The network - Towards Unity For Health

THE NETWORKTOWARDS UNITY FOR HEALTHVOLUME 25 | NUMBER 02 | DECEMBER 2006NEWSLETTERSAD NEWSIn August 2006 Dr. Esmat Ezzat passedaway in her villa in Ismaila, Egypt.Dr. Ezzat was a former SecretaryGeneral and Honorary Member of TheNetwork: TUFH. We will miss her verymuch, and remember her with warmthin our heart. So will Dr. Wagdy Talaat;he wrote a beautiful obituary forDr. Ezzat, which you can read onpage 26.Other - much more trivial - news:this Newsletter’s distribution list willundergo some changes. Some of youwill keep receiving a paper copy of thisNewsletter, others will not. For thelatter, the Newsletter will always beavailable via www.the-networktufh.orgof course. You’ll find more detailsin the letter that accompaniesthis Newsletter.IN THIS ISSUE, AMONG OTHERS:Mobile Unit Servicesfor Old People in Bahrain 10Increasing Dental AwarenessAmong Young Parents 13E-Learning inHuman Nutrition 16Accreditation of MedicalEducation in Central Asia 20Smart ‘Glocal’Partnerships 22Marion Stijnen andPauline VluggenEditorsIn the Newsletter we refer toThe Network: Towards Unity for Healthas The Network: TUFH.1206

contents03040407080909091011121314151516181920212223242424252626272929ForewordA Reciprocal Transfer of InnovationsThe Network: TUFH in ActionAnnual International Conference“We Particularly Liked the Student-friendliness of the Conference” | Improving Your Conference Experiences |Winning Posters | Reflections of the Organising Committee | The 2007 ConferenceBook ReviewA Book for MidwivesEducation for HealthSpecial Issue EfH: Exemplary Network: TUFH Field Experiences | EfH in Electronic Format | EfH Table of ContentsImproving HealthHealth ServicesReferral Behaviour of GPs to Diabetes Support TeamsHealth ResearchBioethics ListservCare for the ElderlyMobile Unit Services for Old People in BahrainRural HealthLodi Declaration on Healthy VillagesIndigenous HealthIndigenous Health Workers in AustraliaHealth PromotionIncreasing Dental Awareness Among Young ParentsIntegrating Medicine and Public HealthSearching for Experiences on IntegrationInternational Health Professions EducationProblem-Based Learning and Community-Based EducationComputer-Assisted Training in the Clinical Skills LabYellow PapersE-Learning in Human Nutrition | Needs Assessment for Medical Education in Rural NepalRural Health Professions EducationCanada Increases Rural Medical EducationNew Institutes and Programmes2 nd UP Global Health CourseAccreditation and Quality AssessmentAccreditation of Medical Education in Central AsiaSocial AccountabilitySocial Responsiveness vs. Social ActivismPartnershipsSmart ‘Glocal’ PartnershipsInternational Diary 2007Students’ ColumnStudents’ Speakers CornerEquity in Delivery of Public Health ServicesOut of the SNO PenBlogs | Student Submissions to EfHStudent InterviewThe Big FiveMember and Organisational NewsMessages from the Executive CommitteeObituary Dr. Esmat EzzatRepresented at International Meetings/ConferencesCelebrating 40 Years of ASPHER | Strengthening the Educational Capacity to Address HIV/AIDSTaskforcesWomen and Health Taskforce: UpdateAbout our MembersExecutive Committee Meeting | New Members Executive Committee | New Staffing at GHETS | Network Alumni:A Defining Moment in My Life | New Members | Re-Assessing Full Members | Moving on: Changes in InstitutionalLeadership | Additional Case Studies for Women and Health Learning Package | Interesting Internet Sites | Tribute to…

FOREWORDA Reciprocal Transferof InnovationsIn Kenya we have less than 5000 medicaldoctors for a country of 32 million people.We need to educate more doctors, doctorsthat will not leave Kenya to work abroad.The first students arrived at Moi medicalschool in 1990. Since then we have graduatedover 350 doctors, 80% of whomstayed in Kenya. And out of 71 districts inKenya, more than 50% have health officersthat are students graduated from MoiUniversity. Why did so many make thedecision to stay? There are several reasons.First, we use community-based educationin the training of our students (somethingthat we have shared with like-mindedinstitutions as Makerere University inUganda and the Catholic University ofMozambique). This approach has made ourstudents socially more accountable to theKenyan communities. What also influencedmany of our students were the electivesabroad. After experiencing healthcaresystems - and life in general - elsewhere,they were able to compare andchoose; many of them chose Kenya.Of course we also encounter problems, asany medical school does. Our universityhospital is one example: with 500 beds itis too small for us to teach our students.We are tackling this problem together withthe Kenyan Government and our internationalpartners (e.g. from Indiana, USAand Maastricht, the Netherlands); we havenow two new teaching laboratories, a newintensive care unit, facilities for 15 healthcentres in western Kenya, and plans for anew maternity and newborn unit.Staff recruitment was another hurdle weencountered when starting Moi medicalschool; it was difficult, because we are faraway from the capital city. We solved thisproblem not only by hiring professors fromoutside Kenya, but also by recruiting andtraining our former graduates. LinköpingUniversity (Sweden) and MaastrichtDr. Arthur Kaufman and Dr. Simeon MiningUniversity (the Netherlands) were a big ‘south to north’. I brought to Ghent - tohelp in faculty development.attend the Network: TUFH Conference -Augustine Chavez, a young doctor fromWe have been able to sustain and improve New Mexico. Though we pride ourselves onour programme in the past 15 years, community-based education in Newthanks to our programmes, and to our Mexico, he observed that students frominternational collaborations.Uganda described returning to the samevillage in different phases of their education,building on their previous surveysSimeon Mining| EC Member; SeniorLecturer, Faculty of Medicine,and projects. He felt our advanced technologyis not as important to communityMoi University, KenyaEmail: mining@mtrh.orghealth as the COBES model and so he isdeveloping ideas for how we can transferaspects of this rich African experience.Moi University teaches us many things andDr. Mining points to some of them. One is When I visited Moi University at thethe importance of ‘community-based medicaleducation’ as a strategy for reducing Mining introduced me to a young doctorNetwork Conference some years back, Dr.the out-migration of health professionals working with volunteer village healthfrom developing countries. Moi’s rate of workers. They were conducting a preventionprogramme against malaria. School80% retention of graduates in Kenya isremarkable! Another is the important role children were enlisted to compete for prizesby seeing who could pick up more plas-of ‘sister’ institutions in industrialisedcountries which can mobilise resources tic refuse in the community, since plasticand technical assistance to schools in collects stagnant water, a breeding grounddeveloping countries.for malaria-bearing mosquitoes. Soon, thechildren cleared the village of this nonbiodegradablewaste. Impressed withHowever, a reciprocal transfer of innovationsis in order. Few academic health these models, in New Mexico we arecentres in the West can emulate the intensityand duration of the COBES (commu-community health workers.employing an ever-growing number ofnity-based education) attachments by studentsin African countries with these programmes.These models should be imported Email:Arthur Kaufman| Secretary Generalakaufman@salud.unm.eduD E C E M B E R 2 0 0 6 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 53

THE NETWORK: TUFH IN ACTIONANNUAL INTERNATIONAL CONFERENCEEvery year The Network: TUFH organises an international scientific and networking conference. Here you find a retrospective of thisyears Conference (Ghent, Belgium from 9 - 14 September), and a preview of the 2007 Conference in Kampala, Uganda.“We Particularly Likedthe Student-friendliness of the Conference”D E C E M B E R 2 0 0 6N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 5In spring 2006 we were offered the opportunityby our university (Maastricht University)to participate in that year’s Network: TUFHConference in Ghent, Belgium. Havingworked actively in the fields of both (medical)education and international collaboration,our attention was drawn immediatelyto this unique organisation about which wehad heard a lot already. Now was the timeto get involved!Conference venue Het Pand was a beautifullocation to get to know The Network: TUFHand its members. The pre-conference daywas a perfect start of a great week due toits small scale character and friendly atmosphere.We appreciated the interactionwith all the participants, green and whitebadged, throughout the whole conference.It was amazing to see so many differentpersons from all over the world gettingto know each other, and it felt great thateveryone was greatly interested in otherparticipants and projects.This genuine interest was expressed notonly during sessions, where professors listenedto students and experts paid attentionto newbees’ opinions, but also afterwards.Throughout the conference therewas ample time to meet and discuss a widerange of topics at a wide range of locations:global endemics in a 16 th century lecturehall, personal hobbies at a baroque operahouse, or peer education projects on one ofthe small wobbly boats while admiring thecanals of Ghent.One thing we liked in particular was thestudent-friendliness of the entire conference.As mentioned before; people werevery interested in our (that is: all thestudents who participated) projects, andtended to be very enthusiastic about our bought some drinks and sat in a large circlecontributions to the conference. The studentposter sessions were a good starting spent a memorable time playing games,on the water side of a small canal. Here wepoint to learn more about the ongoing studentinitiatives from all over the globe. The like we all had known each other alreadysinging songs and dancing ‘Wizard of Oz’workshops conducted by students attracted for years. All who were there that night willlots of participants from all ages, all levels agree: we felt connected and ‘united’ - atof experience, all continents.least for that moment.Ms. Emmaline Brouwer and Mr. Robbert Duvivier at work at the Conference in GhentThis feeling of actually being part of the In our view The Network: TUFH is a diverseconference, as opposed to being just global network which is reflected by thebystanders, lasted throughout the conference.It was a hugely satisfying and encour-the members and conference participants,different countries and regions of origin ofaging experience, and we owe a big thank their different languages, activities, cultures,opinions and backgrounds. But mostyou to all the participants who contributedtowards this feeling. The special mentor/ of all we enjoyed discovering the similaritiesbetween all those wonderful people. Tomentee system worked pretty well to startoff, but at the end of the week we felt like be surrounded by all of them during a weekhaving dozens of mentors!in such an atmosphere was an eye-openingWe would like to share with the readers of experience that definitely strengthened ourthis Newsletter a unique experience that ambition to improve health and healthcarethis conference brought us that we will in this world!never forget. One night, the students ofGhent (who by the way did an amazing job Robbert Duvivier and Emmaline Brouwerthroughout the whole week) took the studentparticipants - and some very young at University, the Netherlands| Medical students at Maastrichtheart professors - out to the city centre. We Email: e.brouwer@student.unimaas.nl4

ImprovingYour Conference ExperiencesOnce again, the Network: TUFH staff providedConference attendees with an incredibleweek of education, collegiality and culturalevents. During the five days, ourConference Evaluation Team was hard atwork talking with attendees about whatwas great, what was not so great and whatthey might like to see in future Conferences.Our intent is to provide members with themost valuable experience when attendingour annual Conference and give attendeesan avenue to help design and format futureConferences.For this year, an overall conference evaluationwas completed showing a mean scoreof 4.5 out of 5.0 (n=70) and another evaluationreferencing the pre-conference andmini-workshops showing a mean score of4.27 out of 5.0 (n=373)! These scores inthemselves show an impressive result forour organisers and presenters, but the datacontained in each survey provides a wealthof information on specific action items tobe used in improving next year’s venue. Inaddition to the written surveys, the evaluationteam interviewed 20 Conference participantsabout their thoughts on the Conference.As always, attendees pointed outthat the opportunity to network amongsuch an exceptionally diverse group of internationalhealthcare professionals wasunprecedented. The following points summarisewhat participants appreciated aboutthe Conference: the ability to share communityprojects in depth through structuredposter sessions; the site visits providedgreat insight into our host communities; thebreadth of daily sessions kept participants’interests; and the sights in the extraordinarycity of Ghent. Areas which Conferenceattendees felt might help improve the 2007Conference included: the provision of particulartracks for attendees to help selectsessions across sub-themes; assurance ofconsistency among facilitators/moderatorsOur intentis to providemembers withthe most valuableexperiencewhen attendingour annualConferenceand giveattendees anavenue to helpdesign andformat futureConferences.through a simple training format (time, didactics,participatory exercises, materials);further assistance in travel planning; keepoverall costs lower; and more attention paidto the balance of academics versus communitymaterial.We look forward to the 2007 Conference inKampala, Uganda, and the opportunity toprovide participants with an environmentof continuous learning; to enrich the healthof our communities through the sharing ofexperiences and knowledge.Joseph Ichter | Ghent ConferenceEvaluation ChairEmail: jichter@salud.unm.eduWinning PostersThe following posters were awarded witha prize during the Network: TUFHConference in Ghent, Belgium:• Best poster award: CurriculumDevelopment at a Midlevel MedicalWorker Programme in South Africa,by Selma Smith (Republic of SouthAfrica).• Poster award: A Survey of Student’sViews about Lesson Plan Implementationin the Nursing and ParamedicalFaculties of Kashan University ofMedical Sciences, by Mehrdad Mahdian(Islamic Republic of Iran).• Poster award: Ethical Regulationsof Human Research Projects inDeveloping Countries, by CarolineMailloux (United States of America).Best Poster at the 2006 Conference inGhent, BelgiumD E C E M B E R 2 0 0 6 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 55

THE NETWORK: TUFH IN ACTIONANNUAL INTERNATIONAL CONFERENCEReflections ofthe Organising CommitteeOrganising a Network: TUFH Conference wasawareness of the importance of socialThe 2007 Conferencea life changing experience for us. We reallyaccountability as a criterion in future deci-In September 2007 The Network: TUFH willfelt like ‘citizens of the world’ when commu-sion processes. Additionally, the large finan-organise its annual Conference in collabo-nicating with participants, consulates, em-cial support we received from these institu-ration with the Faculty of Medicine, Maker-bassies, universities and organisations fromtions and others made it possible to organiseere University, Uganda. This Conferenceover 40 countries. But we were also confront-a financial ‘healthy’ Conference and towill be held in Kampala, Uganda, Septem-ed with what a ‘fortress’ Europe had become,financially support 24 participants.ber 15 - 20, 2007.and all its consequences.The theme of the Conference is Human Re-Finally, the most heart-warming experiencesources for Health: Recruitment, Educationin the organisation of this Conference wasand Retention.probably the fruitful and close co-operationwith the students. The Ghent students, work-After the Conference (September 21 - 23)D E C E M B E R 2 0 0 6ing in the framework of SNO, experiencedthis also as ‘their’ Conference. As a continuationof the Conference they are actually organisingseveral activities in which theywant to evoke the positive and open atmospherethey experienced during the Conference.there will be an optional Post-ConferenceExcursion to Faculty of Medicine, MbararaUniversity of Science and Technology,Uganda.Conference site:www.the-networktufh.org/conference/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 5Mission control at the Conference venueWe set goal to attract new people to the2006 Conference, and therefore were veryhappy to learn that 60% of the participantsattended for the first time. This new inputfrom countries as Romania, Ecuador andZimbabwe undeniably broadened the perspectiveof the Conference and strengthenedthe existing network.Organising this conference was also a challengingintellectual task: defining the Con-For future Conferences we would suggestemphasising the co-operation with other importantactors. During this conference theWorld Organisation of Family Medicine(WONCA) was explicitly present, and this interactionhas been followed up in explorationof future possibilities for co-operation.We wish the organising committee of the2007 Conference in Uganda a similar lifechanging experience!Sara Willems and Jan De Maeseneer |Organising Committee Conference Ghent,BelgiumEmail: sara.willems@ugent.bePreliminary programme:www.the-networktufh.org/conference/programme.aspRegistration:www.the-networktufh.org/conference/registration.aspwww.the-networktufh.org/conference/registrationform.aspPlease note that the deadline for earlyregistration is June 1, 2007.Abstract submission (for Mini-workshops orThematic Poster Sessions):www.the-networktufh.org/conference/abstractchoice.aspference theme (improving social accountability),making this theme relevant bybringing together contributions in a comprehensiveway, and reviewing abstracts. It alsogave us an opportunity to set up a dialogueon the Conference theme with the local communityand stakeholders. We hope that theIt was alife changingexperience.involvement of the governmental stakeholdersin the Conference will also have a longtermeffect, as it might have enhanced their6

BOOK REVIEWA Bookfor MidwivesBook Review of: A Book for MidwivesAuthors: Susan Klein, Suellen Miller, andFiona ThomsonISBN: 0-942364-23-6, pp 527A Book for Midwives is a comprehensive andbeautifully illustrated textbook which encapsulatesthe knowledge necessary for safemidwifery practice in any setting. Not onlydoes this text cover the basic knowledgeabout antenatal, intranatal and postnatalcare as well as the standard midwifery texts,it does so in a way that makes that careavailable to and relevant for midwives in ruralcommunities within developing countries.Midwives learn how to assess women at allstages of pregnancy and labour to enablethem to confirm normality or to recogniseproblems requiring transfer to a medical facility.They are guided in the use of appropriate,and the avoidance of inappropriate,technology and encouraged to use traditionalknowledge safely and effectively.However, this book goes far beyond basicmaternity care to enable the rural midwife tobecome a trusted and respected member ofher community. This guide explores topicssuch as: women’s health, changing communityattitudes, adapting cultural beliefs,finding creative solutions to problems suchas lack of transport and many more. Finally itcovers advanced skills such as external cephalicversion, pregnancy termination, preventionand treatment of STIs and familybe created by midwives or women are shownbeing used in childbirth and community education.Many of these could be used successfullyin any western skills lab setting to replaceor augment expensive teachingmodels.As much as I liked this book, my one problemwas ascertaining for whom, exactly, it wasproduced. With its emphasis on midwifery asa vocation of love rather than remunerationand with such a strong community focus,this book was clearly, not written for the‘professional’ midwife. That is not to say thatthere are not many lessons which could, andshould, be learned by professionals, but thefocus of this text seems to be for the traditionalbirth attendant, or TBA. As TBAs areusually apprentice-trained rather than formallyeducated, they may not be literate andalmost certainly would not be familiar withthe English language. Furthermore, the currentWorld Health Organization policy seemsto be the eradication of TBAs in favour ofprofessional birth attendants (World HealthReport 2005). Perhaps it is time to re-visitThis bookgoes farbeyond basicmaternitycare to enablethe ruralmidwife tobecome atrusted andrespectedmember ofher community.that they can understand and use writtenmaterials. If this were the case, I would certainlypromote this text as filling the nicheand would recommend its translation intolanguages spoken by traditional midwivesall over the developing world.This review has been published before in Educationfor Health, Volume 19, no. 1, 2006.D E C E M B E R 2 0 0 6 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 5planning.that policy as this book demonstrates justhow skilled many traditional midwives areFiona MacVane Phipps | Lecturer inAs someone very involved with clinical skillsand how they can be helped to provide anMidwifery & Women’s health, Universitytraining and preparation of clinical educa-even safer standard of care combining theof Bradford, United Kingdomtors, one of my favourite things about thisbest of medical and traditional knowledge.Email: f.e.m.phipps@bradford.ac.uktext is the all-encompassing emphasis onA more holistic and realistic policy to that ofeducation. It is about working together withreplacing all TBAs with professionals, mightwomen to improve the health of the wholebe to ensure that all traditional midwivescommunity. Simple teaching aids which canhave access to a basic education to ensure7

THE NETWORK: TUFH IN ACTIONEDUCATION FOR HEALTHSpecial Issue EfH:Exemplary Network: TUFHField ExperiencesEfH inElectronic FormatThe Co-Editors and staff of Educationfor Health would like to announcethat future Volumes ofEducation for Health will no longerbe distributed through a publishinghouse. Instead, The Network: TUFHwill host the journal exclusively inelectronic format.D E C E M B E R 2 0 0 6As of March 2007, Education forHealth will be available free ofcharge to all Internet users at thefollowing URL:www.educationforhealth.netN E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 5Changes in education are more productivewhen correlated to changes in healthcare,and vice versa. A system vision is essentialto appreciate how our position can influenceothers and how others can influenceus. The pentagram shows that forces forchange must direct their efforts to servethe common and central purpose of meetingpeople’s needs, highlighting a necessityfor integration of health activities andpartnership. Hence, The Network: TUFHwants to enlarge its membership to policymakers,health service organisations, professionalassociations, health professionschools and civil society representatives.Answering such questions is the ambitionof a special issue of the journal Educationfor Health, to be available mid 2007, inreviewing exemplary field experiencesworld-wide and presenting commentariesfrom distinguished health leaders. Hopefullyit will widen our vision on strategies to createa ‘unity’ of purpose and action amongkey players and point out new excitingareas for research and development.Charles Boelen | Guest editor of thespecial issue of Education for Health;International consultant in healthsystems and health personnel; Formercoordinator of the WHO programme ofFor more information, please contact:efh@network.unimaas.nlEfH Table of ContentsFor the Table of Contents of Education forHealth - Vol. 19, No. 2 please visitwww.the-networktufh.org/publications_resources/educationforhealth.asp(click on Table of Content)How can all these pieces come togetherhuman resources for healthand function productively? Do we know ofEmail: boelen.charles@wanadoo.frprojects where it is beginning to happen?What are the major challenges and constraints?Can Network: TUFH field projectsinduce new dynamics that will benefitboth educational institutions and the overallhealthcare system? How can local projectsinfluence policies at a higher level?8

IMPROVING HEALTHHEALTH SERVICESHEALTH RESEARCHReferral Behaviour of GPsto Diabetes Support TeamsLimited evidence is available in primarycare literature which describes how type 2diabetes mellitus patients are targeted formultidisciplinary care, according to the differentstages of the disease. It is acknowledgedthat General Practitioners (GPs) playa central role in treating, guiding and motivatingpatients to adhere to the treatmentplan. Guidelines suggest the involvement ofcaregivers other than GPs, especially whentherapeutic targets are not met. The useof multidisciplinary care by GPs can be enhancedthrough extended support, includingevidence-based guidelines, feedback,and a nearby diabetes support team thatacts as a complementary partner in care.In a trial conducted in a primary care settingof 320.000 inhabitants in Belgium,the referral behaviour of GPs to multidisciplinarydiabetes support teams was analysed.The diabetes support teams consistedof internists, educators, dieticians, healthpsychologists, and ophthalmologists. Theintervention group received extended multidisciplinarysupport, whereas the controlgroup received minimal support close toregular care. GPs in the intervention groupcould ask for interventions of high leveleducators in their own practice, or coulddecide the educator to visit the patient athome. The use of a free phone number as asingle point of access to the diabetes supportteam, the presence at team meetings,interventions of a health psychologist, andthe provision of extended reports on thepatient’s condition, were also offered to GPsin the intervention group. Sixty-eight GPs inthe intervention group and 45 GPs in thecontrol group brought in respectively 1568and 906 diabetes mellitus type 2 patients.(8%) patients to the diabetes supportteams, resulting in 650 diabetes consultations.Comparing users and non users of thediabetes support teams, values of glycatedhaemoglobin (HbA1c) proved to predict theuse of the diabetes support teams by GPs(p

IMPROVING HEALTHCARE FOR THE ELDERLYMobile Unit Servicesfor Old People in BahrainD E C E M B E R 2 0 0 6N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 5Mobile Unit Services visit the elderly two-three times per weekWorld-wide the number of people over 65 Assessment Procedure for the Elderlyyears of age is increasing. However, this (CAPE) was used to assess the well-beingpopulation is relatively stable in developedand behavioural disabilities of the elderly.countries. In Bahrain, 5% of the It contains 18 items covering four areas:population is above 60, a percentage that physical disability, apathy or inactivity,is anticipated to rise to 25% by the year communication difficulties, and social disturbance.2050. Approximately 1.33% over 65 areNurses were trained to assessliving in residential care.the elderly and complete those forms.As the overall number of elderly people Physical disabilities were most oftenincreases, there is a corresponding rise in related to mobility. Disabilities affectingthe number of older persons with disabilities.bathing were higher among the home-It is estimated that by the age of cared elderly than the institutionalised65-75 years, 3% will have some cognitive (100% versus 93%) and the same patternimpairment, and that by the age of 85 was found for walking (100% versus 95%).years nearly half may be demented. In addition, more home-cared elderly wereHowever, this percentage rises to 66% in bed during the day (100% versus 34%,when the elderly are institutionalised. p < 0.001) and fewer were confused thanthe institutionalised group (39% versusIt has been Bahrain’s government policy 64%). The percentage of elderly who werenot to license any more than the two existingincontinent was higher in the institution-elderly homes in the country. Therefore, alised group (50% versus 17%).in 1994 Mobile Unit Services (MUS) wereestablished for the provision of personal More of the home-cared elderly were ablecare, nursing care, physiotherapy and other to establish good relations with othersservices to the elderly in their own homes. than the institutionalised (89% versusEach unit consists of a team of four (nurse, 45%). And more of them were willing toauxiliary, physiotherapist and helper) that co-operate and do things when askedvisit the elderly two-three times per week. (83% versus 39%).ComparingThe home-cared group were better communicatorsIn our study we have attempted tothan the institutionalisedcompare levels of disability between the (78% versus 57%); they also understoodelderly admitted to an institution and better when others communicated withthose who remained in their homes and them (83% versus 54%).were offered services by MUS. The CliftonThe home-cared group socialised betterthan the institutionalised and had no difficultyestablishing good relations withothers. They were also less objectionableto others during the day. More of theelderly who were admitted to residentialcare had a paranoid attitude, e.g. accusingothers of bodily harm. Although the institutionalisedelderly slept better at nightcompared to those at home, it was foundthat only 9% of the institutionalised elderlywas on regular hypnotic medication.The home-cared group had less sensoryimpairment; 89% had no hearing difficulties,compared to 77% of the institutionalisedgroup, and 67% had no visualimpairment (with or without the help ofglasses) compared to 63%.ConclusionIt was concluded that MUS are very helpfulin providing services to the elderly intheir own home environment, which helpsin promoting their well-being. The homeenvironment usually provides stimulationfor the elderly through continuous activityby family members, friends and visitors.Due to the care and services provided bythe MUS and because of family support,the elderly living in their own home whencompared to the elderly living in theelderly homes were found to be moresocial, less confused and better communicators.Faisal Al-Nasir / Professor of FamilyMedicine; Vice President, Arabian GulfUniversity, Kingdom of BahrainEmail: faisal@agu.edu.bh10

RURAL HEALTHLodi Declarationon Healthy VillagesWe, the 350 participants from 43 countriesfrom all continents who took part in the16 th International Congress of AgriculturalMedicine and Rural Health, held here inLodi, Italy, from June 18 to 21, 2006, discussedthe challenges to providing adequateoccupational and environmentalhealth, food safety, public health and medicalservices in village, and we declare that:• we commit ourselves to a global movementin developing healthy villages torespond to the specific occupational, environmentaland public health problemsand the inadequate access to healthcareand health promotion in the rural areas;• we call for concerted national and internationalefforts to improve the scopeand the coverage of primary healthcareto better address the needs of rural communities,as well as to providing accessto occupational and environmentalhealth services in rural areas and to improvingthe quality of service delivery;• we are determined to advocate and providesupport for the elimination of theworst forms of child labour in rural andremote areas, to promote the legalisationand the official recognition of informaland migrant agricultural workers aswell as to contribute to a global decentwork agenda in villages;• we recommend incorporating the ruraldimension into international, nationaland local environments, occupational,and health action plans to meet the specialneeds of people living in villages;• we recognise the need for increasingstewardship of governments and industryand collaboration between the ministriesof health, environment, labour, agricultureand other relevant stateagencies as well as private enterprisesand workers’ organisations in addressingoccupational, environmental healthand public health risks in rural areas;• we also highlight the importance of theactions taken by local authorities andthe public initiatives to protect and promotethe health of rural populations;• we urge for an increasing collaborationbetween the relevant disciplines, such asmedicine, public health, occupationaland environmental health, health promotion,food safety, chemical safety, agriculturaland veterinary sciences, andsocial sciences for addressing the specialhealth needs of rural populations;• we pledge our support to the internationalactivities related to developinghealthy villages of the WHO and the InternationalLabour Organisation, acknowledgingthe importance of collaborationwith the other relevant UNagencies and the regional bodies;• we encourage the International Associationon Agricultural Medicine and RuralHealth (IAAMRH), the InternationalCommission on Occupational Health, aswell as the organisations of farmers, agriculturalworkers, agricultural industry,and the relevant NGOs and networks totake action to support and promote thedevelopment of healthy villages;• we believe that the healthy village conceptneeds to be introduced in trainingand educational programmes, in order tobuild the necessary human resources toprovide health services of good qualityto rural populations and agriculturalworkers;• we realise the need for adequate and reliabledata collection and analysis forneeds assessment, monitoring and eval-uation of healthy villages programmesand thus we will collaborate for the developmentof international models forrural health profiles and indicators;• we call upon the governmental agenciesand local authorities to ensure equaland proper access of people in villagesto information on public and occupationalhealth and the environment, stimulatesocial and environmental justice,as well as to provide means for empowermentof rural populations to protectand promote their health, and to improvetheir working and living conditions;• we are committed to share our goodpractice and experience in devising, implementingand evaluating programmesfor the development of healthy villages,and will work together to elaborate thenecessary technical tools and guides.www.iaamrh.org/lodideclaration.pdfwe commit ourselvesto a globalmovement indevelopinghealthy villagesto respond tothe specificoccupational,environmentaland publichealth problemsD E C E M B E R 2 0 0 6 N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 511

IMPROVING HEALTHINDIGENOUS HEALTHIndigenous Health Workersin AustraliaThe health of indigenous people in Australiapetent; adequate provision of basic andThe health worker is a valuable member tois continuously compared to the healthfurther education for the indigenous work-a health team dedicated to better healthof other indigenous groups around theforce, including access to appropriate andoutcomes for Aboriginal people. The healthworld and falls short of positive expecta-affordable education courses; the need forworker can expertly lead visiting healthcaretions. Aboriginal and Islander health hasemployers to recognise and support theproviders in a positive direction and toachieved little improvement, as evidencedknowledge gained by indigenous employ-the most effective way of reaching peopleby current mortality rates. The averageees and utilise the workforce appropriately;within their communities.Aboriginal adult’s life expectancy, male orfor employees to have the opportunity toThe challenge for visiting healthcare pro-female, is presently 20 years less than theiraccess professional bodies affording sup-viders is to ask the right questions appro-non-indigenous counterparts.port, development and guidance withinpriately and most importantly, listen to theSince the inception of Australia’s ‘white’their occupation; the development andanswers.government, indigenous health has reachedmaintenance of a career and professionalD E C E M B E R 2 0 0 6N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 5a crisis point in this country. Numerous policieshave sought to address health issuesbut none has been completely effective. TheAboriginal health programme, introducedin the 1960’s, implemented the inductionof an indigenous health workforce.Indigenous health workers were inductedto address the burgeoning gap in healthdeterminants between the indigenous communityand the non-indigenous communityof Australia.The role of the Aboriginal health workerhas experienced a metamorphosis sincethe introduction of the indigenous healthworker occupation. The health industryaccepts as the norm for the indigenoushealth worker the following duties, skillsand responsibilities: the delivery of basicclinical support to fellow health professionalsin community and clinical settings;for their practice to be governed by an evidence-basedphilosophy in clinical competenceand primary healthcare programmemanagement; the ability to contribute tohealth education and promotion, and; tobe ever conscious of cultural protocols andissues for their communities.Support and Barriersdevelopment pathway for employees tomove within the industry.Unfortunately in some areas acrossAustralia, health worker skills and knowledgeare neither valued nor utilised successfully.Racism is a major barrier. Otherhealth professionals discount the valueof indigenous contributions to indigenoushealth, and employers and other healthprofessionals are unclear about the roleof the health worker and therefore healthworkers are under utilized. Outsiders tendto impose their values on a community and‘steamroll’ initiatives of indigenous healthworkers; health workers have a self-defeatistattitude when it comes to real supportfrom employers and other health professionals.Finally, there is a lack of access toappropriate courses, to professional development,and to professional organisationsthat support the health worker profession.To conclude…Health workers are responsible for thehealth and well-being of their communitiesand often own that responsibility to anextent far greater than any other healthprofessional. They have grown and lived inAboriginalhealth workersare responsiblefor the healthand well-beingof their communitiesandoften own thatresponsibilityto an extentfar greaterthan anyother healthprofessional.A number of factors support the successtheir community, they share a passion forRenee Blackman | Nurse Educator andof the Aboriginal health worker within antheir country that is second to none, andIndigenous Health Worker Educator atAboriginal health programme: employmentthey often face the same health issues andthe Mt. Isa Centre for Rural and Remoteof an appropriately selected workforce thatmore often than not suffer the same bur-Health, Australiais both culturally and operationally com-den of illness experienced by their clients.Email: dennis.pashen@jcu.edu.au12

HEALTH PROMOTIONIncreasing Dental AwarenessAmong Young ParentsDespite marked oral health improvements inalence study quantified the severity of theReferencesthe overall population, children in deprivedproblem (ECC) and identified the most vul-ALALUSUUA, S. & MALMIVIRTA, R.families experience a disproportionatenerable groups. Children from families with(1994). Early plaque accumula-share of the disease burden (Alalusuua &the highest occupational level had 7.4%tion, a sign for risk in young chil-Malmivirta, 1994) (Andlaw, 1978) (BelliniECC, compared to 29.6% of the childrendren. Community Dentistry and Oralet al., 1981). A common oral health risk infrom families with the lowest occupationalEpidemiology, 22:273-276.childhood is early childhood caries (ECC),level. Ethnicity and neighbourhood wereANDLAW, R.J. (1978). Oral hygiene andthe occurrence of any sign of dental cariesthe social variables significantly associ-dental caries: A review. Internationalon any tooth surface during the first threeated with ECC. A qualitative study revealedDental Journal, 28:1-6.years of life (De Grauwe et al., 2004).important bottlenecks in an attempt toBELLINI, H.T., ARNEBERGM, P. & VON DERchange dental health behaviour in theFEHR, F.R. (1981). Oral hygiene andAlthough current sensitising programmesmost vulnerable population groups (e.g.caries: A review. Acta Odontologicain oral health contribute substantially tothe lowering of the prevalence rates ofdental health problems in the generalpopulation, they have limited success inenhancing awareness and access to dentalcare in socially vulnerable groups. Theacknowledgement that these current pro-the impotence of parents in their attemptto guide and support their children in performinggood oral hygiene habits).Based on these results, a multi-axial interventionwas developed: oral health wasimplemented as a recurrent point of atten-Scandinavia, 39:257-265.DE GRAUWE, A., APS, J.K.M. & MARTENS,L.C. (2004). Early Childhood Caries(ECC): What’s in a name? EuropeanJournal of Paediatric Dentistry, 2:62-70.WATT, R.G. (2002). Emerging theories intosocial determinants of health:D E C E M B E R 2 0 0 6grammes, mainly focusing on health behaviouralchanges, are not able to bridge thegap between social classes, has led to theemerging of new theoretical approachesand intervention programmes. Thesetake into account the social determinantsof health, and the relationship betweenthe social environment and health (Watt,2002).A community project was initiated by threecommunity health centres, all located indeprived areas in Ghent, Belgium. Theyinvolved keynote organisations in the developmentand implementation of the project:Child & Family (a Flemish public agencytaking care of the welfare and health of allchildren from zero to three years), Ghenttion in the monthly consultations at thebaby clinics run by Child & Family, a sensitisationcampaign for care givers was setup. Dentists were informed about possiblesolutions for financial barriers and werestimulated to actively involve in communityactivities on oral health. Finally, severalactivities were set up to improve theknowledge and to influence the attitudeof the target group (a poster campaign inthe neighbourhood, a board game on oralhealth for mother groups, didactical materialfor schools, etcetera).An evaluation of this community projectidentified as key elements: the intensivecollaboration with and active involvementof community organisations; using sup-Implications for oral health promotion.Community Dentistry OralEpidemiology, 30:241-247.Sara Willems, Jacques Vanobbergen,Luc Martens, Jan De Maeseneer |Ghent University, BelgiumEmail: sara.willems@ugent.beN E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 5University, the Dentist Association Ghent,porting educational material adapted toschools, et cetera. The aim of the projectthe target group; keeping the messagewas to develop and implement an adequateuncomplicated, multi-evidence-based intervention to tackle ECC,lingual and realistic;taking into account the characteristics ofand includingthe targeted population group.games in oralhealth education.Two research projects provided the basis inthe development of the programme. A prev-13

IMPROVING HEALTHINTEGRATING MEDICINE AND PUBLIC HEALTHD E C E M B E R 2 0 0 6N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 5Searchingfor Experiences on IntegrationFunctional and conceptual division betweenpublic health and medicine (individual clinicalcare) has become a constant in thedeveloped countries’ sanitary system organisation.This division and the variety ofdefinitions of public health and medicinecompetences make it difficult to know howtasks are distributed, and which criteriahave been used to set the boundaries thatseparate both fields. Recently publishedstudies show the enormous variability oftasks division in developed countries(Starfield et al., 2004).The separation between services is probablydue to traditional organisation of servicesand the attitude and perception of managers,health workers and community membersabout what their tasks are and howthese tasks have to be fulfilled (Gofin etal.).Frequent consequences of this separationare the lack of comprehensive planningregarding some areas of care, misuse ofservices, and barriers for an improvement ofpopulation’s health. An example of that ishealth promotion. It is frequent to observevarious health organisations, public health,primary care and others, having somedegree of responsibility on health promotion.If the separation prevails, who isfinally in charge of health promotion? Howto avoid duplication? Is there any degree ofcoordination between services in charge?BieofBioef (the Basque Foundation for SanitaryInnovation and Research) is developing kOs(Komunitateen Osasuna Osatzen -Integrating the Health of Communities), aproject that tries to answer some of theprevious questions. One of the objectives ofthis project is “to explore effective modelsof collaboration/integration between theservices in charge of health promotion atthe local/community level, and to studywhich factors make these models viable,sustainable, and effective”.In a first stage, an observational transversalstudy has been made. Health promotionprogrammes and activities being developedin local settings of more than 5000 inhabitantsat the Basque Country-ComunidadAutonoma País Vasco (BC-CAPV) in Spainhave been reviewed.Information about main health promotionissues, target population, responsible team,collaboration with other institutions, evaluation,and financing was collected.ResultsThe main health promotion issues beingtackled at the local/community level aredrug consumption, physical activity, alcoholand tobacco, and healthy eating. The percentageof the 65 studied municipalitiesdeveloping programmes or activities onthese issues is as follows: drugs 95%,physical activity 20%, alcohol abuse 15%,and healthy eating 5%.In general, some degree of collaboration/integration between organisations andinstitutions can be found in all programmesrelated to drug consumption, but only in3% of the rest of the programmes. This differencehas to do with the relevant implementationof the General Plan AgainstDrug Consumption of the Basque Country.The Plan is launched and developed by theSocial Affairs Department. It is articulatedaround general and specific objectivesdefined by inter-institution committees(departments of the Basque Governmentlike Social Affairs, Health, Education, localGovernments, and others), and later on areadopted, adapted and implemented bylocal/municipal Governments. These participatinglocal institutions receive strategic,methodological and financial supportfrom the central Government, and participatein the further evaluation.Who is finally incharge?How to avoidduplication?Is there anydegree ofcoordinationbetween servicesin charge?ConclusionsThe results of this work show that whendifferent administrations (central and localin this case) consider that coordination/integration is desirable, they are able to putin place the mechanisms (programme planning,guidance, evaluation, etcetera) andthe financial support necessary to make ithappen.ReferencesSTARFIELD, B., SEVILLA, F., AUBE, D.,BERGERON, P., DE MAESNEER, J.M.,HJORTHAL, P., LUMPKIN, J.R.,MARTINEZ OLMOS, J., & SARRIA-SANTAMERA, A.(2004). Atenciónprimaria y responsabilidades de saludpública en seis países de Europa yAmérica del Norte. Un estudio piloto.Rev Esp Salud Pública, 78:17-26.GOFIN, J. et al. Integrating medicine andpublic health; www.the-networktufh.orgItziar Vergara Mitxeltorena | BasqueFoundation for Sanitary Innovation andResearch; Member of the taskforce onIntegrating Medicine and Public HealthEmail: vergara@bioef.org14

INTERNATIONAL HEALTH PROFESSIONS EDUCATIONSEXUALPROBLEM-BASED LEARNING AND COMMUNITY-BASED EDUCATIONComputer-Assisted Trainingin the Clinical Skills LabThe Faculty of Medicine, Suez CanalSixteen training rooms were provided withUniversity (FOM/SCU) clinical skills lab wascomputers connected to a network, enablingestablished in 1981 as the first skills lab instudents to view prepared multimedia con-Egypt at that time. The lab aimed at stan-tent at any time. The training started with adardising training and evaluation of basicpre-lab session during which studentsclinical skills, and promoting the humanisticwatched a movie related to one skill, andattitudes in students approach to patients.the specialist was present for any clarifica-Students are trained on their peers or ontions needed. Students then entered theirmodels (manikins) by junior staff memberstraining rooms, where they revised selectedwho have been trained in advance by seniorparts of the movie and navigated throughfaculty specialised in respective skills. Thedifferent links (surface anatomy, commonTraining rooms are provided with com-weekly sessions use checklists for differenterrors, critical errors, illustrations, abnormalputers connected to a network, enablingskills to standardise performance. Thesechecklists are tested for validity and reliabilityand updated regularly.Other learning materials include handouts,illustrating charts, models for surface anatomy,video films, CDs for related materials,signs, and questions related to the skill).Then they practiced the skill on each otheror on the model, guided by the checklistsand the movie, and received feedback fromtheir instructor and their colleagues.Opinionsstudents to view prepared multimediacontent at any timedemonstrating and practicing during andafter the lab sessions.For more information, please visit:D E C E M B E R 2 0 0 6and questions related to the steps of theskill. Periodic and final evaluation is donefor students’ clinical performance and backgroundknowledge of different skills.New Learning MethodologyIn 2005, a new learning methodologywas introduced (and applied on 2 nd yearstudents in the skills lab) through aproject funded by the Higher EducationEnhancement Projects Funds. The outcomesof this project were:• revision and re-validation of all checklistsusing Delphi technique,• production of audio-video films for differentskills which are relevant, standardised,and serve as training material,• production of computer-generated multimediaprogrammes which are self-explanatory,interactive, and readily available atany time,• well-prepared educational setting fulfillinghighly standardised criteria,• data about the impact of the new methodon the learning process, which could leadto application of the new methods on allbatches, with continuing improvement.Evaluation of the new teaching methodologywas done through soliciting faculty andstudents’ opinions about the content, quality,and process, using anonymous questionnaires.Overall, the majority of faculty andstudents agreed that the scientific content(100.0% and 97.3%), appropriateness ofillustrations used (97.8% and 95.7%), logicalsequence of steps (100.0% and 96.3%),audio (95.7% and 79.8%), and video quality(97.8% and 89.0%) were good to excellent.The great majority of students confirmedthey will use the products for selflearning(93.5%). Also, more than 90% ofthe students considered the new teachingmethodology better than the old one, beingmore informative, more interesting, and givingenough time to understand scientificbackground, practice, and ask questions.As for total satisfaction with sessions amongstudents, the great majority of responses(96.3%) ranged between good and excellent.Therefore, the new teaching methodologyin the skills lab facilitated and enhanceddemonstration and practice of skills, encouragedstudents’ self-directed learning, andfacilitated their mastery of required skills bycsl.nelc.edu.egSomaya Hosny, Adel Mishriky andMirella Yousef | Vice Dean forEducation, Project Director; Professor ofCommunity Medicine, Member of theProject Management Team; Lecturer ofCommunity Medicine, Project Co-Director | Faculty of Medicine, SuezCanal University, EgyptEmail: crdmed@ismailia.ie-eg.comMore than 90%of the studentsconsidered thenew teachingmethodologybetter thanthe old one.N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 515

INTERNATIONAL HEALTH PROFESSIONS EDUCATIONYELLOW PAPERSBetween those outstanding publications that were already published in leading journals, and some preliminary notes scribbled on thelast page of an agenda, there are also papers or reports that belong to the in-between (‘grey area’) category. Papers that, for whateverreason, have not been published before. Within this ocean of ‘grey’ papers, there are some which by content are most relevant to theNetwork: TUFH’s mission and aims. We will pick those pieces of gold from the ‘grey’ ocean, change their status to ‘yellow’ (because wecan’t print in gold) and publish these in this section. Below you will find two of such yellow papers.E-Learningin Human NutritionE-learning presents a host of new opportu-human nutrition course, and regressionferences, although in 2003/2004 wenities for institutions to cost-effectivelyanalysis was used to estimate the associa-achieved the higher percentage of stu-expand access to education and improvetion between final grades and number ofdents with very high grades (≥ 16.0).educational outcomes, which will poten-hits in the web pages. We also comparedA potential limitation of our study is thattially enhance the learning process (O’Neillfinal grades in human nutrition duringwe used the number of hits as a measureet al., 2004).2003/4 and the last four years.of e-learning, although this proceduremight not be reliable to evaluate the e-D E C E M B E R 2 0 0 6The University of Porto engaged in a pilotproject in 2003/2004, using e-learning tosupport students in human nutrition classes.Our primary goal was to deliver somee-learning solutions to improve the educationaloutcomes. We adapted our traditionalstudent-centred, problem-basedResultsOur experience in this pilot study was thatWebCT allowed delivering innovative e-learning strategies for engaging students,addressing many of the educational problemsassociated with traditional teaching,and serving diverse student populationslearning process. Most of our teachingtakes place on campus and face-to-face,and occurs in a blended learning style. It isalso important to recognise that the presentfindings are based on cross-sectionaldata, and a causal relationship cannot beinferred.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 5approach into a blended-learning experience,using WebCT 4.0 as the e-learningplatform. This allowed lecturers to retaintheir facilitator role, and encouraged studentsto explore, analyse and make decisionsusing objects and simulations embeddedwithin web pages. E-learning was usedin teaching and learning in a whole rangeof ways, e.g.: using computer-generatedpresentations with lectures; creating electronicpublication of lecture notes; settingcomputer-based bibliographic searches;using real databases to retrieve information;using bibliography to attend lectures;and putting students into ‘real’ task situations.In these settings, under the guidanceof teachers, they discover how toapproach the evaluation of the problem(different ages, employment status andgeographic residence).Students emphasised that e-learningincreased significantly their communicationwith professors, and their performancein the course; and that e-learning facilitatedlearning at anytime and anywhere,and reduced the obstacles of time anddistance, providing greater equality ofopportunity.Each ‘hit’ in the web pages increased thefinal score in 0.002 points (in the regressionanalysis, final score was the dependentvariable and the number of hits wasthe independent variable; beta = 0.002,intercept = 11.8, r 2 = 0.13, p = 0.012).The more visited pages were the ones thatConclusionsStudents demonstrated high satisfactionwith e-learning, and performance in finalgrades was related to the number of hits inthe web pages of the human nutritioncourse. These results indicate that an e-learning approach in human nutrition mayimprove a student-centred learning experience,with high satisfaction rates amongstudents, and opportunities for the utilisationof e-learning in the nutritional sciencesare remarkable.ReferenceO’NEILL, K., SINGH, G. & O’DONOGHUE, J.(2004). Implementing eLearning programmesfor higher education: A reviewand acquire needed information and skillsincluded guidance to practical sessions,of the literature. Journal of Informationto understand the mechanisms involved inputting students into ‘real’ task situationsTechnology Education, 3, 313-323.the problem and how to approach thein a problem-based learning approach, andmanagement of the situations.pages that exhibited content materialsPedro Moreira | Correspondingfrom learning sessions.author, Associate Professor, FaculdadeIn order to evaluate the project, studentsde Ciências da Nutrição ecompleted a self-administered question-When we compared mean final grades inAlimentação da Universidade donaire on the web. Evaluation outcome washuman nutrition during the last five years,Porto, Portugalalso expressed as the final grades in thewe did not find statistically significant dif-Email: pedromoreira@fcna.up.pt16

Needs Assessmentfor Medical Education in Rural NepalAs part of their training, GeneralPractitioners (GPs) in Nepal must spend fivemonths in a rural district general hospital.There was concern that although studentsgained a lot of practical experience in suchplacements, there was not much structuredteaching/learning.MethodologyA modified Delphi process was employedto assess the learning needs of GP trainees.Participants in the Delphi were fivesenior doctors with experience working inOkhaldunga mission hospital.The first step in a Delphi process is to introducea question or concept for discussion.Each participant was given backgroundmaterials to help them answer the question:“What are the most important thingsthat the Medical Doctorate in GeneralPractice (MDGP) trainee should be learningduring their district hospital placement?”These materials were:• a copy of the previous MDGP curriculumfor the placement,• results of a community survey on healthneeds in the area,• guidelines for community-based learning,and• the top 10 diseases seen in Okhaldungaoutpatient department during one year.During the second step, participants usedthis material and their own extensive experienceto write their responses. Commonthemes were identified and grouped together.Differences in opinion were also noted.The collated list was sent to the participants,for them to review and amend. Thisstep is a critical part of any Delphi process.For the first time, participants have theopportunity to review the opinions of thewhole group. They have the opportunityto change their input or add new thoughtsstimulated by the document.A GP trainee working in a rural hospital in NepalIn the fifth step the amended documents • appreciates the role of the District Generalwere sent back to the organiser for further Hospital within the wider context of thecollation and editing. A single revised documentcommunity’s health and the district healthis produced and distributed back out system.to the participants who were asked to rankthe relative importance of each item. These competencies formed the basis forIn this small study a simple tally system was a core curriculum for the District Hospitalemployed to work out the overall ranking by Placement. Data gathered during the Delphiall participants. In larger studies, or when process was also used to develop a moresome participants are more experienced detailed ‘aims and objectives’ document,than others, a more complicated ‘weighting’which led to the design of study guides cov-system may be appropriate. After this ering core areas not currently being taughtprocess a final document was developed. in a systematic way.ResultsConclusionsUsing this process of needs assessment, a Although the study was small, the informationconsensus was reached on seven essentialit documented has helped produce GPscompetencies for practice:learning materials focused on the health• exhibits confidence and is capable of needs of rural communities in Nepal.independent decision making at the districtWe now have clear goals for both studentslevel,and teachers as to what the students should• manages both emergencies and chronic know by the end of their placement.health problems appropriately within the As a needs assessment tool the Delphi processlimited resources of a District Generalis flexible, practical, requires relativelyHospital,little time commitment from participants,• considers the patient’s social, geographic and develops valuable consensus. The availabilityand economic situation when makingof email makes participation possiblemanagement decisions,even from quite remote areas.• communicates well with patients andstaff,Katrina Butterworth | Department of• works co-operatively with other health Emergency and Family Medicine, Patanprofessionals as part of a team,Hospital, Nepal• promotes health and prevents disease, Email: mkbutter@wlink.com.npandD E C E M B E R 2 0 0 6 N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 517

INTERNATIONAL HEALTH PROFESSIONS EDUCATIONRURAL HEALTH PROFESSIONS EDUCATIOND E C E M B E R 2 0 0 6N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 5Canada IncreasesRural Medical EducationCanada, the world’s second largest countrywith 10,000,000 square kilometres, hasonly 31,974,363 people. Although 21.1% ofCanadians are rural (living in rural areasand small towns of less than 10,000 peoplebeyond the commuting zones of the largercentres), only 9.4% of physicians are locatedin rural areas: 16.0% of family physicians/general practitioners and 2.4% ofspecialists (Pong & Pitblado, 2006). Of thestudents who entered Canada’s 16 medicalschools in 2000, only 10.8% were from ruralbackgrounds; about 22.4% would havebeen expected from the population comparisonused (Dhalla et al., 2002). This discrepancyhas been identified as a major problemand recommendations for improvementhave been developed (Task Force, 2005).Rural Students and Rural MedicalEducationThere is increasing evidence in Canada (as inthe rest of the world) that physicians from arural background and/or having had ruralmedical education during medical schooland/or post graduate residency training,are more likely to become practicing ruralphysicians (Carter et al., 1987) (Rourke etal., 2005) (Chan et al., 2005) (Easterbrooket al., 1999). The importance of admittingrural students and providing rural medicaleducation, combined with the need for morephysicians, especially rural physicians, hasprompted major exciting changes in medicaleducation all across Canada. The number ofstudents entering Canadian medical schoolshas dramatically increased from 1,763 in theyear 2000 to 2,380 in 2005. And the proportionof students from rural areas has risento about 15%, doubling the number of studentsfrom rural areas entering medicalschools. Much of the capacity for trainingthe increased number of students has beendeveloped in regional, rural and remote communities,so the students are provided amuch greater opportunity for rural medicaleducation. Many of Canada’s medical schoolsnow include compulsory rural clinical experiencesfor all students, with optional moreextensive clinical placements for those studentswho are particularly interested. Sixmedical schools have developed regionalsatellite medical campuses for students todo most of their medical school educationaway from the central metropolitan universitycentre. There is an increasing recognitionacross Canada of the importance of interprofessionaleducation in order to enhancethe effectiveness of team work in healthcaredelivery. This approach is particularly relevantto rural healthcare and is also beingdeveloped with team-based rural clinicalplacements. Some medical schools, such asMemorial, have a long standing focus on ruralhealth, with a rural and regional focusedcurriculum content and clinical placements.Since its inception, over 30% of Memorialmedical students have been from rural areas,and currently it is about 40%.NOMSThe most exciting new development in ruralmedical education in Canada is the establishmentof the Northern Ontario MedicalSchool (NOMS); its inaugural class of 56medical students began in September 2005.The NOMS is in a very rural part of Canada,with its two main campuses (in Sudbury andThunderbay) located 1,000 kilometres apart(Rourke, 2002). Its medical education programmefocuses on educating doctors forrural and remote areas and includes an admissionpolicy focused favouring studentsfrom northern and rural areas. NOMS undergraduatemedical programmes provide astrong rural northern and Aboriginal contentand context, with very distributedlearning experiences in the pre-clerkshipyears one and two. Years three and four areplanned to be small community horizontalexperiential clinical clerkships, all supportedby robust information technology.Postgraduate LevelAt the postgraduate level, rural family medicinetraining streams have been developedat a number of medical schools that focusspecifically on developing the skills for ruralpractice through a combination of rural context,curriculum and learning experiences(Rourke et al., 2000). Some medical schools,such as Memorial, have as high as 40% oftheir Family Medicine graduates enteringrural practice (CAPER, 2004) (Hutten-Czapskiet al., 2002). A few other schools, suchas the University of Western Ontario, havedeveloped an extensive rural regional educationaltraining opportunity for specialtyresidents as well (Rourke, 2005) (Rourke &Frank, 2005). In order to have the greatestimpact on improving the health of the ruralpeople of Canada, this major medical educationshift of focus towards remote, rural andregional medical education must be accompaniedby the concurrent development of appropriaterural health facilities and ruralhealthcare teams.ReferencesCAPER (2004). New physicians in RuralPractice. www.caper.caCARTER, R.G. (1987). The relation betweenpersonal characteristics of physicians andpractice location in Manitoba. CanadianMedical Association Journal, 136:366-368.CHAN, B.T.B., DEGANI, N., CRICHTON, T.,PONG, R.W., ROURKE, J.T., GOERTZEN, J. &McCREADY, B. (2005). Factors influencingfamily physicians to enter rural practice.Canadian Family Physician, 51:1246-1247.DHALLA, I., KWONG, J., STREINER, D.,BADDOUR, A., WADDELL, A. & JOHNSON,I. (2002). Characteristics of first-yearstudents in Canadian medical schools.Canadian Medical Association Journal,166(8):1023-8.EASTERBROOK, M., GODWIN, M., WILSON,R., HODGETTS, G., BROWN, G., PONG, R. &NAJGEBAUER, E. (1999). Rural backgroundand clinical rural rotations during medicaltraining: Effect on practice location.Canadian Medical Association Journal,160:1159-63.18

NEW INSTITUTIONS AND PROGRAMMESHUTTEN-CZAPSKI, THURBER (2002). Whomakes Canada’s rural doctors? CanadianJournal of Rural Medicine, 7;95-100.PONG, R. & PITBLADO, R. (2006). Geographicdistribution of physicians in Canada:Beyond how many and where. CanadianInstitute of Health Information.www.cihi.caROURKE, J.T.B., INCITTI, F., ROURKE, L.L. &KENNARD, M. (2005). Relationshipbetween practice location of Ontario familyphysicians and their rural background oramount of rural medical educationexperience. Canadian Journal of RuralMedicine, 10(4);231-239.ROURKE, J. (2005). A rural and regional communitymulti-specialty residency trainingnetwork developed by the University ofWestern Ontario. Teaching and Learning inMedicine, 17(4);376.ROURKE, J. & FRANK, J.R. (2005). Implementingthe CanMEDS physician roles in ruralspecialist education: The multi-specialtycommunity training network. Education forHealth: Change in Learning & Practice,18(3);368-378. Joint issue with Rural andRemote Health, 5:406. Online available atrrh.deakin.edu.auROURKE, J. (2002). Building the New NorthernOntario Rural Medical School. AustralianJournal of Rural Health, 10:112-116.ROURKE, J., NEWBERY, P. & TOPPS, D. (2000).Training an adequate number of rural familyphysicians. Canadian Family Physician, 46:1245-1248.Task Force of the Society of Rural Physiciansof Canada (2005). Strategies to increasethe enrolment of students of rural originin medical school: Recommendations fromthe Society of Rural Physicians of Canada.Canadian Medical Association Journal,172(1): 62-65 (pdf).YEATMAN, D. & KEALEY, L. (2006). CanadianMedical Education Statistics, 28.www.afmc.ca/forms/order.htmlJames Rourke | Dean, Faculty ofMedicine, Memorial University ofNewfoundland, CanadaEmail: dean@med.mun.ca2 nd UPGlobal Health CourseThematic poster session amidst the greens of Silungan farmIn April, 2006, there were 34 medical,nursing and dentistry students who joinedthe 2 nd University of the Philippines GlobalHealth Course (UP-GHC) amidst the greensof historic Morong, Rizal, Philippines. Apioneering effort for the UP, for the countryand even for Asia.UP-GHC is thought of as another strategyto further enhance social accountability inmedical education. Medical students RaoulBermejo (Student Network Organisation)and Mike Gnilo (part of the Network:TUFH taskforce on Integrating Medicineand Public Health) were proponents of theidea. They were inspired by internationalconferences such as the Finnish DiplomaCourse in Global Health in Helsinki andthe Network: TUFH Conference in Atlantaheld in 2005. The UP-GHC was developedwith the vision of complementingtraditional medical teaching with a coherent,socially-relevant, interdisciplinaryapproach to health and development.In 2006 the workshop was expanded fromthree to five days, and reached out to studentsin other health professions who werelikewise interested in the broader socialdimensions of the health sciences.One very popular UP-GHC activity wasthe theatre arts workshop on gender andreproductive health, organised by thePhilippine Education Theatre Association(PETA).There were several members of the UPCMFaculty who shared their experience andexpertise on a variety of global healthissues: injury, psychosocial issues relatedto war and trauma, reemerging infectionsand global pandemics.World Health Organization (WHO)Representative to the Philippines Dr. JeanMarc Olive, the Philippine Departmentof Health Director of the Health HumanResources Development Bureau, andfriends from the voluntary sector, wereguest faculty members.The thematic poster session on studentwork on global health issues, held creativelyamid the trees and garden, was aformat well received by the participants.Portia Fernandez-Marcelo | AssociateProfessor, College of Medicine, Universityof the Philippines, the PhilippinesEmail: portiafm@yahoo.comD E C E M B E R 2 0 0 6 N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 519

INTERNATIONAL HEALTH PROFESSIONS EDUCATIONACCREDITATION AND QUALITY ASSESSMENTAccreditationof Medical Education in Central AsiaIn the Central Asia Republics (CAR), theCAR nations. There is no legal frameworkdemise of the Soviet system and its infra-for such a regional system and no regionalstructure also precipitated the collapse ofbody that can authorise, require or overseethe formerly centralised medical educa-a regional process. Planners have, there-tion system. In its place, nation-basedfore, agreed to develop national modelsmodels with individualised approaches toin the short term. The ultimate goal is tostructure, content, language, duration anddevelop a unified regional system that usesaccreditation of medical instruction werea transparent, data-driven, peer-review pro-developed.Meeting in Kazakhstan of CAR medicalcess to inspire quality improvement.D E C E M B E R 2 0 0 6CAR medical educators formed a regionalCouncil of Rectors in mid-2001 to helpovercome this post-Soviet fragmentation.The rectors collaborate to solve shared problemsin such areas as financing for medicaleducation, workforce planning, establishingnew schools, setting admission standards,creating access to patients for clinical training,improving faculty pedagogical skills,academic leaders, staff from ministriesof health and education, andinternational experts• establish accountability;• eliminate poor quality programmes;• provide recognition of excellence bypeers, nationally, regionally and internationally;Slowed ProgressFinally, political instability in the regionhas slowed progress in reforming medicaleducation. Uprisings and presidential electionsin several countries distracted ministrystaff and medical academy leadershipfrom focusing on the planning project. Anumber of senior rectors who originally ledthe charge for change have been replaced,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 5and developing standardised graduationexaminations. A common thread in allthese issues is quality; the rectors believethat quality improvement can be driven bythe accreditation process.Rationale for AccreditationIn October 2005, after two years of studyand planning, nearly 60 representativesfrom four countries met to define a processfor the accreditation of medical educationin CAR. Building on past involvement,attendees represented the importantstakeholder groups with an interest inquality improvement in medical education:ministry representatives from health andeducation, medical academy and postgraduateinstitute rectors, and students.• help develop faculty by engaging themin the quality assurance process; and• improve quality of healthcare providedto patients.They also acknowledged the importanceof including two perspectives in the planningprocess, namely, the legal frameworkof existing national accreditation systemsand the institutional and educationalmodels that could inform the process.Steps CompletedBy September 2006, several major stepswere completed: review of multiple internationaldocuments and models; analysis ofthe legal framework of existing systems andoptions for establishing regional co-opera-eroding the long-term knowledge baseneeded to sustain the reform process.Fortunately, international collaborators fromthe WFME, the Educational Commission forForeign Medical Graduates/Foundation forthe Advancement of International MedicalEducation and Research, the Associationof American Medical Colleges, the LiaisonCommittee on Medical Education and theNational Board of Medical Examiners havebeen stalwart in their support.Funding for the project came from theUS Agency for International Developmentthrough the American International HealthAlliance and Abt Associates. US facultyfrom the University of South Florida Healthtion; and development of a prototype data-Sciences Centre coordinated the efforts.The participants outlined a rationale forbase to warehouse and analyse informationaccreditation, including that accreditationto support the accreditation process. TheKathleen Conaboy and Zhamilyacould:WFME’s standards for basic medical educa-Nugmanova | Coordinator for interna-• improve quality of education offered;tion were endorsed and are currently beingtional medical education programmes,• help assure that students acquire cer-adapted for use in Central Asia.University of South Florida; Director oftain competencies;the regional (Almaty, KZ) office of AIHA• provide the catalyst for change at medi-Confounding the idea of regional system isEmail: kathleenconaboy@sbcglobal.netcal academy;the strong sense of sovereignty of the five20

SOCIAL ACCOUNTABILITYSocial Responsivenessvs. Social ActivisimResponsiveness suggests a static, insularmorphing into an impotent lowly skilledpoint of view premised on comfort withinbureaucracy suckling inefficient economicJohannesburg Metro Health Districta societal or group interest. We are oftenempowerment.vested with individual self-interest andexpand to group needs mostly aroundThe DHS in urban areas in South Africa ismaintaining our survival. Only sometimesbeing driven by a ‘comprehensive preven-can we go beyond and abandon self-inter-tive’ approach and yet being depletedest or see self-interest in terms of theof generalist clinicians with nurses andwider interest. This ‘higher purpose’ mightspecialists dominating a system that doesbe driven by moral, religious, Marxistnot produce quality balanced with equi-or Freudian needs. Whatever the higherty. Family medicine enjoys the ability topurpose, it often happens through personalcrisis and catharsis to produce socialactivists (the Paulo Freires etcetera drivenfrom within) that make such an enormousimpact on wider society.Group Interest vs. Higher PurposeApartheid South Africa created its crisiswhich saw post-apartheid efforts like theANC National Health Plan (1994), theWhite Paper on Transformation of HealthServices (1997) that outlined major changesthat are reshaping the landscape ofhealth. The District Health System (DHS)is finally being built with the NationalHealth Act (2003). It is all a very creditableframework. However, the higherpurpose of an anti-apartheid struggle isbecoming embroiled in the messy job oftransformation and change management.The Government speaks of commitmentto primary healthcare, but capacity andquality in the DHS is declining, despitebuilding some more accessible facilities.The DHS is still hostage to hospitals. AsSouth Africa has proceeded down thispath, societal consensus has fracturedwith various interest groups. These newlyaddress these issues with management ofresources, awareness of the subjective andrelating to the context. Family medicinehas become a partner with Governmentin developing the DHS clinically. The difficulties,however, are that universitiesperceive this as ‘outreach’, and those fewyoung recruits attracted to training arelosing the memory of the apartheid pastand state alignment forces apologies forits deficiencies.Family Physicians as Social ActivistsHow we proceed in this effort without sinkinginto self-interest is a challenge. Can wesupport self-development of trainee FamilyPhysicians with a higher purpose as socialactivists and advocates for patients? Canwe continue to produce a catharsis?Many leaders in family medicine in SouthAfrica attended the Medical University ofSouth Africa and often anecdotally quotethe group-based course in Whole PersonMedicine as psychotherapeutic, and theoverall lack of structure as very intimidatingand crisis-inducing, yet very critical totheir growth as Family Physicians. We areees very much in the centre of the DHSwhere the needs are greatest, annexingthe space between state and university,and letting the learning emerge in a nurturinggroup exercise. We should createFamily Physicians as social activists, withthe state and university as terrains ofstruggle for a caring and equitable qualityprimary healthcare service. You, asNetwork: TUFH Newsletter reader andsocial activist, can help.See www.edistrictnews.com for more onthis very embryonic process.D E C E M B E R 2 0 0 6 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 5formed groups are driven more by theirnarrower group interest rather than a continuedhigher purpose. The Governmentrails against consumption, yet all eyes areon being part of the rapidly expandingblack middle (and obscenely rich upper)class. The public service is at risk ofexploring a learner-centred course as wellas health systems management skills tomake sure Family Physicians can invokesome critical thinking about self, societyand system (as a whole person), and alsonavigate management in a transformingSouth Africa. We must place young train-Shabir Moosa | Head, Departmentof Family Medicine, JohannesburgMetro Health District Coordinator,Wits University-Gauteng FulltimePostgraduate Programme Development,South AfricaEmail: shabir@drmoosa.co.za21

PARTNERSHIPSSmart‘Glocal’ PartnershipsBased on her excellent contributions atNGOs in Kelantan, to upgrade the qualityUniversiti Sains Malaysia (USM), at herof life of a local community through thecountry and international levels, Rogayahimplementation of health as well as devel-Ja’afar was appointed as a Full Professor ofopmental projects. It involved all partiesMedical Education in November 2003. Inas partners in identifying local problems2006 she presented her professorial publicand issues, planning, implementation andtalk titled Smart ‘Glocal’ Partnerships inevaluation of projects. Medical studentsMedical and Health Professional Educationof USM learned about the art of plan-- Thinking Globally and Acting Locally.Rogayah Ja’afar’s presentation focusedning, negotiating and working closely withcommunity members, local Governmentagencies and NGOs. They learned to makeDr. Rogayah Ja’afar presenting herprofessorial public talkon University and Community Smarta difference at the grassroots and com-D E C E M B E R 2 0 0 6Partnerships, establishing educationalprogrammes in the medical and healthsciences that are more relevant and meaningfulto both communities and learninginstitutions. She recommended establishing‘glocal’ partnerships in the trainingof health professionals, ‘glocal’, meaningmunity levels through community drivenresearch activities. This experiential learningis something that they could notachieve from their medical text books andby remaining in the university campus.Based on the success of the Kampongagainst women. Seven institutions in thedeveloping world implemented the modulesas pilot institutions and the learningpackage has been offered free of chargein CD format or on-line to training institutionsin the developing world.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 5thinking globally but acting locally whereinternational models are adopted andadapted to local contexts.Rogayah shared with the audience twoexamples of smart ‘glocal’ partnerships inwhich USM and The Network: TUFH wereactive initiators and partners:University Partnership for EssentialHealth ResearchThe concept of University and CommunitySmart Partnerships was first introducedthrough a pilot project known as theUniversity Partnership for Essential HealthResearch (UPP) by The Network: TUFH inthe early 1990s.Cherang Laut Development Project, a smartpartnership model and blue print was createdand introduced into the School ofMedical Science, Community and FamilyCase Studies (CFCS) Programme and thismodel has been implemented since the2000-2001 academic session.Women and Health ProjectThe second example of USM’s involvementin developing smart partnerships atan international level is through a globalWomen and Health Project named BuildingCapacity in Women’s Health: HarnessingICT for Health Care Training in DevelopingCountries. This project saw USM, TheNetwork: TUFH and GHETS as active partnerswith financial support from GlobalIn ConclusionThe UPP and WHLP programmes under theNetwork: TUFH umbrella - with the activeparticipation of USM - are perhaps thetwo most successful and relevant smartpartnership demonstration projects of TheNetwork: TUFH so far.In concluding her public lecture, Rogayahstressed that society ultimately wins whenacademic medicine builds bridges to thecommunity in carrying out its trainingprogramme, relevant health services andresearch ‘with’ and ‘in’ the real worldof the common people. Rogayah reiteratedthat developing smart partnershipsdemands a high level of commitment,patience, tolerance and professionalismNetwork: TUFH members from 18 countriesKnowledge Partnership (an internationalfrom all partners. It does require a clearworld-wide participated in the programmeNGO based in Kuala Lumpur, Malaysia).understanding of the common goal andthrough local partnership projects. USMmost importantly the ability to think glob-was selected to join UPP through its pio-Under The Network: TUFH a special inter-ally and to act locally.neering partnership project: the Kampongest group was formed: the Women andCherang Laut Community DevelopmentHealth Taskforce (WHTF). This taskforceThis article was based on an interview thatProject. This was USM medical school’sproduced a digital learning package withMarion Stijnen held with Rogayah Ja’afarfirst effort to develop smart partnershipsinitially five modules on women’s health,at the Network: TUFH Conference in Ghent,with local Government, community andranging from adolescent health to violenceBelgium22

INTERNATIONAL DIARYDiary 200710 - 14 March, 2007, Ismailia, Egypt7 - 13 July, 2007, Maastricht,Annual International Conference of21 st International Workshop on Communi-the NetherlandsThe Network: Towards Unity for Healthty-based Education Incorporating Problem-International Master in Affective Neuro-15 - 20 September, 2007, Kampala, Ugandabased Learning - Innovative Approaches.Organised by Faculty of Medicine, SuezCanal University, Ismailia, Egypt. Furtherinformation: fax: 2-64-3209448; email:crdmed@ismailia.ie-eg.comscience - XIX Advanced Course on MoodDisorders. Organised by the Maastrichtand Florence Universities, the PsychopharmacologyUnit of the Bristol University andthe Sackler School of Medicine in Tel Aviv.Further information: tel: 31-43-3685332;International Conference on Human Resourcesfor Health: Recruitment, Educationand Retention. Organised by TheNetwork: TUFH and Faculty of Medicine,Makerere University.15 - 16 March, 2007, Maastricht,email: h.steinbusch@np.unimaas.nl; Inter-Post-Conference Excursion to Facultythe Netherlandsnet: www.afn.unimaas.nlof Medicine, Mbarara University ofVisitors Workshop: A Primer on theMaastricht Approach to Medical Education.Organised by School of Health ProfessionsEducation, Faculty of Medicine, MaastrichtUniversity, Maastricht, the Netherlands. Furtherinformation: School of Health ProfessionsEducation, P.O. Box 616, 6200 MDMaastricht, the Netherlands; tel: 31-43-3881524; fax: 31-43-3885639; email: she@oifdg.unimaas.nl; Internet: www.she.unimaas.nl21 - 26 March 2007, Khartoum, SudanThe 2 nd International Conference onMedical Education in the Sudan - TowardsBetter Quality in Medical Education. Organisedby the Faculty of Medicine, Universityof Khartoum, Sudan. Further information:email: ahfahal@hotmail.com; Internet:www.edc-sudan.org11 - 26 June, 2007, Maastricht,the NetherlandsSummer Course: Expanding Horizons inProblem-based Learning in Medicine,Health and Behavioural Sciences. Organisedby School of Health Professions Educa-22 - 27 July, 2007, Windsor, UKInternational course on Developing Leadersin Healthcare Education (Residential Course).Organised by the Association for the Study ofMedical Education (ASME). Further information:fax: 44-131-2259444; email: jenniferb@asme.org.uk; Internet: www.asme.org.uk24 - 28 July, 2007, Singapore18 th Wonca World Conference: Human Genomicsand its Impact on Family Physicians.Further information: fax: 65-6222-0204;email: rccfps@pacific.net.sg25 - 29 August, 2007, Trondheim, NorwayAssociation for Medical Education in Europe(AMEE) 2007 conference. Organised byAMEE in corporation with Faculty of Medicine,Norwegian University of Science andTechnology, Trondheim, Norway. Further information:phone: 44-1382-381953; fax: 44-1382-381987; email: amee@dundee.ac.uk;Internet: www.amee.org/conf07Index.htmlScience and Technology21 - 23 September, 2007, Mbarara, UgandaFurther information: Network: TUFH Office,PO Box 616, 6200 MD Maastricht, theNetherlands; tel: 31-43-3881524; fax: 31-43-3885639; email: secretariat@network.unimaas.nl; Internet:www.the-networktufh.org2 - 7 November, 2007, Washington DC, USAAAMC annual meeting. Organised by Associationof American Medical Colleges (AAMC).Further information: Internet: www.aamc.org/meetings3 - 7 November, 2007, Washington DC, USAAPHA annual meeting. Organised by AmericanPublic Health Association (APHA). Furtherinformation: Internet: www.apha.org/meetings/29 - 30 November, 2007, Maastricht,the NetherlandsVisitors Workshop: A Primer on the MaastrichtApproach to Medical Education.D E C E M B E R 2 0 0 6 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 5tion, Faculty of Medicine, Maastricht Uni-Organised by School of Health Professionsversity, Maastricht, the Netherlands. FurtherIt is possible to add events to this Interna-Education, Faculty of Medicine, Maastrichtinformation: School of Health Professionstional Diary from behind your computer.University, Maastricht, the Netherlands.Education, P.O. Box 616, 6200 MD Maas-Information inserted in our website data-Further information: School of Healthtricht, the Netherlands; tel: 31-43-3881524;base (www.the-networktufh.org) will beProfessions Education, P.O. Box 616, 6200fax: 31-43-3885639; email: she@oifdg.automatically included in the InternationalMD Maastricht, the Netherlands; tel: 31-unimaas.nl; Internet: www.she.unimaas.nlDiary of our journal Education for Health,43-3881524; fax: 31-43-3885639; email:and in the Network: TUFH Newsletter.she@oifdg.unimaas.nl; Internet: www.she.unimaas.nl23

STUDENTS’ COLUMNSTUDENTS’ SPEAKERS CORNEROUT OF THE SNO PENEquity in Deliveryof Public Health ServicesDuring the Network: TUFH Conference inFix the ProblemBlogsVietnam, I attended a session about PrimaryIt is clear that equality in health service• SNO blog: www.snotufh.blogspot.comHealth Care, Global Prospective. In this ses-provision does not mean just the availabil-• SNO - Eastern Mediterranean Regio blogsion the major issue was accessibility andity of it, but actual utilisation by all whowww.sno-emr.blogspot.comequity in the delivery of public healthneed it in optimal time.• SNO - Latin America blog:services; many differences occur betweenHere I put forward some ideas that couldwww.sno-latinoamerica.blogspot.comdeveloped and developing countries. In thishelp fix the problem. It really needs inte-article I would like to focus on the equity ingrated and complementary efforts fromThe blogs give you a platform where youdelivery of public health services throughall community members, side by side withcan discuss common tasks and exchangePrimary Health Care (PHC), the simple carelocal and international health authorities,ideas and experiences. Through this regularthat should be available to all individualsto improve health status for all:communication you can build effective col-to protect lives and promote health status• Political commitment is important tolaborations with local SNOs within the re-D E C E M B E R 2 0 0 6by concentrating on protective medicine.PHC centres should offer health education,motherhood and childhood health, managementof most prevalent and killing diseases,immunisation, supplementation of essentialand life saving drugs, and mental health.ensure a solid background. They oftencontrol the provision and distribution ofservices, especially in developing nations.• Health authorities should do their bestto plan according to the needs of communities,which must be based on healthstatistics and distribution of health prob-gion.Student Submissions to EfHAs always, the editorial staff of the Network:TUFH journal Education for Health(EfH) is eager to receive submissions fromN E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 5ProblemsDelivery of PHC should be based on equality,availability, accessibility and sustainability,so it can help in distribution andredistribution of health services. Currently80% of the population in developing countrieslives in rural areas, receiving only20% of services. Their health problems arecomplicated and integrated with healthrelated issues as low socio-economic status,poverty and illiteracy. Their whole life-styleshould be upgraded to improve health.Poor communities and individuals living inurban areas and big cities also live withthese risk factors. Many patients cannotpay to benefit from the available healthservices due to high costs of investigationsand treatment. Equity should also meanlems.• Local community and community membersshould be involved in all steps of planning,delivery, evaluation and improvement ofpublic health services.• Health insurance companies (Governmentaland private) should include those whocannot pay. They could offer poor individualsto pay less, or they can categorisefamilies and individuals according totheir socio-economic status and have feesdiffer according to category.• Community-oriented medical/healthschools should be supported financially intheir community-oriented activities.• Health education via all available toolscould increase awareness. Health promotionat primary and secondary schoolsmedical students. Now that EfH is an e-journal, students will have an opportunityto share their ideas and projects with aneven wider audience.All articles, of course, are subjected to anintensive review process. Students who arenot ready to write a full-length articlemight want to consider writing a Letter tothe Editor or a Brief Communication. Forinformation about writing and submittingarticles to EfH, see the ‘Author Instructions’which can be accessed from the Network:TUFH website by first clicking on ‘Educationfor Health’ under ‘Publications’.appropriate distribution of specialisedcould be established, so that students canhealth centres, cancer centres for example,take the gained knowledge home to theiraccording to prevalence of health problemsfamilies.in the country (and not only in big cities).Also, we should not forget the need ofMojahid Hassan Elbadry | 5 th yearequity in medical personnel, by preparingmedical student, Gezira University,good centres and working environments forSudan; SNO Regional Representative forthem in rural areas.the Eastern MediterraneanEmail: mojahid24@yahoo.com24

STUDENT INTERVIEWHow do students from all over the world perceive the educational programme at their Faculty, or the educational system in their country?How do they see the future, for their nation and for themselves? And what changes would they make, if they had the chance? We wantedto know. Therefore every Newsletter December edition we ask a student five questions.The Big FiveThis interview was conducted with Hiskeis essential in this process, is a good tutorvan Ravesteijn, 6 th year medical student(next to motivated students of course).at the Faculty of Medicine, MaastrichtYou need someone who challenges you,University, the Netherlands. Hiske is alsosomeone who is able to talk about what isSNO member.going on in a group, someone who is passionateabout being a tutor. If not, I wouldWhy did you choose to study Medicine?rather sit in the library and study with myMy interest in the human being was thefriends in a more traditional course.main reason for me to study Medicine. Iwas longing for more knowledge aboutthe way we function. I did not really realisethat by studying Medicine, I would becomea doctor. I did realise though, that bystudying Medicine I would learn competencesthat I would not gain if I chose tostudy something else.Can you as a student influence the educationalprogramme of your Faculty?Fortunately: yes. In Maastricht studentsare encouraged to participate activelyin the improvement of the curriculum.In addition, there is the possibility to organiseactivities for students by students. Thereis a student organisation for complementarymedicine that often organises lecturesfor those who are interested. Another studentorganisation facilitates an extracurricularcourse in tropical medicine for thestudents of the 2 nd and 3 rd year, of which Iwas one of the organisers a couple of yearsago. There are tutorial groups, lectures,practicals and even an excursion. Studentsand teachers participate voluntarily.What is your opinion about innovativeeducation formats like problem-basedlearning (or the education format thatyour own Faculty uses)?What part of your study was the most educationalto you (e.g. internship, research orbeing ill yourself)?When talking about education, experienceis the key word for me. I learn by doing.During my internships I have learned alot. I found out that I enjoy the specialityof psychiatry most, so the internships inmental healthcare clinics have been thebest for me.In our new curriculum we start internshipsin the 4 th year. In the final year of ourstudies we are called semi-doctors. We getmore responsibilities, like taking care ofthe ward. This is a good starting point forthe residentships that will follow.What would you change if you were Deanof your Faculty? Or on a national level ifyou were Minister of Education in yourcountry?I wish that there would have been moreemphasis on the fact that what we learnin our Faculty is one way of regarding thehealth and illness of the human being.But almost no attention has been paid tothe philosophy of science and medicine inspecific. In my opinion a doctor should beeducated in this field.Ms. Hiske van RavesteijnWhen talkingabout education,experienceis the key wordfor me.I learn bydoing. Duringmy internshipsI have learneda lot.D E C E M B E R 2 0 0 6 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 5Problem-based learning is group learning.By teaching each other what you havelearned, you learn more effectively becauseyou need to study more thoroughly. What25

Member and organisational NewsMessages from the executive committeeObituaryDr. Esmat EzzatHow The Network: TUFHRemembers EsmatIt is an honour to have this opportunity toAt the end of her period as Secretaryspeak about this great lady: Dr. Esmat Ezzat,General of The Network (1999), EsmatFormer Secretary General of The Network: To-wrote the following to the Newsletterwards Unity for Health, and Former Co-readership: “My last words as a Secretary-Founding Dean of the Faculty of Medicine,General are: we need to reinforce andSuez Canal University in Ismailia, Egypt.tighten scientific cooperations, both regionaland international. Networking withDr. Esmat was not an average leader, whoscientific organisations is to be rapidly de-passed away - after a full life of struggle,veloped. We have to strive to make knowl-battles, few losses, but mostly great triumphsedge at the service of humanity and to- leaving a very deep impression on the livesproduce a better quality of life for presentD E C E M B E R 2 0 0 6N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 5of her loyal followership and on those whowitnessed her struggle or even benefitedfrom her. As she went up in her career fromregional and national to international levels,her roots went deep down in the fertile landof the country side of Egypt, the place whereshe came from and where she always wantedto stay and serve. The sense of belonging tothe simple, unprivileged, poor people wasvery clear and always reflected in all her visionand missions. Those simple people werealways top ranked in her priority list, evenwhen she was at the top of international organisationslike The Network, up to the lastminute of her life.At a personal level, I was - and still am - sovery impressed by her strong character, unbelievablecharisma, and very sweet simplicity.In some situations, I catch myself impersonalisedby her very influencing character andunconsciously do things exactly the way sheused to be doing. She was my mentor and myneighbour, and I used to run to her after work- especially after her retirement - to get heropinion on a piece of work, to tell her all thegood or bad news about our school, or to helpher reading or writing e-mails. Once or twice Iran to her to simply cry on her shoulder like ababy! She was a very good listener, and anexcellent thinker till the last moment.Now, if I may speak not just about, but alsoto Dr. Esmat:Dr. Esmat EzzatI miss you so much already. Such a feeling ofemptiness in my life after you left. Every timeI get that feeling, I know what to do: I recallone of the many times that we were together.I remember, some 30 years ago, when youintroduced me to the simple people of El-TalEl-Kibeer District in Ismailia. They were verysuspicious about that city boy who was anxiousto catch the last bus by the end of theday, back to Cairo where he lived. That washis first priority during the day. When I lookat myself now, only going to Cairo like a visitorthese days, either to attend a meeting orto use its international airport, I realise thetremendous change that has happened to mylife because of you. I wonder how many peoplehave also been influenced by your strongcharisma, and adopted voluntarily your nobelconcepts, uncompromised principles, andgenuine beliefs? A lot I guess.You can now rest in peace. The peace thatyou have never known all your life as youspent most of it fighting corruption, ignorance,poverty, and above all closed minds.Wagdy Talaat | Head of Medical EducationDepartment, Faculty of Medicine,Suez Canal UniversityE-mail: watalaat@ismailia.ie-eg.comand future generations”.These words make clear what Esmat stoodfor. Other words that depict Esmat are:ISMAILIADEANZOHAIRCARINGPASSIONATECOMMUNITYEDUCATIONDETERMINEDCOMMITTEDNEPHROLOGYHONORARYMEMBERPEOPLE’S PERSONWOMENEMPOWERMENT26

TASKFORCESREPRESENTED AT INTERNATIONAL MEETINGS/CONFERENCESThe Network: TUFH is being represented at meetings and conferences all over the world. Here are two reports of our representativesCelebrating40 Years of ASPHERmultiple collaborations and sharing ofknowledge and know-how.At the occasion of the coincident meetingof the Board of ASPHER, on behalf of theNetwork: TUFH Executive Committee aproposal was submitted to strengthen therelationship between both organisations.Dr. Gerard Majoor (left) and Dr. David Bor (right) at the ASPHER 2006 conference28 th ASPHER Conference, Maastricht, in public health education, coinciding withSeptember 2006the launch of a bachelor programme inCelebrating 40 years of ASPHER, the European Public Health by the host institution,Association of Schools of Public Health inMaastricht University’s Faculty ofthe European Region, and discussing the Health Sciences. Discussions on this themeneeds to advance public health in Europe did not reach final conclusions but emphasisedover the next 40 years. That was thethe need for ASPHER to develop adominant agenda for the approximately vision on a European dimension in public200 participants in the 28 th ASPHER health in Europe.Conference, held in September 2006 inMaastricht, the Netherlands.The third conference theme addressedcapacity building and manpower development.The first main theme of the conferenceHere, The Network: TUFH - repre-addressed the expanding domain of public sented by David Bor and Gerard Majoor -health. Here Ulrich Laaser and others mentionedwas given an opportunity to share itselements like the impact of new experiences with some 30 conference par-preventive health technologies; promotion ticipants. It was particularly striking thatof ethical sensitivity for issues of justice, quite a few young participants fromsolidarity, diversity, etcetera; roles of publicEastern and Central Europe were attract-health professionals as advocates and ed. Perhaps this may give us a clue hownegotiators (at an ‘interface’); and the to get a stronger involvement from thoseneed to prepare for new kinds of ‘manmade’regions in The Network: TUFH. In general,disasters.in this theme severe shortcomings in pub-lic health capacity building and manpowerThe second conference theme focused on development were listed. It was concludedthe development of a European dimension that the best solutions must be build onGerard Majoor | Past Chairman ofThe Network: TUFHEmail: g.majoor@oifdg.unimaas.nlCelebrating40 years ofASPHER,the Associationof Schools ofPublic Healthin the EuropeanRegion, anddiscussingthe needs toadvance publichealth inEurope over thenext 40 years.D E C E M B E R 2 0 0 6 N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 527

Member and organisational NewsREPRESENTED AT INTERNATIONAL MEETINGS/CONFERENCESStrengthening the Educational Capacityto Address HIV/AIDSInaugural Meeting, Gaborone,mation systems, including libraries andAt the meeting, each country was joinedMay 2006data;by other invited guests to form workThe World Health Organization (WHO)• the need for skills in attracting and man-teams. We followed the above process toseeks to strengthen the educational capac-aging multiple funding sources;develop clear goals, objectives, measures,ity (SEDCAP) of health professional schools• the need for skills to manage inter-sec-timeline for action, and estimated cost forto meet societal health needs. The WHOtorial networking - within health pro-each step. Countries differed in their ap-Performance Improvement and Educationalvider teams; between the disciplines likeproaches. For example, Botswana choseTeam gathered some 60 individuals in Ga-public health and medicine; betweento focus only on training nurses, but atborone, Botswana to kick off a demonstra-public and private sectors; and amongstmultiple schools. Uganda chose to traintion project focusing upon the preventioninternational partners like other govern-multiple health professionals, but only atand treatment of HIV/AIDS and targetingments, NGOs, universities, drug compa-Makerere University. Each country seemedfive sub-Saharan African countries: Botswa-nies, etcetera;to choose a strategy that had the great-D E C E M B E R 2 0 0 6N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 5na, Burkina Faso, Malawi, Mozambique, andUganda. The pilot aims to strengthen thehuman and institutional resources of healthprofessions schools to address HIV/AIDS.The systems for healthcare and trainingin these five countries are shaped by theirunique social and political contexts. Yet,several have adopted expansive mission,vision and value statements that call uponcollaborative, multidisciplinary approaches.For example, Uganda’s mission statementreads: “to improve the health of Ugandaand beyond promoting health equity byproviding quality education, research andhealth services” (emphasis added). AndBotswana’s statement of values includes:“assuring social responsibility, competenceand caring, promoting accountability forone’s own health and collaborating withpartners”. The five countries have alreadyleveraged substantial local and internationalresources and accomplished much.Their collaborative processes reflect theprinciples of The Network: TUFH.In preparing for the conference, countryrepresentatives developed wish-lists toguide our discussion on workforce growthand development. The following commonthemes emerged:• the need for additional buildings andinfrastructure;• the need for improved access to infor-• the Sisyphean challenge to stem traineeand workforce attrition;• the corollary challenge to train and attracttalented young leaders;This wish-list could frame an agenda for TheNetwork: TUFH and Education for Health.Maldistribution of clinicians remains a crucialsystems issue. One strategy is to placeschools of multiple health professions inrural areas. The Walter Sisulu Universityin Umthatha, South Africa takes this approach.In addition to increasing the potentialto recruit local students, these institutionscontribute to local economic andcultural development, thereby increasingthe potential to attract and retain healthprofessionals in areas that had consideredundesirable previously.The conference focused upon increasingthe number of practitioners (rather thanon decreasing attrition or redesigning thesystem). The conveners of the meeting ledthe participants through a familiar qualityimprovement process:• plan: orient and achieve stakeholderownership, develop a situational analysis,establish goals;• prepare for and conduct teaching (includingdeveloping faculty);• evaluate teaching through assessmentof the student’s performance (and systemperformance?);• revise methodology.est likelihood of rapid success. We all leftthe conference with a sense of accomplishmentand hopeful for ample WHO fundingover longer timeframes.David Bor | Member of the Network:TUFH Executive CommitteeEmail: david_bor@hms.harvard.eduMaldistributionof cliniciansremainsa crucialsystems issue.One strategyis to placeschools ofmultiple healthprofessions inrural areas.28

TASKFORCESABOUT OUR MEMBERSWomen and Health Taskforce:UpdateThe Network: TUFH Women and Healthsuccessfully leveraged small investmentsTaskforce has had a very eventful and activeyear. At this year’s Network: TUFH Conferencein Ghent, taskforce members facilitateda pre-conference workshop, three poster(less than $5,000) into important improvementsin community knowledge regardingwomen’s health issues.Mr. Evan Russell, Ms. Bridget Canniff,Ms. Caroline Mailloux, and Ms.Marion Billingssessions, and a mini-workshop. SeventeenNighat Huda | Chairperson, Women &members of the taskforce, as well as oneHealth TaskforceNew Staffing at GHETSstudent, received fellowships from GHETSEmail: nighathuda@zmu.edu.pkGHETS is pleased to announce the arrivalto attend the Conference, selected usingof a new Executive Director, Marion Bill-rigorous criteria developed by the taskforce,representing all different regions ofthe world. The taskforce is currently planninga packed programme for the 2007Network: TUFH Conference in Kampala; welook forward to seeing you there!The taskforce is also pleased to announcethe completion of a 2 nd edition of the Women& Health Learning Package (WHLP). The1 st edition was published in 2005 and containedfive educational modules on variouswomen’s health topics. The modules werewritten by active members of the taskforce,with support from GHETS and the GlobalKnowledge Partnership. The modules werethen piloted at seven member institutionsin Egypt, India, Kenya, Mexico, Pakistan,Sudan and Uganda.The new 2 nd edition contains nine additionalmodules on a variety of topicsfrom cervical cancer to the role of men inpromoting reproductive health. It is availablefor download from the Network: TUFHwebsite, or by writing to GHETS (info@ghets.org).The taskforceis pleased toannounce a2 nd edition ofthe Women andHealth LearningPackage.Executive Committee MeetingReports submitted by the Executive Committee(EC) for the September 2006Meeting: www.the-networktufh.org/calendar/misc.asp?t=announcementsNew MembersExecutive CommitteeThe EC-members Nosa Orobaton (representingthe African region) and LauraFeuerwerker (representing the Latin Amer-ings. Marion graduated with a Bachelor’sdegree in Human Biology from Brown Universityin Providence, RI, USA. She alsoreceived an MSc in Public Health from theLondon School of Hygiene and TropicalMedicine in the UK.GHETS is also pleased to welcome anothernew member to the team, Evan Russell.Evan received a Bachelor’s degree in Neurosciencefrom Brown University in Providence,RI, USA. In the past, he has workedbriefly for US Senator Barack Obama as aHealth Policy Scholar, and also served asthe Public Relations Director for Adopt aDoctor, a US-based non-profit organisation.Now he is the new GHETS Developmentand Programme Officer.Both Marion Billings and Evan Russell attendedthe 2006 Network: TUFH Conferencein Ghent, Belgium. We hope you hada chance to meet them! They will alsoboth be at the 2007 Conference in Kampala,Uganda.Rachel True, the former Executive Director,left GHETS in July 2006 to be closer to herfamily in California. In addition, BridgetCanniff has also recently left GHETS fora new position at the Northwest Port-D E C E M B E R 2 0 0 6 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 5In addition, three projects received fundingican region) have resigned as EC members.land Area Indian Health Board, workingthis year to implement the WHLP at the com-For the upcoming year Nosa Orobatonwith Native American communities in themunity level. These projects used the materi-will be succeeded by Simeon Mining fromPacific Northwest of the USA. We willals from the WHLP to: educate recently grad-Kenya, and Laura Feuerwerker by Deyani-miss them both enormously!uated doctors about female genital cuttingra González de León Aguire from Mexico.For more information about GHETS,in Egypt; train female community healthIn September 2007 - during the Generalplease contact info@ghets.org or go toworkers in Pakistan; train women, childrenNetwork: TUFH Meeting in Kampala,www.ghets.organd volunteers in camps for internally dis-Uganda - there will be new elections forplaced persons in Sudan. All three projectsthese two EC memberships.29

Member and organisational NewsABOUT OUR MEMBERSNetwork Alumni:A Defining Moment in My LifeI look back with a sense of fulfilment inhealth promotion, planning, management,having been a part of The Network: TUFHleadership, the TUFH concept, and socialsince 2001. In Londrina I was elected asaccountability are all helpful in my roles.a Regional Representative for the SNO.From then on, I literally fell in love withThere is no greater time to do the bestthis unique and nurturing Network. Forthings you want to do in your life thanthe next three years, I was active in Thewhen we are young. It is in the mountainsNetwork: TUFH as a paper presenter, fa-of Benguet that I was born for a reason. Itcilitator of SNO workshops, and member ofis here where I want to be of service as aConference committees. I wrote about the‘health social oncologist’. And I thank God,organisation and held seminar-workshopsmy parents, mentors, friends and studentsfor students. Five years have passed, andfor the inspiration. And - among many oth-D E C E M B E R 2 0 0 6still I harbour unfathomable gratitude andintense inspiration from all experiences inThe Network: TUFH.I wanted to be a ‘social oncologist’, addressinghealth neoplasms in my community.After graduating from the UniversityDr. Ryan Guinaranlack of local research and documentation.Researching on ethno pharmacology, culture,history, and the community has beeners - The Network: TUFH for the preciousprivilege and blessing in being a part ofit. Becoming a part of The Network: TUFHwas a defining moment in my life.Ryan Camado Guinaran | FacultyMember, College of Natural Sciences,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 5of the Philippines College of Medicine in2002, I set out to be just that. I became avolunteer consultant of health programmesand a doctor for health missions of the university,non-government and governmentgroups. I also became a researcher for theFoundation for Clinical Epidemiology Inc.,the Department of Health, and the Universityof the Philippines Manila NationalInstitutes of Health.Today, I am back in my own community inthe mountainous province of Benguet, Philippines.Having gained skills and knowledgefrom schooling in Manila, and havingamassed priceless perspectives from allover the world through conferences suchas The Network: TUFH’s, I try hard to bea multipotential individual, realising thata doctor who wants to be a ‘social oncologist’has various roles.I am a faculty member of the College ofinteresting. I continue to be a volunteerdoctor to health missions in our region anda volunteer school physician in an elementaryschool in our municipality. My areas ofvoluntarism are youth, health, culture andindigenous peoples, and community development.We founded a youth NGO to emboldenefforts to preserve and promote ourindigenous Igorot culture. Similarly, I wasselected to lead four different youth organisationsin our region that aims to promoteyouth leadership, formation, volunteerismand service, youth capability-building, andadolescent health. A lifelong learner, I amalso finishing my Masters studies in CommunityDevelopment this school year.Today, I find myself involved in endeavourswhich seemingly may be out of the traditional‘health/doctor’ concept. However, Iam happy because I see these as fields Iwant to be competent in as a ‘youth socialoncologist’, for these are fields yearning toSt. Louis University, the PhilippinesEmail: cguinaran@hotmail.comToday, I findmyself involvedin endeavourswhichseeminglymay be outof thetraditional‘health/doctor’concept.Natural Sciences of the St. Louis Universitybe addressed in my community. I do viewin Baguio City. I and a group of young pro-health as an encompassing web of factors.fessionals set up our own humble researchThe tasks are great and demanding, but thecompany (RESEARCHMATE) to address thenuggets that I gained from The Network on30

Moving on: Changes inNEW MEMBERSInstitutional LeadershipThe Secretariat received information aboutFull Memberschanges in leadership with the following• School of Health Sciences, University ofNetwork: TUFH members. We have listedVenda, Thohoyandou, Republic of Souththe names of the former and new (Vice-)AfricaDeans/Directors for you:• WONCA, Albuquerque, NM, United States• Dr. Waldir Eduardo Garcia, Faculty ofof AmericaMedicine, Universidade Estadual de Londrina,Brazil has been replaced by Dr.Individual MembersIsaias Dichi, dichi@sercomtel.com.br• Dr. Elena Barragan, Cinco Saltos, Rio• Dr. Ayo Soladoye, College of Medicine,Negro, ArgentinaUniversity of Ilorin, Nigeria has been• Dr. Raheem Kherani, Richmond, Britishreplaced by Dr. Bode James Bojuwoye,Columbia, Canadacolmedilor@yahoo.comAdditional Case Studies forWomen and Health LearningPackageUntil recently, all case studies in the Womenand Health Learning Package (WHLP)were available in English only. The Womenand Health Taskforce, with support fromGHETS, has been working to compile translationsof case studies, as well as any casestudies that have been adapted to differentregional or cultural settings.Several new Spanish case studies will soonbe available for download on the Womenand Health Learning Package website, at:www.the-networktufh.org/publications_resources/trainingmodules.aspIf you have used the WHLP and have translatedor adapted any case studies, andwish to share them, please contact KarenKoprince at intern@ghets.org• Mr. Anthony Amalba, School of Medicineand Health Sciences, University forDevelopment Studies, Tamale, Ghana• Mr. Felix Apiribu, Agogo Hospital, NursesTraining College, Agogo, Ghana• Mr. Anyidoho Louis Yao, School ofMedicine and Health Sciences, Universityfor Development Studies, Tamale, Ghana• Mrs. Franciska Koens, VU UniversityMedical Center, Amsterdam, theNetherlands• Prof. Ahuka Ona Longombe, School ofMedicine, University of Kisangani, Goma,Republic of Congo• Ms. Julia Elisa Bereda, School of HealthSciences, University of Venda, Polokwane,Republic of South Africa• Dr. Solomon Mabapa, Faculty of HealthSciences, University of Venda,Thohoyandou, Republic of South Africa• Ms. Makondelele Mulaudzi, School ofHealth Sciences, University of Venda,Thohoyandou, Republic of South Africa• Mr. Lungelo Khanyiso Ndaba, Center forBiokinetics, Recreation and SportsScience, Universtiy of Venda,• Dr. Abdullahi Nur Hassan, Faculty ofMedicine, Alzaem Alazhari University,Khartoum, Sudan• Dr. Huseyin Cahit Taskiran, Faculty ofMedicine, Dokuz Eylul University, Izmir,Turkey• Dr. Kate Cauley, Boonshoft School ofMedicine, Wright State University,Dayton, OH, United States of AmericaRe-Assessing Full MembersIt is with pleasure that we would like toinform you that the following Full Memberhas been awarded a continuation of its FullMembership up to 2011:Faculty of Health Sciences, Walter SisuluD E C E M B E R 2 0 0 6 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 5Thohoyandou, Republic of South AfricaUniversity, Mthatha, Eastern Cape, Republic• Mrs. Rachel Tsakani Lebese, School ofof South AfricaHealth Sciences, University of Venda,Giyani, Republic of South Africa• Dr. Alia Hussain Ali Zawawi, KingAbdulaziz Medical University, Riyadh,Saudi Arabia• Dr. Hanan Alkadri, King Fahad NationalGuard Hospital, Riyadh, Saudi Arabia31

Member and organisational NewsABOUT OUR MEMBERSThe Networktowards unity for healthNewsletter Volume 25 | no. 2 | December 2006ISSN 1571-9308D E C E M B E R 2 0 0 6Interesting Internet SitesThe Network: TUFH Interactive - Recommended Internet siteswww.the-networktufh.org/publications_resources/interactive.aspReport of the Commission on Intellectual Property Rights, Innovation andPublic Healthwww.who.int/intellectualproperty/en/The World Health Report 2006 - Working Together for Healthwww.who.int/whr/2006/en/index.htmlToward Universal Access to HIV Prevention, Care, and Treatment. 3 by 5 Report for theAmericaswww.paho.org/English/AD/FCH/AI/3X5AmericasReport.pdfBest Practices in Intercultural Healthidbdocs.iadb.org/wsdocs/getdocument.aspx?docnum=564741Treatment Education - A Critical Component of Efforts to Ensure Universal Access toPrevention, Treatment and Careunesdoc.unesco.org/images/0014/001461/146114e.pdfEditors: Marion Stijnen and Pauline VluggenLanguage editor: Sandra McCollumThe Network: Towards Unity for HealthPublicationsP.O. Box 6166200 MD MaastrichtThe NetherlandsTel: 31-43-3885633, Fax: 31-43-3885639Email: secretariat@network.unimaas.nlwww.the-networktufh.orgLay-out: Graphic Design Agency Emilio PerezPrint: 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 5Tribute to…* John Snow, Inc. Vice President Dr. TheoLippeveld was the 2006 recipient of theAmerican Association of Public Health’sOutstanding Service Award. Dr. Lippeveldwas chosen for “his leadership in revitalisingroutine information systems” in lowerincomenations. He has made significantcontributions in the field of global publichealth and health system planning andmanagement for more than 25 years, and isthe co-founder of the Routine Health InformationNetwork (RHINO), an internationalnetwork advocating for improved routinehealth information systems.* John Hamilton has been appointed an Of-Sciences Library has opened the Kerr L.White Health Care Collection Website:historical.hsl.virginia.edu/kerr/ Dr. Whitehas been described as “perhaps the mostinfluential figure in the field of health servicesresearch, a discipline that emergedfrom his study of health care delivery.Dr. White donated his personal collection tothe Health Sciences Library in 1992, a collectionwhich he acquired over five decades.White describes it as a ‘collection of ideas’,and it indeed serves as a road map of howHealth Services Research and Primary CareMedicine have evolved in the last century.* In 2006 Dr. Henk Schmidt - also Honoraryinclude: evidence of a significant impacton the field of research in the professions;service to the research community; contributionsto the growth of new investigators;contributions to translation of research forpractice; and regular participation in DivisionI. According to the selection committee,the career of Henk Schmidt fitted thesecriteria exceptionally well.ficer of the British Empire (OBE), announcedMember of The Network: TUFH - receivedin the Queens Birthday Honours List, Sun-the Distinguished Career Award, presentedday June the 18 th , 2005. The citation wasby the American Educational Research As-“For contribution to medical education association Division I. This award, which ispast Director of the University of Durhamgiven every other year, honours individualsStockton Preclinical Medical School”.who, over a significant number of years,have been exceptionally productive and in-Mrs. Marcia Mentowski (Division I’s Past* In honour of Dr. Kerr L. White - Honoraryfluential scholars and contributors in profes-Vice President) and Dr. Henk SchmidtMember of The Network: TUFH - the Healthsions education. The criteria for this award32