faculty training, and1991, officially launched what was thenoriented towards public health and whichevaluation of the effects of global healthcalled the International Health Medicalis socially accountable, in keeping with theeducation and experiences.Education Consortium (IHMEC). Facultyhumanitarian goals of global health.and programme administrators from 24universities attended this meeting and committedthe new organisation to raising theprofile of global health training in medicalschools. In 2005, IHMEC changed its nameto the Global Health Education Consortium(GHEC) and broadened its membership toinclude all other health professional disci-One exciting project consistent with thisapproach is the Innovative Medical SchoolProject. The project is an alliance of eightinnovative medical schools seeking totrain physicians for service in underservedcommunities. The schools are developing acommon evaluation framework with whichThrough most of its existence, GHEC membershipand focus has been on NorthAmerica. In 2007 GHEC named a VicePresident of International Operations andthrough a European partner organisation,is expanding its international operation.GHEC will soon add overseas membersand increase international participation inD E C E M B E R 2 0 0 8plines. Since then, IHMEC/GHEC has sponsored17 annual scientific meetings hostedby various universities in North and CentralAmerica and in the Caribbean. Additionally,GHEC now co-sponsors four to five regionalconferences in collaboration with host universitieslocated throughout North America.GHEC now has more than 70 institutionalmembers and in the coming years will beworking to extend its membership beyondits traditional medical school base toinclude public health, nursing and otherallied professions as well as educationalinstitutions in low income countries.Recently, GHEC held a special symposiumin Sacramento, California to celebrate 17years of Alliances and Leadership in Globalto measure and compare accomplishments.Participating schools are locatedin South Africa, the Philippines, Cuba,Australia, Canada and Venezuela.Another project, the Trans-InstitutionalAlliance for Global Health, was initiatedin 2007 with the collaboration of theCentre of Global Health at the Universityof Virginia. Taking a different but complementaryapproach, the project has twoobjectives:• to characterise the priorities and activitiesof major North American universityprogrammes directed at transnationalinstitutional capacity building;• to identify the main problems confrontingthese programmes and opportunities forits programme.GHEC continues to exert considerableinfluence within and beyond the consortiumof educational institutions committedto improving the health and humanrights of underserved populations globally.Through its work to expand and improveeducational programmes globally, GHECin association with like-minded organisationssuch as The Network: TUFH, seeks tobring closer the day when access to qualityhealthcare and the full attainment ofhuman rights are realities for all.Additional information is available at:www.globalhealthedu.orgFor more information contact Thomas Hall:N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 7Health. During this period, the number ofreducing them through collective action.thall@epi.ucsf.eduacademic centres with global health programmeshas grown rapidly.Plans for the FutureAnvar Velji and Thomas Hall |GHEC has prepared a five-year programmeCo-Founder GHEC, Clinical ProfessorProjects and Productsplan (2010-2014) that calls for substantialUniversity of California, USA; ExecutiveThrough projects undertaken and productsgrowth, a number of new projects, and theDirector GHEC, Department ofproduced, GHEC seeks to enlist the exper-periodic review and upgrade of existingEpidemiology and Biostatistics, Universitytise of its membership in the developmentinitiatives. Major activities will include theof California, USAof high quality educational materials andexpansion and upgrade of the modulesEmail: anvarali.velji@kp.org;programmes for the benefit of all. By meansproject and other educational materials,thall@epi.ucsf.edu15

INTERNATIONAL HEALTH PROFESSIONS EDUCATIONMEDICAL EDUCATIONConsortiumfor Longitudinal Integrated CurriculaThe Northern Ontario School of Medicineand learning core clinical competenciesas a parallel stream to the standard teach-(NOSM) is the first new medical schoolacross multiple disciplines simultaneously.ing hospital-based clerkship model. Inin Canada in over 30 years. A joint initia-Generally, all major medical disciplines areAugust 2006, NOSM hosted a workshoptive of Lakehead University in Thundertaught concurrently in a developmentalwhich brought together representativesBay and Laurentian University in Sudburysequence that integrates clinical medi-from six of those medical schools in North(two regional centres more than 1000cine with its biological and social scienceAmerica. Last year, a follow up three-km apart), NOSM was established withunderpinnings. Students develop meaning-day workshop of this group plus others,a social accountability mandate to beful continuous relationships with patientsknown as the Consortium of Longitudinalresponsive to the needs of the people andand with clinical teachers. Motivated byIntegrated Curricula (CLIC), took place incommunities of Northern Ontario.their intense relationships with individualBoston. CLIC is a growing internationalpatients, students develop a strong sensenetwork of medical schools committed toLongitudinal Integrated Clerkshipof professionalism and social account-improving the quality and effectiveness ofD E C E M B E R 2 0 0 8NOSM is the first medical school in theworld in which all third-year medicine studentsundertake a longitudinal integratedclerkship.In four-year medical programmes, studentsin the third year make the transition fromprimarily classroom learners to clinicians.ability. They observe the full course oftheir patients’ medical illness and recovery(when possible), learn about the challengesof navigating the healthcare system,and extrapolate to populations whenapplicable. Through longitudinal relationshipswith mentors, they receive frequent,clinical education. The workshop was hostedby the Cambridge Integrated Clerkshipof Harvard Medical School.In 2008, there have been two CLIC events.As part of the International conferenceCommunity Engaged Medical Education inN E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 7The standard model involves the studentsrotating through sequential blocks (clerkships),each of which provides concentratedlearning in a specific clinical discipline(Internal medicine, Surgery, Paediatrics, etcetera). A longitudinal integrated clerkshipinvolves the students in learning thecore clinical disciplines integrated togetherover a prolonged period of time.The NOSM third year is the ComprehensiveCommunity Clerkship (CCC), in which studentslive and learn in one of 12 large ruralor small urban communities in NorthernOntario outside Thunder Bay and Sudbury.The students are based in family practice,where they meet patients and follow them,including into specialist and/or hospitalcare. Supervised clinical experience is complementedby direct teaching from localand visiting specialists and family physicians,as well as by distance education.developmentally appropriate feedback.This approach lends itself to urban andrural settings, to community and tertiarysites, and to advantaged and disadvantagedpopulations.STUDENTSDEVELOPMEANINGFULCONTINUOUSRELATIONSHIPSWITH PATIENTSAND WITH CLINI-CAL TEACHERS.the North in June, there were three CLICHothouses and the annual CLIC Meetingin November was hosted by the Universityof California at San Francisco. This CLICMeeting was attended by 90 participantsfrom 25 different medical schools,many of whom are planning or have juststarted longitudinal integrated clerkships.Highlights of the programme includedkeynote addresses on Future Directions forLongitudinal Integrated Clerkships: WhatRole for Residents and Residency Training?and Longitudinal Integrated Clerkshipsin the Future of Undergraduate MedicalEducation, as well as a panel discussioninvolving former and current longitudinalintegrated clerkship students. In addition,there were multiple parallel workshop sessionswhich explored a diverse range oftopics from professional identity developmentto research questions and initiatives.Roger Strasser | Founding Dean,The CCC is one of many models of longi-Northern Ontario School of Medicine,tudinal integrated clerkships. DifferentCLICCanadamodels share common elements: compre-A growing number of medical schoolsEmail: roger.strasser@normed.cahensive patient care over time; continu-offer models of longitudinal multi-ing learning relationships with clinicians;specialty integrated third-year clerkships16

IMPROVING HEALTHJMHPE: THIRD GROUP OF GRADUATESOn Sunday the 27 th of April 2008, the thirdgroup of fellows graduated from the JointMaster of Health Professions Education(JMHPE) programme, developed in collaborationbetween Maastricht University (the Netherlands)and Suez Canal University (Egypt).Two years after the graduation of the pioneergroup of seven, and one year after the secondgroup of 20 graduates, another 19 fellowsfollowed in their footsteps. Thirteen of themgraduated with honours, which means thatthey have received an eight on a ten-pointscale for at least half of their unit registrationsat first attempt. Ten countries in theArab region were represented: Egypt, Bahrain,Saudi Arabia, Yemen, Sudan, Jordan, Syria,Palestine, United Arab Emirates and Iraq.The success of a programme can be measuredby different parameters: the number of graduates,the number of applicants for the nextclass, and the regional attraction of the programme.All of these aspects show evidenceof the success of this joint programme:• The enrolment increased in the first threeyears from 10 and seems to have stabilisednow at about 30 participants.• In the first group, seven of the ten participantscame from Egyptian universities andthe remaining three from the East Mediterraneanregion. In 2008, 14 of the 30 participantsstill come from Egypt, 12 from theregion and two from beyond the region.The JMHPE degree is a reward, but it is also aresponsibility. The career developments of someof the fellows who graduated earlier bear witnessto this: their further career paths includea Deanship, Head of a Clinical Resource Centreand Coordinator of the JMHPE programme!We are proud of the high standard of thesepioneers in health professions education reformin the Arab world, and we wish the graduatesmuch success in this exciting endeavour.Jan van Dalen and Wagdy Talaat |JMHPE DirectorsEmail: j.vandalen@sk.unimaas.nl;watalaat@ismailia.ie-eg.comHEALTH AUTHORITIESWhat Would I Changeif I Were Minister of Health?Starting the process of change is usuallydifficult, but a comprehensive nationalhealth insurance programme in Jordan is adream that has to be brought into reality.Every citizen, regardless of colour, religionor place of residence, has the right toreceive the best quality of healthcare.Health services should be accessible tothose areas and people with the highestneed for such services, focusing in particularon tackling inequities in health.Healthcare workers should be encouragedto upgrade and update their knowledgeand skills through participation in local,regional or international activities thataim at improving their clinical, researchand communication skills. The Ministry ofHealth should cover the expenses of theseactivities and offer incentives for thosewho attend them. Moreover, teaching/training programmes would be plannedand conducted in collaboration with medicalschools, teaching hospitals, associationsof health professions, NGOs andinternational organisations.Research in health sciences is very important;it helps planners in setting up priorities,assessing achievements and formulationof health policies. Quality of care,professional achievements and researchwould be taken into consideration in decisionsrelated to promotions and incentives.I would concentrate on improvingthe reporting and documentation systemsand set a registry for communicable andnon-communicable diseases to form anational data-base for health planningand policy making.An important issue is the improvement ofthe efficiency of budget allocation, andspending directed at health promotion tothe public. It is important to attract non-budgetary funds, foreign investments andinternational organisations’ funds forDr. Darwish Badranfinancing target programmes and capacitybuilding of public health services. Directorsof hospitals, health centres and specificprogrammes would be authorised to spendfrom the funds they raise.I would help in the creation of a system ofregulations, policies, procedures and standardsin the field of health and care,including medical aid, private practice andpatients’ referral, pharmaceutical industryand medical products.Finally, improving working and living standardsof health personnel should go handin hand with implementing these changes;this will give them more job satisfactionand increase their productivity, which willbe reflected on the standards of healthcarein the country.Darwish Badran | Director, Centre forEducational Development, University ofJordan, JordanEmail: dhbadran@ju.edu.joD E C E M B E R 2 0 0 8 N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 717

IMPROVING HEALTHHEALTH AUTHORITIESD E C E M B E R 2 0 0 8N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 718Health Reformin ColombiaColombia is a tropical country, located inthe northern part of South America, with44,000,000 inhabitants; a life expectancyat birth of 72 years (66 years for men and74 for women); a birth rate of 19.86 per1000 inhabitants; and with cardiovasculardisease, murder, cerebrovascular disease,chronic lung disease and diabetes as thefive leading causes of death.Major ChangesSince the ‘90s, the country has initiatedprofound economic and social policies,which resulted in the adoption of a newConstitution (1991). This change establisheda new organisation of national life.In that context there were three majorchanges that affected the healthcare system:• First, the establishment of the rule of law,in which education and healthcare arerecognised as fundamental rights for allpeople, without distinction of any order.• Second, the strengthening of decentralisationprocesses in search of better conditionsfor development of regions andlocalities, seeking equitable access of allpopulation groups to opportunities andbenefits of national development.• Third, the introduction of a model ofeconomic and social development, withthe primary purpose of encouraging institutionalpluralism in various public andprivate fields. The model also incorporatesthe country into the global flows of politicalthinking that led the movement of theso-called ‘modernisation of the state’ andthe trends of globalisation of economies.System General Health InsuranceIn Colombia the ‘health reform’ was a totalchange in the healthcare system. Existingschema fragmented organisation, publicassistance for the poor, financed withtion groups with the capacity to financetheir healthcare. This National HealthSystem turned into a System General HealthInsurance (SGHI) - made up of multiple institutions- which was obliged to ensure, as anindividual and collective right, healthcare forthe whole population.Since the introduction of SGHI in the year1993, there has been considerable progressin the rates of insurance coverage.To date, the Ministry of Social Protectionestimates that over 90% of the Colombianpopulation is affiliated to the System.UnsatisfactoryIn connection with the Provision of HealthServices, various studies show that theplanning, organisation and functioning ofthe healthcare providers have lost the conceptof space-catchment area; they do nottake into account the accessibility of thepopulation to them, nor the geographical,cultural, economic, population and epidemiologicalcondition. They ignore the socialorder in terms of meeting the health needsof the population, which has led to seriousproblems of equity in income and theprovision of benefit plans, and requires theformation of networks to provide servicesto ensure the user the right to attend them.In connection with public health, the BasicCare Plan has been defined. This planfocuses on complementing the communityadvocacy and prevention-defined benefitplans. But there is dispersal of activitiesamong the various actors and territoriallevels and fragmentation of responsibilities.Therefore, the impact of the sharesis dissolved, the attention to people andcommunities is not timely and sufficient,and there is a loss of transparency in themanagement of resources.The fulfilment of the shares of health promotionis unsatisfactory in some of the municipalities;these do not report information onTHE CHARACTER-ISTICS OF THENEW SYSTEM OFHEALTH SERVICESHAVE HAD SIG-NIFICANT IMPACTON THE FORMSOF LINKAGEAND ON THEPERFORMANCEOF HUMANRESOURCESIN HEALTH.Government funds; social insurance for workers,public and private, financed by contributions;and private services for the populaactivitiesof vaccination, or this informationis inconsistent or incomplete.The characteristics of the new systemof health services have had significantimpact on the forms of linkage and on theperformance of human resources in health.Improvement in these key factors in theprocess of healthcare - individually andcollectively - is critical in the implementationand operation efficient, cost-effectiveand quality.The major challenges are getting to universalhealth service, and ensuring the qualityof provision.Miguel Ruiz Rubiano | Dean, Facultyof Medicine, Universidad el Bosque,ColombiaEmail: miguelruiz@hotmail.com

WOMEN’S HEALTHPreventing Paediatric HIVin Rural South AfricaHIV/AIDS treatment has become moreAt each site, we held a brief celebration tocommonplace for adults in some areas incongratulate the staff on their successes,South Africa since the Government approvedapplauded those who contributed to thepublic provision of antiretroviral (ARV) ther-change, and asked what more we could do.apies in 2003. Despite uneven progress, theI helped each team understand its prog-growing local knowledge that desperatelyress in comparison to neighbouring sitesill people can recover rapidly after receivingand trained site mentors to continue thetreatment has created an enormous demandimprovement process and share successfulfor antiretrovirals. In contrast, effectivestrategies between teams.treatment for HIV-positive pregnant womenduring their pregnancies remains a rarity.HIV/AIDS office at Mbazwana clinicFrom 10% to 80%The system designed to prevent mother-to-We are still evaluating the long-termchild transmission of HIV has lagged farbehind gains in treating non-pregnantadults living with AIDS.HIV Transmission to InfantsThe Institute for Healthcare Improvement(IHI) is a US-based NGO that collaborateswith the Umkhanyakude Health District andthe Centre for Rural Health at the UniversityKwaZulu-Natal (KZN) to improve the widespreaddistribution of ARV’s in the rural KZNhealth system. Between June and August of2007, I worked with the physicians, nursesand HIV/AIDS counsellors at two publichospitals and six clinics to strengthen effectivetreatment of pregnant women withAIDS in this district. Our goal was to improveefforts to place eligible pregnant women onHAART (Highly Active ART) treatment, inorder to prevent the transmission of HIV totheir children. The communities served bythese facilities are deeply rural and verypoor. Unemployment hovers near 70% andmore than one of every three pregnantwomen are HIV positive.tem and why many women are not offeredtreatment early enough in their pregnanciesto prevent HIV transmission to their infants.Each clinic’s data was illuminating; thoughmany women learned their HIV status, fewwere having the blood work needed todetermine whether treatment was right forthem. And of those women giving blood forCD4 counts (a method of determining theimmune system’s health), very few wereactually told their test results and evenfewer were referred for lifesaving treatment.Elegantly SimpleWith some coaching, each of these clinicteams began looking for solutions toimprove their success at treating eligiblepregnant women. Each clinic began a ‘livessaved’ campaign, creating a clinic posterthat counts each two lives saved - the childand the mother - for every pregnantwoman put on treatment. The practicalsolutions the teams devised were oftenelegantly simple. Mbazwana Clinic simplymoved its HIV counselling from outsideeffects of this brief intervention. At MseleniHospital, the PMTCT improvement teamconducted an audit of their own labourward. They found that before our collaboration,fewer than 10% of the women presentingfor labour had CD4 lab resultsrecorded in their patient-held medicalrecords. Two months after our pilot projectconcluded, 80% of HIV positive womenpresenting to the labour ward had receivedtheir CD4 lab results. This one blood testdetermines which women and childrenstand to gain the most from ARV treatmentduring pregnancy.Small changes such as these promise tremendousbenefits to communities devastatedby a growing paediatric HIV epidemic.All of the health workers in thisregion are touched personally by HIV andAIDS. Many of the nurses and counsellorsI worked with have children in their ownfamilies who are HIV positive. The will toprotect children is enormous. The simpletools that harness this will are the key toD E C E M B E R 2 0 0 8 N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 7the clinic in a nearby building to a roommeaningful improvement.Using improvement methods developed byadjacent to where antenatal care is pro-IHI, I helped multi-professional teams ofvided. In one week, the team went fromJessica Greenberg / MD Candidate,clinic and hospital staff to track and evalu-sending blood tests for 20% of pregnant2010, Harvard Medical School, Unitedate their own success at identifying preg-women, to sending 100% of the necessaryStates of Americanant women with AIDS and beginningtests. Mseleni Hospital began to screenEmail: jgreenberg@hms.harvard.eduappropriate treatment. I sat down with thewomen waiting for ultrasound to ensurenurses and counsellors at each clinic tothat all women who had blood drawn forunderstand how pregnant women seekingCD4 counts got their results.antenatal care move through the clinic sys-19

IMPROVING HEALTHINDIGENOUS HEALTHTraditional MedicineMappedThe phenomenon of globalisation causesutilised to comprehend and systematisean increasing mobility of populations fromthis data;An interview held in Indiamany parts of the world, from Asia in par-• a virtual platform and a network of localticular, all having different cultural tradi-institutions to collect, systematise andremedies and on the evidence of their nega-tions. While generally regarded as a wealthexchange the multilingual informationtive side effects. Questions were also askedfor the receiving communities, cultural dif-that was generated by the research.on the cost per episode of illness in relationferences may limit and cause inequalitiesto pharmacological treatment. Doctors werein effective healthcare delivery. Therefore,A horizontal decentralised approach wasalso asked about their perceptions andit is important to understand the patients’used among partners, with equal oppor-use, if any, of traditional remedies to ‘treat’cultural backgrounds and their behaviourtunity to share ideas, creativity, resources,the most common illnesses affecting theirin relation to symptoms and ill health forresponsibilities and results. The relationshippopulation.a more effective communication betweenwas based on professional respect, culture-D E C E M B E R 2 0 0 8health professionals and patients, for a bettercomprehension of their health problems,and higher quality care.The Centre for Training and Research inPublic Health of the Sicilian Region (CEFPAS)promoted a three-year study on traditionalsensitivity, and a constant exchange ofviews and experiences for individual andgroup growth.Main StudiesThree main studies were contemplated bythe project:These are some of the most relevant results:• Production and validation of data gatheringtools related to the different targetgroups. The common format was inEnglish; it was adapted to the differentcultural contexts and was translated intothe six local languages.N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 7medicine in six European and Asian countries(Italy, Greece, India, Nepal, the Philippinesand Thailand) to study and map a number ofsymptoms interpretations, remedies adoptedby the populations, perceived efficacy ofthe selected treatment, and its possible sideeffects and cost. The five symptoms selectedwere: diarrhoea, fever, headache, joint painsand spontaneous abortion. The ensuing analyticalmaps were made accessible to professionalsworld-wide through the innovativeapplication of ICT instruments. The informationis useful to better understand patientsfrom different cultural backgrounds, makequicker and more precise diagnoses and offermore cost-effective and better clinical andhuman care. The project was financed by theEuropean Union.A population studyInterviews were conducted with a sample ofthe general population of the selected fieldstudy sites, comprised of men and womenof different age groups and urban and ruralareas. Sixty individual interviews and fivefocus groups (one per symptom/illness)were carried out in every country of theproject. The collection of data included thepopulation perception of causes of ‘illnesses’,the treatment used, its cost, its perceivedeffectiveness and any possible side effects.A healer’s studyFive traditional healers were interviewed ineach context. The main questions regardedtheir training, their initiation, the type ofremedies they used, their perceived effec-• A total of 360 interviews to the generalpopulation were conducted: additionallyfive focus group discussions, 50 interviewsto PHC doctors, ten to gynaecologists/midwives,35 to traditional healers,and five to traditional birth attendants.• Creation of a virtual platform using thelatest ICT technology that houses thedata collected, analyses, maps, and otheruseful information on the project.ConclusionsThe knowledge gained through this crossculturalproject on traditional medicineacross Euro-Asiatic cultures is valuable tohealth and social care professionals of allcontinents. The maps on behaviour andpractice can guide professionals to bettertiveness and their knowledge of possibleunderstand the health problems affectingTools and Methodsnegative side effects. They were asked infor-people from different cultures, make a moreThe project included:mation on the cost of ‘treatments’ and theappropriate and earlier diagnosis, and offer• a series of ethno-anthropological stud-payment modalities.a more effective and efficient clinical andies on traditional medicines using semi-human care quality.structured questionnaires, open interviewsThe PHC doctors studyand other quali-quantitative researchTen PHC doctors were interviewed in eachPina Frazzica | Director General CEFPAS,instruments and ethnographic/compara-country. They were asked about their knowl-Italytive approaches for data collection andedge of the causes of common illnesses thatEmail: frazzica@cefpas.itanalysis. Multi-angulation analysis waspeople believe in, on local use of traditional20

HEALTH PROMOTIONOral Health Promotionin South AfricaOral diseases adversely affect overall qualitytion - we conducted studies to determinecurriculum: the LifeSkills Training (LST). Inof life, self-esteem and social confidence.predictors of gingivitis among adolescentsaddition to teaching stress-coping skills,Although oral diseases are largely prevent-and to explore the association between atti-the LST curriculum provided informationable, they still pose a significant burden totude to oral health and smoking. Given theon short-term health consequences ofmany people in marginalised communities,existing evidence linking household povertysmoking, focusing on effects such as badwhere pain control and dental treatment arewith stress among adolescents and in linebreath and its influence on social interac-still not readily accessible. Of the nine prov-with the salutogenic theory of Antonovsky,tion, especially as it relates to the adoles-inces of South Africa, Limpopo Province haswe were particularly interested in exploringcents’ romantic aspirations.the lowest human development index, andhow rural adolescents’ ability to cope with•A randomised controlled trial showed thatthe recent national children oral health sur-stress, as measured on a sense of coherenceafter two years, when compared to thevey suggests that the adolescents in thisscale, influence their oral health.usual health education taught in 11 con-province have the highest burden of poorperiodontal (gingivitis) health. Gingivitiscommonly presents as frequent gum bleedingupon tooth brushing. In addition to thefact that periodontal diseases, if not controlled,could lead to tooth loss, there is alsogrowing evidence that periodontal diseasesare a risk factor for pre-term low birth weightand cardiovascular diseases in adulthood.Behavioural Risk FactorsBacterial plaque accumulation on teeth thatcould result from irregular tooth brushing isthe main aetiologic agent implicated inperiodontal diseases. However, other importantrisk factors include smoking and stress,both of which are also common risks forcardiovascular diseases. The recognition ofthese common risk factors - together withthe realisation that there are limitedresources to run oral health promotion programmesseparately from other programmesdirected at promoting general health -informed the WHO’s resolve in 2007 to formallyadopt the integrated approach to oraldisease prevention. This public healthThis photo was used during the oralhealth promotion project: “Boy beingrejected by a girl as a result of badbreath developed from smoking”Project’s Findings• Adolescents who did not live with theirmother were more likely not to be brushingregularly.• This study further demonstrated thatadolescents with a predisposition to copeadequately with stress and those notsmoking were more likely to brush regularlyand experienced a good gingivalhealth, irrespective of the level of oraltrol schools, the LST curriculum taught inten schools was very effective in promotingadolescents’ regular tooth-brushingbehaviour and good gingival (gum) health.• However, the intervention did not significantlyreduce smoking prevalence, butincreased non-smokers’ cigarette-offerrefusal self-efficacy, which may reducesusceptibility to future smoking.• Nevertheless, the LST curriculum alsosignificantly reduced alcohol use amongadolescents in schools that received theprogramme as compared to the controlschools.• Future programmes designed to promotehealthy behaviours among adolescentsshould consider ways to enlist the supportof the family members, particularlytheir mothers where possible.• Furthermore, considering that we foundthat on average only 60% of the curriculumwas taught, we would need to investigatehow the teachers and studentsthemselves found the curriculum in orderto improve the outcomes of the curriculumwith regards to smoking prevention.D E C E M B E R 2 0 0 8 N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 7approach seeks to address modifiable riskhygiene.factors common to both oral health and• Smoking onset on the other hand, wasBart van den Borne and Olalekangeneral health, but only limited evidence isleast likely when youth strongly believeAyo-Yusuf | Researcher, Associateavailable on its effectiveness. While the rolethat smoking causes bad breath and thatProfessor - PhD Student - Faculty ofof oral hygiene and smoking is well docu-bad breath has negative social conse-Health, Medicine and Life Sciences,mented, there is only limited information onquences, such as peer rejection.Maastricht University, the Netherlandsthe role of stress in oral health.• These results supported the implementa-Email: b.vdborne@gvo.unimaas.nltion and evaluation of an interventionIn the initial phase of our project - leadingintegrating oral health promotion with aup to an intervention for oral health promo-social skills-based smoking prevention21

STUDENTS’ COLUMNOUT OF THE SNO PENSTUDENTS’ SPEAKERS CORNERWelcome BackKenyaThis article was written early 2008.Security had issued a ban on all livebroadcasts, cutting off the opposi-Co-facilitaters of the SNO pre-conference workshopA semblance of calm had returned intion’s press conference in mid-sen-Kenya, so I decided that it was a goodtence. And by then, the slums began toHOW TO BECOME ANtime to travel to Eldoret and find outburn; countrywide riots were mounted.EFFECTIVE LEADER OF CHANGEwhat our school’s schedule would be,As medical students we face the need to identify thesince all I was getting back home wasThe efforts to salvage the countrymain health issues affecting our communities andconflicting information. I had to trav-started. In the nick of time, the inter-outline approaches to a solution. In order to accom-el because I was expecting an exam innationally pressured negotiationsplish this goal, medical students should have leader-the opening week. All the way acrosssucceeded, resulting in the formationship skills. This was a concern for the Student Networkthree provinces, the roads were barri-of a coalition Government. This wasOrganisation (SNO). Members of the SNO suggestedcaded by youths, demanding moneythe deal everyone had been waitingD E C E M B E R 2 0 0 8this topic for a pre-conference workshop at the 2008Network: TUFH Conference in Colombia.We received support from the organisation and manypeople were involved in this process. John Hamiltonwas invited to facilitate the workshop. With no doubt,and a lot of enthusiasm, he started to get everythingfrom motorists. We were forced out ofthe vehicle at three stops to chantanti-Government slogans!In 2007 an orderly election day wasfollowed by a suspiciously long countingperiod. Many electoral officers hadfor: to seal political peace and restore‘normalcy’.Now the politicians are back to thecity; and the poor Kenyans? Many arestill languishing in displacementcamps; children in many areas haveN E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 7ready. His principal objective was to involve studentsas much as expert professors in this topic.The SNO pre-conference workshop Student LeadershipDevelopment - How to become an effective leader ofchange?aimed to address strategies of enabling stu-dents to gain the skills of leadership for change for thegood of patients, communities, healthcare, and healthworkers. It was co-facilitated by Ian Cameron (Universityof Newcastle, Australia), Roger Strasser (NorthernOntario School of Medicine, Canada), Dimity Pond(University of Newcastle, Australia), Tarun Sen Gupta(James Cook University, Australia), and Lina Acuña (LaSabana University, Colombia). The student contributorswere Job Magire (Moi University, Kenya), RileySavage (James Cook University, Australia), and SofiaContreras (La Sabana University, Colombia).turned off their cell phones or disappearedwith the official counts. Someof them waited two days to resurface,with up to 20,000 more votes for theincumbent than observers had recorded.As results trickled in, the opposition’slead suddenly dwindled fromover a million to 40,000 votes. Timeaccelerated, tension mounted, andconfusion gripped the country. Onething grew uncomfortably clear: someonewas manipulating the results.Tension steadily cut across the nation,suspicion-driven propaganda took centrestage; rumours flew by text message,radio, television, and word ofmouth. As one newswoman put it:no school to go to because manyschools were looted and burnt; thehealth centre is no more. The dividebetween poor and rich is even widernow. It continues to breed dissentionand hopelessness since the peopleare acutely aware that their life is notas it ought to be, not as good as thatof people in the city a few milesaway. Many Kenyans are too poor tohave a decent life, and too disillusionedto believe the situation willimprove in their lifetimes.Nevertheless, welcome back Kenya,and as Kofi Annan succinctly stated:“The job of national reconciliationand reconstruction … must be carriedDuring the workshop we had the opportunity to ex-“In the old days, at least these thingsout in every neighbourhood, village,change experiences with doctors and other studentshappened behind closed doors. Thisand hamlet of the nation”.from different cultures who taught us that creativity,time they did it right out in front ofcommitment and collaboration are the secrets foreveryone, then asked us not to notice”.God bless Kenya, and we need a par-success of leadership. We returned home with a littleadigm shift.more knowledge, and willingness to be useful to ourThree days after Kenyans cast theircommunities.ballots, Mwai Kibaki was announcedJob Siekei Mogire, SNO Chairpersonthe winner. Half an hour later he wasEmail: jobsm2005@yahoo.comSofia Contreras | SNO Secretary General, Colombiasworn in before a preassembled crowdEmail: raquelcome@unisabana.edu.coof dignitaries. By the time the ceremo-22ny was ending, the Ministry of Internal

STUDENT INTERVIEWHow do students from all over the world perceive the educational programme at their Faculty, or the educational system in theircountry? How do they see the future, for their nation and for themselves? And what changes would they make, if they had thechance? We wanted to know. Therefore, in every Newsletter December edition we ask a student five questions.The Big FiveThis interview was conducted with DimaWhat is your opinion about innovativeJarrar, sixth-year medical student at theeducation formats?Faculty of Medicine, University of Jordan,When I started, the integrated programmeJordan.was applied. Before that time, they studiedall the basic sciences individually, but weWhy did you choose to study Medicine?studied systems. For example when weMy father is a doctor (Senior Consultantstudy the cardiovascular system, we learnAudiologist); through him I became inter-the pharmacology of it, the biochemistryested in medical issues. But also, I alwaysabout it, et cetera. I think it is better thanwanted to be helpful to my community,studying everything separately; it helps inand specifically to its sick people.Can you as a student influence the educationalprogramme of your Faculty?Yes, we have some influence. By the end ofthe year, we can give our opinion aboutrotations and doctors through a survey.Resulting improvements are applied duringthe years after us, so the students thatfollow us will benefit from it. This methodensures continued progress to reach higherand better levels of medical education.We also have conferences with the Dean;once a year he invites us to discuss mattersthat are important to us and to theFaculty.the clinical years. We were also the firstyear to use the skills training laboratory. Itis very helpful, but unfortunately it is notalways available to us, because we have tobe under supervision when using it.What would you change if you were Deanof your Faculty? Or on a national level if youwere Minister of Education in your country?During rotations we have our own patients.We take care of them and we take their history,but the patients do not depend on ourexamination and examination results, asthe diagnosis has already been made. AsDean I would prefer to let the students bepart of the team, and not only be theobservers. Let them be part of the diagnosis,and of setting the therapy. By giving themthe space to contribute, they can feel thepressure and responsibility, which will makethem better and more efficient doctors.Being a Minister of Education would be verychallenging! I would change the criteria forentering medical school. Now it depends onMs. Dima Jarrarcine was just not their main interest.Therefore, I think students should be interviewedabout their motivation, and thisinterview should be given a high margin inthe selection process.Imagine if you were to choose: a practicein a town or in a rural area. What wouldyou choose and why?It is harder to work in a rural area, ofcourse. I think for that I need to be moreexperienced, so that I can deal with thelimited resources. Therefore, I prefer tostart my working carrier in our capital,Amman. Later on, I can go and work inrural areas. They have a right to good,efficient and accessible service, as they arealso a part of the Jordanian community. Itdoes not mean that because they live inD E C E M B E R 2 0 0 8 N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 7your grades in high school. But I do notrural areas, they must be ignored. I wouldthink grades reflect how good a doctor yousee it as part of my national, professionalcan be. I think it should be based more onand ethical duty to support them, as theyyour interests; your interest in medicine saysare usually the people who need our helpmore than just good grades.the most.We started in the first year with approximately300 students; through the yearswe lost 120 of them, mostly because medi-23

MEMBER AND ORGANISATIONAL NEWSABOUT OUR MEMBERSD E C E M B E R 2 0 0 8N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 724Experiencesin the Eastern Mediterranean RegionREGARDING THECURRICULUM,THE COLLEGEDEVELOPED ITSOWN HYBRIDCURRICULUM.To stay more connected with The Network:TUFH between our annual conferences, weencourage our members to use email andInternet links to make contacts directlywith other member institutions(see: www.the-networktufh.org/publications_resources/interactive.asp).The Executive Committee (EC) has suggestedincreasing interaction between theEC and the Network: TUFH membership intheir specific region. Regional discussionlists, which will give the EC (and vice versa)the opportunity to communicate directlyvia email with the membership in theirspecific region, have been created to facilitatecommunication.One of the discussion lists that have beencreated is the Eastern Mediterranean Region(EMR) discussion list (network-em@nic.surfnet.nl - for subscription, unsubscription,list-archives, you can visit the listshomepage: http://nic.surfnet.nl/archives/network-em.html).Through this discussion list, GhanimAlsheikh (Regional Adviser, Human ResourcesDevelopment, WHO, Eastern MediterraneanRegional Office) asked an interestingquestion: dissemination of the waveof innovation mostly took place during the1980s, but how many of the present medicalschools in the EMR are adopting innovativeprogrammes? To find out Alsheikhcalled upon all to exchange opinions andexperiences that could result in useful recommendationsand action plans.In support of the above, the Newsletterwants to start a column in which everyonecan present their EMR experiences. Westart the column with some of the first reactionsto Ghanim Alsheikh’s appeal.Nighat Huda | Professor of MedicalEducation, Controller of Examination,Department of Medical Education andExamination, Ziauddin Medical University,Pakistan:Dear friends,I would like to share with you informationabout Ziauddin Medical College, affiliated toZiauddin University.In 1996, since its inception, the Medical Collegeinitiated an innovative programme withthe objective that the graduates producedwill have better understanding of the contextthat they are going to practice, and self learningskills to face the challenge of exponentialgrowth of knowledge.As a result, a partnership was developed withthe adjoining community, and the Universityassumed responsibility of a population of20000. PHC was established with seed moneyfrom the University. The Family MedicineDepartment runs the PHC and other community-basedactivities. A committee comprisingof community elders, counsellors, et ceteraruns the activities including financialmanagement. The site is used for under andpost graduate training. An integral part ofthe curricula is family attachment in whichundergraduate medical students are attachedto two to four families for two years.Both Departments of Family Medicine andCommunity Health Sciences are responsiblefor education, research and service.Regarding the curriculum, the College developedits own hybrid curriculum. In the firstthree years an integrated curriculum was introduced,with PBL being the major strategy.Initially, PBL was started in the first threeyears and now it is also implemented in thefourth year. Seven cohorts have graduatedfrom this system. Graduates strongly favourPBL. The curriculum is reviewed yearly andnecessary changes are made.With regards to assessment, two major decisionswere taken: a centralised Departmentof Examination was established, and students’result was notified as ‘satisfactory’and ‘unsatisfactory’. Again, for those interestedin this design, the process could beshared. Unfortunately, the summative examinationscould not be changed to integrated,due to the requirements of the regulatorybody of subject-based assessment.The entire model has been developed withinthe entire budget with no dependency onfunding, either from national or internationalinstitutions.I will be glad to respond to your queries pertainingto the information provided. Thanks!WHY ARE WE SOLATE IN THEREGION TO ADAPTINNOVATION INOUR MEDICALSCHOOLS,THOUGH WESTARTED EARLY INTHIS DIRECTION?

Fathi Maklady | Vice President forpost-graduate and research, Suez CanalUniversity, Egypt:Dear Dr Ghanim,You raised the very important question -and also concern - why we are so late in theregion to adapt innovation in our medicalschools, though we started early in this direction(not only that, but we contributed inthe wave of innovation world-wide, mainlySuez Canal and Gazeira medical schools).In my opinion there are three main reasons:• The lack of the political commitment atthe level of the Ministry of Higher Education.We at Suez Canal Universityfought to spread the idea: tens of workshopsand site visits et cetera, with littlesuccess. Five years ago, the Governmentwanted to innovate higher education inEgypt through its national project; thereis now a strong movement, and alsoachievements as revising curricula, improvingteaching skills, changing studentassessment, programme evaluation,and working hard towards accreditationaccording to international and regionalstandards (I should not undermine herethe efforts done by WHO in that respect).• The commitment of the medical school’sleadership. When the Dean and his associatewere convinced of - and dedicatedto - innovation, there were a substantialnumber of changes in that direction.Unfortunately, the system collapsed insome of those schools after the leadershipleft, because of the lack of institutionalisationof the system.I BELIEVE THATSUSTAINABLETRAINING ANDWORKSHOPSWOULD YIELDCHANGE IN THELONG RUN.Amany Refaat | Professor, Department ofCommunity Medicine, Faculty of Medicine,Suez Canal University, Egypt:Dear Profs. Fathi and Ghanem,Allow me to be optimistic - as usual - andlook at the glass as half full. Let me summarisemy point of view as followed:• The number of innovative health professionaleducational institutions is increasingall over the world; however, the majorityof these are the newly establishedones. I am sure that the numbers in theEMR increased as well. If we kept our expectationof radical changes to oldschools, we will be truly disappointed.• I believe that sustainable training andworkshops would yield change in thelong run. Therefore, I assume the manyworkshops and courses that were conductedthroughout the previous two decadesresulted in the current changes inthe region. However, they are not meetingour hopes yet.It is with pleasure that we would like toinform you that the following Full Memberhas been awarded (a continuation ofits) Full Membership:Up to 2013:Master of Health ProfessionsEducation, Maastricht University,Maastricht, the Netherlands.Bronze Full MemberNEW MEMBERSIndividual Members• Dr. Abraham Joseph, Institute of PublicHealth Bangalore, Vellore, India;• Dr. Beatriz Almeida De Frenk Manuel,Faculty of Medicine, Edwardo MondialeUniversity, Maputo, Mozambique;• Dr. Judi Gravdal, Rosalind Franklin University/ChicagoMedical School, AdvocateLutheran General Hospital, ParkRidge, IL, United States of America.INTERESTING INTERNET SITESThe Network: TUFH Interactive -Recommended websiteswww.the-networktufh.org/publications_resources/interactive.aspThe World Health Report 2008:Primary Health Carewww.who.int/whr/2008/whr08_en.pdfWHO Global Atlas of the Health Workforcewww.who.int/globalatlas/default.aspThe Concept of Prevention: A Good IdeaGone Astray?jech.bmj.com/cgi/content/full/62/7/580D E C E M B E R 2 0 0 8 N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 7• The resistance from the medical staff.This can be overcome by three steps:awareness - sharing - commitment.Again, I think it is an important issue you• I agree with you that we are still havingthe ‘top to bottom’ culture, even in ourinnovative schools. However, I hope thatsome of the graduates will change thatin future, with more democratisation allReducing Health Care Costs trough Prevention(Prevention Institute)www.preventioninstitute.org/documents/HE_HealthCareReformPolicyDraft_091507.pdfraised. It may be worth a round table dis-over the area.cussion to come out with practical recommendations.25

MEMBER AND ORGANISATIONAL NEWSABOUT OUR MEMBERSTASKFORCESD E C E M B E R 2 0 0 8N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 726Family Medicineand Primary Healthcare in Africa• Primafamed is a two-year projectwith a mission to improve the healthof the population of Africa and toreach equity in healthcare deliveryby strengthening community-orientedprimary healthcare. Primafamed is coordinatedfrom Ghent University andtries to support African universitiesin their efforts to establish and improveprimary healthcare education.More information can be found at thewebsite: www.primafamed.ugent.beKey activities include:- In July 2008, a meeting was held betweenPrimafamed and the two partneruniversities in Sudan to establishfamily medicine training.Gezira University has developed aone-year family medicine trainingprogramme that started in August2008.Ahfad University is working on afour-year family medicine curriculumwith the Arab Board of Medicine tobe initiated in December 2008.- Primafamed also organised a conferencein Uganda (17-21 November,2008) to share experiences, ideas,knowledge and skills on training Africanfamily physicians.- During the Primafamed conference,the African Journal of Primary HealthCare and Family Medicine waslaunched. This open access journalserves as a repository for cuttingedge,peer-reviewed research in allfields of primary healthcare and familymedicine (PHCFM) in a uniquelyAfrican context.Encouraging scholarly exchange betweenfamily medicine and primaryhealthcare researchers and practitionersacross Africa, PHCFM provides acontextual and holistic view of familymedicine as practised across thecontinent. The journal is availableonline at www.phcfm.org- The Flemish Government and Primafamedhave been key supports in theprocess of Defining Family Medicinein Africa. Networking and communicationis a key project outcome.Therefore a Google Group has beenstarted (http://groups.google.com/group/african-family-medicine).It provides an opportunity to networkacross Africa in a closed forum,communicate and shape key issuesin these developments.- The Network: TUFH has become amember of the International InterdisciplinaryAdvisory Board of Primafamed.Dr. Bishan Swarup Garg(member of the Network: TUFH ExecutiveCommittee) will be the representative.• The WONCA Africa Regional Conferenceis planned for 25-28 October2009, in Johannesburg, South Africa:Family Medicine in the African Context.INTERPROFESSIONAL EDUCATIONTASKFORCE: AN UPDATEThere seems to be a resurgence of interest inIPE internationally this year as more countriesgrapple with:• an increasing ageing population;• a decreasing youth to take up traditionalhealthcare professional education and positions;• the 70% shortage internationally of healthprofessionals which is becoming more apparent;• the brain-drain from developing countriesto westernised countries which continues;• the focus on prevention, primary and communitycare which continues.Health professionals are now being educatedto work more flexible hours, and encouragednot to think they will be operating in thesame profession for the rest of their lives (aswas once the case).The way in which healthcare personnel are educatedis constantly under review. In the UKnow the professional bodies require a proportionof the curriculum to be multiprofessional,and often this means interprofessional.Changes in legislation in Canada have meantthat litigation is not just the concern of thosemedically qualified, and that the leader - orthe person responsible within the interprofessionalteam - is legally responsible.The All Together Better Health Conferenceheld in Stockholm this year was attended byover 300 people interested in IPE developmentsinternationally, and the collaborationbetween the IPE networks continues to grow.The World Health Organization will launchtheir Framework for Action of Inter-professionalCollaboration and Practice. I hope thisstimulates colleagues into thinking throughother ways in which we can encourage thesharing of good practice in IPE.Dawn Forman | Chair of the taskforce IPEEmail: dawn.forman@btinternet.com

Taskforce Carefor the Elderly Gets New ChairAt the last Network: TUFH Conference in Colombia,I volunteered to become the Chairpersonfor the taskforce Care for the Elderly.I guess you are interested in getting to knowme, just as I would like to get to know everyone.So who am I?Who am I?I am the new Chairperson for the taskforceCare for the Elderly, but this you alreadyknow! I am a Psychiatrist and Senior Lecturerin the Department of Psychiatry at the Collegeof Health Sciences, Makerere University,Uganda. I am also the Head of the ClinicalServices in the Psychiatric Department of MulagoNational referral hospital.My research interests include geriatric psychiatryand cognitive impairment in HIV/AIDS. I received my medical degree, as wellas my Masters degree in Psychiatry, at MakerereUniversity Medical School. Currently I amon a collaborative PhD programme betweenKarolinska Institute, Sweden and MakerereUniversity.I have served as secretary to the Associationof Uganda Women doctors, am a member ofa number of scientific associations includingthe International Psycho Geriatrics Associationand the Social Accountability taskforceof The Network: TUFH. I also serve as a memberon the Young Psychiatrists Council for theWorld Psychiatric Association.Special Vulnerable GroupThe elderly as individuals face many challengesworld-wide and so do the few healthprofessionals who try to provide services forthem. With the inversion of the populationpyramids in many countries, special serviceshave to be instituted for the elderly. Coupledwith this reality is the fact that as we growolder we have a multitude of complicationswith aging, like failing physical health, decreasedsocial networks and a vulnerabilityto physical and psychiatric complications.A Bogotá health centre which caters for the elderly communityIn a number of countries, the services for the tings as may be appropriate, and lastly, theelderly are often inadequate or are expensive use of the World Health Organization toolkitand lack coordination for them to be effectiveto the larger target group, with only a service is delivered to the elderly at primaryas an instrument in helping to ensure thatfew able to access them. Indeed, the elderly health centres.are often neglected in services provided forthe eneral population; therefore, an effort All this we hope to do for the future, in orderhas to actively be made to reach this special to contribute to the care of the elderly andvulnerable group.make their lives more comfortable and fulfilling.Future PlansThe future of the taskforce will depend on Noeline Nakasujja | Chair of thethe many ideas that have been floated by the taskforce Care for the Elderlytaskforce members, with me as the Chair to Email: drnoeline@yahoo.comdrive the process.I am very grateful for the responses I havereceived from members and I would like tosummarise future plans.The aims and objectives of the taskforce willhave to be evaluated to reflect its activities.There is much we can learn from other taskforces,like the development of learning modulesfor interprofessionals as well as specificgroups. The development of small recreationalprogrammes for the elderly in different set-D E C E M B E R 2 0 0 8 N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 727

MEMBER AND ORGANISATIONAL NEWSTASKFORCESIntroducing the Taskforce SocialAccountability and AccreditationThe taskforce on Social Accountability andmade some progress in the interval. Re-leagues to support the development ofAccreditation (TSAA) held its formal inau-cruitment continues in the needs assess-the Patan Academy of Health Sciences, agural meeting on September 30 th , 2008 inment study and interested parties arenew distributed and community-basedconjunction with the Network: TUFH Con-encouraged to contact the Principal Inves-institution explicitly based on social ac-ference in Bogotá, Colombia.tigator (shafik.dharamsi@familymed.ubc.ca)countability principles and processes. ItBuilding upon the insights and enthusiasmto explore enrolment of their site in thehas received parliamentary approvalgained over two workshops in Ghent andstudy. A paper outlining the relationshipsand seed funding from the new Govern-Kampala, we were fortunate to have theand opportunities for bringing together ac-ment.support of the Network: TUFH Executivecreditation activities and those related to• The LCME/CACMS accreditation systemCommittee in formally establishing thesocial accountability is in the final stagesfor North American medical schoolstaskforce and developing an electronic fo-of preparation.(148) has established new standards inrum for the enthusiastic group of col-the realms of ‘service learning’ and theD E C E M B E R 2 0 0 8leagues. These colleagues met last yearand established a rough work plan to advancethe potential for accreditation systemsto reflect and enhance the principlesof The Network: TUFH and its constituentmembers.The bulk of the Bogotá Conference wasgiven over to exploring in some detail ourpotential approach to analysing and modifyingthe WFME standards. A subcommitteehas agreed to review the WFME standardsin their entirety and draft suggestedmodifications.climate of a medical school that are directexpressions of social accountabilityexpectations. The LCME has expressedan interest in working on broader issuesof SA.• Bob Woollard, Jan de Maeseneer andothers have been working in East AfricaN E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 7A number of interrelated issues include:• building on World Federation for MedicalEducation (WFME) and other standardsand modifying them to moreclosely reflect social accountability;• defining the nature of the standards,evaluation of compliance and consequencesof non-compliance in the variedinternational context for accreditationsystems;• assessing the current state of affairs;• preparing of pilot initiatives for implementation;• ensuring a focus on ‘equity’ and other SAvalues in the standards and their use;• including premedical school preparationand admissions processes in the scope ofthe standards;Thereafter, this work can be taken forwardinto a number of venues where taskforcemembers are active:• Charles Boelen is working with a newnetwork of schools focused on SA. Thishas created an opportunity to discusspotential pilot institutions for the standards.• The WHO has planned a meeting inGeneva in February 2009 to launch aninitiative in Quality Assurance andAccreditation. While this does not specificallyaddress social accountability,Charles Boelen is engaged in the planningand process.• The Association of Faculties of Medicineof Canada has received federal fundingon the development of accreditation systemsacross disciplines and along thespectrum of life long learning.There are undoubtedly many additional activitiesand opportunities that can bebrought forward, and taskforce membersare encouraged to report any efforts ofwhich they are aware.It is evident that a number of internationaltrends make the existence of the TSAAvery timely. If we are fortunate enough to‘catch this wave’, we will be well positionedto make major contributions to the developmentof global medical education.We will be following up this report with the• distinguishing between ‘social respon-for the next phase of their initiative indraft standards for your review and ratifi-siveness’, ‘social responsibility’ and ‘so-social accountability and has convenedcation. In the interval, your counsel, advicecial accountability’;a planning group of academic leaders.and work are welcome as we move forward• distinguishing between ‘policing’, ‘en-• Taskforce member Moses Galukande ofinto a new world of opportunities.abling’ and ‘quality assurance’ in theUganda has been leading the develop-role of systems of accreditation.ment of an accreditation system thereRobert Woollard and Charles Boelen |based on modified WFME standards re-Chairs of the taskforce SocialThe Working Groups that were establishedflecting social accountability principles.Accountability and Accreditationin Kampala (Literature review, Survey/• An international consortium of medicalEmail: woollard@familymed.ubc.ca;Needs assessment, and White paper) haveschools is working with Nepalese col-boelen.charles@wanadoo.fr28

REPRESENTED AT INTERNATIONAL MEETINGS/CONFERENCESThe Network: TUFH is being represented at meetings and conferences all over the world.Here is a report of one of our representatives.Expanding Horizonsin Medical EducationExpanding Horizons in Medical Education:Global Health Education for allMedical Students, Bellagio-Italy, September2008Seventeen participants from various partsof the globe met in Bellagio, Italy in September2008, at the invitation of Ben GurianUniversity. The topic of the conferencewas Expanding Horizons in Medical Education:Global Health Education for all MedicalStudents. This theme is central to theNetwork: TUFH’s activities and it will begood if our next Conference in Jordan canhave a session on this topic.The aim of the Bellagio conference was tosuggest guidelines for teaching and learningglobal health in medical schools. Atthe end, there was a consensus that globalhealth gets done properly only in a multidisciplinaryfashion and that a critical next stepis a conference on the planning of effectivemultidisciplinary global health education.The following five topics were discussedin depth:The meaning and scope of globalhealth and medicine (GHM)The consensus was that medical studentsshould study GHM, preferably when they livein an unfamiliar culture, in order to providethem with a personal, emotional, and professionalexperience not otherwise available.This training will sensitise them to other cultures,enable liaisons with medical studentsfrom these cultures, and offer first handknowledge of community and individual GHproblems and of ways to manage them.Criteria for choosing internationalplacementsA wide variety of experience has accumulatedwith medical students studying at internationalsites. Placements must deal effectivelywith the following areas: establishinginter-institutional understanding betweenthe local and distant institutions; defininga structured educational programme, withappropriate local and distant supervisionand evaluation; medical and personal safety;logistical and administrative arrangements,including travel, room and board.Core competencies in global healthand medicine education (GHME)While core competencies should apply acrosssites anywhere in the world, for studentsfrom southern as well as northern countries,another set of competencies should be definedthat are tailored to each specific site.Although a few of the following competencies(e.g. teamwork) may be included in agiven school’s curriculum unrelated to GHM,it was included in case they are not alreadypart of a given curriculum.Individual core competencies include: crosscultural competence,especially communicationskills; understanding the geographicburden of disease; using minimal resourcesto solve clinical problems; awareness ofsocial and environmental determinants ofhealth, as well as health inequities; teamworkand collaborative problem solving;professionalism and ethical behaviour; considerationof personal living and health requirementsfor global health workers.Community core competencies include: conductinga limited, population- or communitybasedstudy; applying knowledge of preventivecare; understanding impact of migration,movement and marginalisation on health;understanding various global health players.International collaboration for medicaleducationEffective inter-institutional collaborationrequires transparency, trust and professionalismin reaching mutual understand-The Network: TUFH is being represented atmeetings and conferences all over the world:• WHO Regional Committee for the WesternPacific, September 2008, the Philippines.Represented by Noel Juban.• Bellagio Conference on ExpandingHorizons in Medical Education: GlobalHealth Education for all MedicalStudents, September 2008, Italy.Represented by Abraham Joseph.• 124 stWHO Executive Board Meeting,January 2009, Switzerland.Represented by Pertti Kekki.ing regarding commitment to a long-terminstitutional partnership that includeseducational, research and other activities.This understanding must extend to a preliminarymapping out of governance, administration,roles and responsibilities andevaluation of the collaboration.Information technology (IT) in GHMEThis topic was scheduled, but discussedonly to a limited extent. However, the followingsummary is offered as a basis for furtherdiscussion. A basic problem has been toclearly define the educational value and useof IT in medical education, which potentiallyincludes three functions: communication,data access, and active learning using a computeror other communication tool that canaccess the Internet. Whereas communicationand data access is self explanatory and limitedonly by the rate of expansion of communicationsand computer technology, by contrastusing the computer to learn - which willundoubtedly increase in the future - is a neweducational domain that is not well understood.Computer-based learning strategiesshould be accompanied by careful, ongoingevaluation of technical and human engineeringfactors, as well as learner achievement,before being introduced generally.Successful use of IT may increase educationalcapacity in resource poor countries andstrengthen intern institutional collaboration.Abraham Joseph / Past Chairman of TheNetwork: TUFHEmail: abrahamjosepha@gmail.comD E C E M B E R 2 0 0 8 N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 729

MEMBER AND ORGANISATIONAL NEWSINTRODUCING MEMBERSNorthern Ontario Schoolof MedicineThe Northern Ontario School of Medicineserving Northern and rural communities.(NOSM) in Canada is a pioneering Faculty ofNOSM will train physicians able to practiceMedicine. For the whole of Northern Ontario,and engage in research anywhere in thethe School is a joint initiative between Lake-world, but who have a particular under-head University and Laurentian University,standing of people in Northern and remotewith main campuses in Thunder Bay andsettings.Sudbury, and multiple teaching and researchsites distributed across Northern Ontario.InnovationNOSM faculty, staff, and students do notA medical school like no other, NOSM has afunction in a traditional medical schoolstrong emphasis on the special features ofbuilding. Rather, the walls of the School areNorthern Ontario. These include: a diversitythe boundaries of Northern Ontario, and atD E C E M B E R 2 0 0 8of cultures and geographical locations; varyingillness, injury and health status patternswith their specific clinical challenges; a widerange of health service delivery modelswhich emphasize supporting local healthcareand interdisciplinary teamwork; and thepersonal and professional challenges, re-any given time an individual may be workingat one of the School’s two campuses, or in aremote rural or urban community.One of the most important innovations todate has been on the distributed communityengagededucation front. In their first year,Over 70 distributed communityengagedlearning sitesThe LNGs also provide a mechanism for bothan individual community and the School tostay abreast of each other’s respective developments.Membership of the LNGs varies,N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 7wards and satisfactions of medical practicein Northern and rural environments.NOSM is the first Canadian medical schoolestablished with a mandate to be socially accountableto the cultural diversity of the regionit serves, including: Aboriginals, Francophones,remote communities, small ruraltowns, large rural communities and urbancentres. Evidence of this mandate can befound in the School’s curriculum, administrativestructure, research programme, studentdemographics, continuing professional educationprogramme, and more (see www.nosm.ca).Our Vision and MissionNOSM is a pioneering Faculty of Medicineall students (in pairs) spend four weeks livingand learning in an Aboriginal community(Module 106). In the second year, they dothe same for eight weeks in remote and ruralcommunities (Modules 108 and 110), andthey spend the entire third year in a ComprehensiveCommunity Clerkship (CCC) within alarge rural or smaller urban centre. In thesecentres, Local NOSM Groups (LNGs) havebeen created, made up of local educatorsand community volunteers, to ensure localrepresentation within the School, and to facilitatethe smooth integration of medicalstudents into communities by means of orientationprogrammes and introductions tocommunity members.The third-year students acquire practical,depending on the need and desire of eachcommunity. Generally, membership includesbroad representation from faculty, communityleaders, individuals, and local healthcareprofessionals. Groups meet on a regularbasis and discuss such issues as: recruitment,retention, showcasing the community,travel, support for NOSM students, linguisticand cultural issues, and any other issue theGroup feels is of importance to both NOSMand its community.While the School has two main campuses inSudbury and Thunder Bay, we see thewhole of Northern Ontario as the true campusof the school. The map shows all thecommunities in Northern Ontario where ourundergraduate and postgraduate learnersworking to the highest international stan-patient-centred learning through the CCCundertake part of their training. Social ac-dards. Its overall mission is to educate skilledprior to completing their studies in the Re-countability to these engaged communitiesphysicians and undertake health researchgional Academic Health Centres in Sudburyremains foremost in our strategic plan.suited to community needs. In fulfilling thisand Thunder Bay. As the School continues tomission NOSM will become a cornerstone ofevolve, more LNGs will be included in a pro-Marc Blayney | Vice Dean, Department ofcommunity healthcare in Northern Ontario.gressively expanding network of relation-Professional Activities, Northern Ontarioships, thus fulfilling NOSM’s commitment toSchool of Medicine, CanadaOur Studentsbuild partnerships with communities andEmail: marc.blayney@normed.caNOSM will seek out qualified students whohealth organisations across all of Northernhave a passion for living in, working in andOntario.30

INTERNATIONAL DIARYDiary 20091 - 4 March, 2009, Johannesburg,4 - 5 April, 2009, Seattle WA, USA29 August - 2 September, 2009, Malaga,Republic of South Africa18 th Annual GHEC Conference - Transcend-SpainWonca African Regional Conference -ing Global Health Barriers: Education andAMEE Conference. Organised by theFamily Medicine in the African Context.Action. Organised by Global HealthInternational Association for MedicalOrganised by World Organization of FamilyEducation Consortium (GHEC) in coopera-Education (AMEE). Further information:Doctors (WONCA). Further information:tion with University of Washington, Seattleemail: amee@dundee.ac.uk; Internet:Internet: www.globalfamilydoctor.com/WA, USA. Further information: Internet:www.amee.orgconferences/conferences.aspwww.globalhealthedu.org16 - 19 September, 2009, Basel,15 - 19 March, 2009, Ismailia, Egypt20 - 22 May, 2009, Halifax, CanadaSwitzerland23 rd International Workshop on Communi-International Conference on CollaboratingWonca Europe 2009 - The Fascination ofty-based Education Incorporating Problem-Across Borders II - Building BridgesComplexity: Dealing with Individuals in abased Learning, Innovative Approaches.between Interprofessional Education andField of Uncertainty. Organised by SwissOrganised by Center for Research &Development in medical education &health services, Faculty of Medicine, SuezCanal University (FOM/SCU), Ismailia,Egypt. Further information: email: CRD-MED@ismailia.ie-eg.com; Internet: crdmed.tripod.com26 - 27 March, 2009, Maastricht,the NetherlandsVisitors Workshop: A Primer on theMaastricht Approach to Medical Education.Organised by School of Health ProfessionsEducation, Faculty of Health, Medicine andLife Sciences, Maastricht University,Maastricht, the Netherlands. Furtherinformation: School of Health ProfessionsEducation, P.O. Box 616, 6200 MDMaastricht, the Netherlands; tel: 31-43-3885611; fax: 31-43-3885639; email:she@oifdg.unimaas.nl; Internet:www.she.unimaas.nl3 - 4 April, 2009, Padua, ItalyInternational Conference on EqualOpportunities for Health - Action forPractice. Organised by Dalhousie University,Halifax, Canada. Further information:email: joan.sargeant@dal.ca; Internet:www.cabhalifax2009.dal.ca25 - 29 May, 2009, Washington DC, USAGlobal Health Conference. Organised bythe Global Health Council.Further information: email:conference@globalhealth.org; Internet:www.globalhealth.org/conference5 - 8 June, 2009, Hong Kong, ChinaWonca Asia Pacific Regional Conference -Building Bridges. Organised by WorldOrganization of Family Doctors (WONCA).Further information: Internet:www.wonca2009.org15 - 26 June, 2009, Maastricht,the NetherlandsSummer Course: Expanding Horizons inProblem-based Learning in Medicine,Health and Behavioural Sciences. Organisedby School of Health ProfessionsEducation, Faculty of Health, Medicine andSociety of General Medicine, WorldOrganization of Family Doctors (WONCA).Further information: email: a.studer@schlegelhealth.ch; Internet: www.congressinfo.ch/wonca2009/home.phpAnnual International Conferenceof The Network: TUFH10 - 15 October, 2009, Amman, JordanInternational Conference on AchievingQuality in Health Care: Challenges forEducation, Research and Service Delivery.Organised by The Network: TUFH and theFaculty of Medicine, University of Jordan.Post-Conference Excursion:October 16, 2009: Mu’tah University,Karak, JordanFurther information: Network: TUFH Office,P.O. Box 616, 6200 MD Maastricht,the Netherlands; tel: 31-43-3885638;fax: 31-43-3885639; email:secretariat@network.unimaas.nl; Internet:www.the-networktufh.org/conferenceD E J C A E N M U B A E R R Y 2 0 0 9 8 N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 7Development: A plan of Action to AdvocateLife Sciences, Maastricht University,and Teach Global Health. Organised in theMaastricht, the Netherlands. Furtherframework of the EU Project ‘Equalinformation: School of Health ProfessionsIt is possible to add events to this Interna-Opportunities for Health: Action forEducation, P.O. Box 616, 6200 MDtional Diary from behind your computer.Development’, implemented by DoctorsMaastricht, the Netherlands;Information inserted in our websitewith Africa Cuamm in collaboration withtel: 31-43-3885611; fax: 31-43-3885639;database (www.the-networktufh.org)29 partners and associates from the healthemail: she@oifdg.unimaas.nl; Internet:will be automatically included in thecommunity. Further information:www.she.unimaas.nlInternational Diary of the Network:email: s.foresi@cuamm.org; Internet:TUFH Newsletter.www.mediciconlafrica.org/globalhealth31

MEMBER AND ORGANISATIONAL NEWSABOUT OUR MEMBERSTHE NETWORKTOWARDS UNITY FOR HEALTHTribute to…Newsletter Volume 27 | no. 2 | December 2008ISSN 1571-9308* The Faculty of Medicine, UniversidadEditors: Marion Stijnen and Pauline VluggenMayor de San Simón (Cochabamba, Bolivia)Language editor: Sandra McCollumhas awarded our Secretary General Jan deMaeseneer with a Doctor Honoris Causa.The Network: Towards Unity for HealthThis degree recognises of the prominentPublicationswork he has done in their institution as aP.O. Box 616, 6200 MD Maastrichtprofessional, teacher and researcher, coop-ment of family medicine training in theThe Netherlandserating to improve development and healthcontext of primary healthcare.Tel: 31-43-3885633, Fax: 31-43-3885639in Cochabamba.Email: secretariat@network.unimaas.nl* March 16, 2008 was a milestone in thewww.the-networktufh.orgThe cooperation between Ghent Universityhistory of the Aga Khan University (Kara-(Jan de Maeseneer works at its Faculty ofchi, Pakistan). On that day, 25 years ago,Lay-out: Graphic Design Agency Emilio PerezD E C E M B E R 2 0 0 8Medicine and Primary Health Care) andUniversidad Mayor de San Simón started in1997, with an exchange of students: GhentUniversity students performed clerkships indifferent environments in Bolivia (especiallyin primary healthcare), and Bolivian studentsparticipated in clerkships in Belgium.the University received its Charter as a private,international university.In a short period, Aga Khan University hasestablished a reputation for excellenceand moved towards accomplishing its visionof impacting and improving the livesof many. In just 25 years, the UniversityPrint: Drukkerij GijsembergN E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 7Already in the first encounters, there was aclear focus on primary healthcare and familymedicine.In 2006 - thanks to a grant from the BelgianProvince of Oost-Vlaanderen and thecity of Ghent - the construction of the communityhealth centre Nueva Gante in theneighbourhood of San Miguel Pampas wasstarted. Initially, the centre was a service ofprimary healthcare delivery. The concernwas to make the centre accessible, especiallyfor those most in need in the communityof San Miguel Pampas. A second role ofthe centre was its function as a ‘trainingcentre’, not only for residents in family medicine,but also in other disciplines. A thirdimportant aspect was that this health cen-expanded its academic programmes to 11teaching sites in eight countries: Pakistan,Kenya, Tanzania, Uganda, UK, Afghanistan,Egypt and Syria - representing a diversityof cultures and creeds.MOVING ON: CHANGES ININSTITUTIONAL LEADERSHIPThe Secretariat received information aboutchanges in leadership with the followingNetwork: TUFH members. We have listed thenames of the former and new (Vice-) Deans/Directors for you:• Dr. P. Narang, Mahatma Gandhi Instituteof Medical Sciences, Wardha, India hasbeen replaced by Dr. Shakuntala Chhabra(chhabra_s@rediffmail.com);• Dr. Abraham Joseph, Schieffelin Instituteof Health Research and Leprosy Centre,Karigiri, India has been replaced by Dr.Mannam Ebenezer (karigiri@vsnl.com);• Dr. Abdel Salam Saleh, Ahfad Universityfor Women, Omdurman, Sudan has beentre wanted to function as a kind of ‘labora-replaced by Dr. Khalid Fadlalla Badr eltory’ for new orientations in primary health-Din (bader_1942@yahoo.com).care delivery. The special focus is here onthe participation of the local populationGround breaking of Aga Khanin a ‘community-oriented primary care’Hospital and Medical College byprocess.His Highness the Aga KhanRecently the centre became fully operational.This is an important achievement, becauseit sets the agenda for the develop-32