President's Report 2003-2004 to the World Medical Association's General Assembly

Tokyo, Japan
October 2004

It has been a great honour and privilege to have represented the World Medical Association over the last twelve months as your President. My enduring memory has been the warm, friendly and respectful welcome from physicians worldwide. It was the reaffirmation of our Declaration of Geneva that 'my colleagues will be my sisters and brothers'. We all share a common professionalism underpinned by our core values.

My main theme has been the Right of a Child to Health Care advocating our Declaration of Ottawa, highlighting the gap between the rich and poor both between and within the nations of the world, seeking to raise awareness and encouraging professional links particularly in education and research. I spread the message to Africa at the Ugandan Medical Association and in South Africa, to America in Miami at the Academy of Pharmaceutical Physicians, New York at the Hispanic Development Foundation, Portland, Oregon to the medical students during their Global Health Week, as well as in Malta, where the theme was taken up in a four minute television feature augmented by their own archives.

Emphasizing that Violence is a leading public health problem, particularly impacting on the lives and well-being of children, I pressed the message of the WMA's Statement, agreed by us at Helsinki last year, at a meeting of the English Speaking Union in Canterbury, at the Dominican Medical and Dental Society in the Dominican Republic and at the annual meeting of the International Federation of Medical Student's Associations (IFMSA) in Ohrid, Macedonia, where the major theme was 'Violence and Health'.

And finally I attended the 24th International Congress of Pediatrics in Mexico, where I joined in as a speaker at the Symposium on the Application of Children's Rights. At the Congress, Ms Carol Bellamy from UNICEF emphasized that six out of the eight Millennium Development Goals were child-focused - that these were the goals of each government of the nations of the world. UNICEF is publishing a Report on 'Progress for Children' this fall.

Dr. Joy Phumaphi from WHO stressed the 'unfinished agenda' for the Alive at Five initiative. 11 million children were dying each year from preventable and treatable conditions. Children are bearing one-third of the world's burden of disease, 9/10ths of which was affecting the poorer countries who had the least resources to cope with it. She said we all know who is at risk, where they are, what we must do and how to do it.
There are several concomitant initiatives such as the Child Survival Partnership involving UNICEF, WHO, and the World Bank that WMA, as the Association representing world's physicians needs to join, and two effective pilot projects: Child Watch Africa and the Save the Children's' Saving New Born Lives, which are physician-driven.

I have contacted all our national medical associations about the need to develop our Declaration of Ottawa further and am currently collating the replies which are still coming in and will prepare a further report.

There were two other areas that I informed you that I would wish particularly like to support as your President. Firstly, action to stop the increasing health problems of sub-Saharan Africa and to try and include more African National Medical Associations in our work and, secondly, the importance of medical education in this mission. My first engagement was to attend the 'Strategies for Survival' Conference of the South African Medical Association under the inspired leadership of Dr Kgosi Letlape. In the very challenging times ahead, all the members of the profession in South Africa were united in the ethical values that underpin medical practice and their quest for improved health services for the underserved. At the Annual Meeting of the Ugandan Medical Association, there was the opportunity of meeting the Presidents of the Kenyan and Tanzanian Medical Associations in conjunction with the World Health Organization, who were discussing the setting up of an East African Medical and Dental Association.

With medical education, my aim was to raise awareness of international issues in a sustainable way by encouraging all medical students to do a month's elective in a developing country and suggest 'exchanges' during residency training programmes with the support and encouragement of joint research initiatives. I visited the International Department of Cornell Medical School, where 40% of the students already have international assignments, met the Dean of New York College of Medicine and joined an inspired core of dedicated medical students who had arranged a Global Health Week at Oregon Health and Sciences University in Portland, Oregon. The energy and enthusiasm apparent at the IFMSA Conference in Ohrid, Macedonia, where I participated in the impressive opening ceremony held in the Roman Amphitheatre, bodes well for the future. Members of the IFMSA are given free associate membership of the WMA after they graduate and have to move on from their own association. I hope that many of these young and dedicated physicians will attend our meetings and continue to help shape the future.

Our continuing work with other international professional associations is essential if we are to get our important messages across to the wider world community. I attended the excellent International Federation of Dentist's (FDI) first Regional Conference on Oral Health of the African Region, where the importance of including the major oral health problems within collaborative general health programme was stressed in the presence of the Ministers of Health, WHO, representatives from academia and dental practitioners. This was an inclusive conference dealing with the particular problems of the Region and one which we should emulate in all our own Regions. The European Forum for Good Clinical Practice held a Conference on Clinical Research involving academia, industry, medical organizations, NGOs and the European Platform for Patient Organizations to rescue reliable, ethical research initiatives on children and influence the current European legislation.

The World Health Profession's Alliance Conference held in Geneva after our Council Meeting in Divonne was a major innovation for the WMA. It is essential that we use such forums to join with other health professional colleagues to help tackle global problems such as AIDS in a coordinated way. We must rise above the unnecessary turf battles that have belittled us all. The combined energy should be used to advocate our own shared policies so that together we can have much greater impact.

We are also a Founder Member of Oxford Vision 2020 dedicated to the prevention of the forecast pandemic growth of largely preventable chronic diseases in the low and middle - income countries and the poorer segments of society in the developed world. The forum includes academia, industry, professional and other non-governmental organizations, patient groups and young people. It focuses on three risk factors tobacco, diet and lack of exercise and four chronic diseases, diabetes, cardiovascular disease, chronic lung disease and some cancers which lead to 50% of deaths globally. Our profession should set an example and follow the lead of our American colleagues with regard to diet, smoking, and exercise and reduce our own BMIs !

As the WMA was a participant in the development of the Framework Convention on Tobacco Control, I had the opportunity of encouraging its implementation during my visit to Malta with a meeting with the Minister of Health and some progress has been made with regard to the hazards of passive smoking on the island. Increasingly, other countries are following the example of the Republic of Ireland and I wrote to the Prime Minister in the UK who has so far failed to respond to the lead of his own Chief Medical Officer.

As the global representative body of some 7 million physicians, we have a duty to support our 'brothers and sisters' in times of great difficulty. In conjunction with our Human Rights Unit, I tried through contacts to help free Dr. Oscar Elias Biscet, who is still languishing in a Cuban jail as a result of his endeavours to promote human rights.

Some 10,000 doctors were on strike when I visited the Dominican Republic. Their concerns were the deteriorating situation in Government Hospitals and the catastrophic effects of the fall in the value of the peso on the basic maintenance of the hospitals and their own salaries. With the President of the Colegio Médico Dominicano, I visited the Hospital General Materno Infantil and met with the faculty, residents and the administration. The acute services budget was running at 15% of the hospital's needs. Hospital blackouts would last up to 13 hours. Sometimes, the only available light during emergency operations had been from the LCD display of a mobile phone. Three of the local television channels were present at the Press Conference held after my tour of the wards.

The collapse of the health system in Zimbabwe , whose government policy has endorsed with the other African countries WHO's 'Right to Health', is a humanitarian disaster with an additional 20,000 children dying each year in 2002 than would have died ten years previously. Cuban doctors have been imported to try and reverse the effects of the loss of physicians from the country but they are unable to provide a proper primary care service in view of the language difficulties and have settled in the cities. I met with a dynamic group of non-governmental organizations, including Amani Trust, Amnesty International, Zimbabwe Association and ZADHR to be appraised of the current culture of repressive violence and torture in Zimbabwe, which is being reinforced by the 'War Veterans' and Youth Militia.

At the meeting of the BMA Annual Representative Body in Llandudno, I met Dr Raj Doolabh, who was then Treasurer of the Zimbabwe Medical Association, which is one of our member associations. He did not expect significant change in Zimbabwe until Robert Mugabe retired. Mr. Mugabe is using food to buy votes to ensure that the next regime will protect him from prosecution for crimes against humanity. Members of the opposition were being denied treatment for HIV/AIDS. By-elections caused by their deaths allowed their replacement by ZANUpf members Dr. Raj Doolabh suggested that the main help physicians from outside Zimbabwe could give their colleagues in Zimbabwe was through Continuing Medical Education, which is now mandatory in the country. Dr. Kgosi Letlape was organizing a Conference on AIDS in late September in South Africa and that this might have been a forum where we could have met with the executive of ZIMA. Unfortunately, this did not prove possible.

Physicians in Iraq have started to develop links with the WMA following the attendance of Dr. Brennan on their behalf (because of visa problems) at the Council Meeting in May.
I met with some Iraqi physicians from Baghdad and several others who had emigrated to the US at a recent Iraqi Medical Specialty Forum in Washington. The security situation was very serious. Dr. Khalili, a neurosurgeon, who had been kidnapped himself, said the main problems were security, a regular supply of electricity and water and the maintenance of medical supplies and provisions for government hospitals. On the other hand the budget for health had been increased from $16 million in Saddam Hussein's time to $905 million. 600 extra medical facilities for essential care had been developed, with 110 primary health care centres. Certain areas of the country, such as Kurdistan, were peaceful and safe. It was suggested that a conference including all interested national medical associations in the region might be held to see how the health problems in the region and in particular those in Iraq could be addressed. This is a contribution that the WMA might make with WHO, subject to funding which I gather could be raised.

My last visit to a National Medical Association before handing over the badge of office to the President-elect, Dr. Yank Coble Jr., in Tokyo is to Iceland to discuss the topic of 'Professionalism' and the values that underpin our work on behalf of the individual patient and humanity in general. An important reflection and the reason why it is essential that the WMA continues to support physicians in their work worldwide.

"Wherever the Art of Medicine is loved, there is also the love of humanity"
Hippocrates, 400 BC

James Appleyard, MA(Oxon), MD (Kent), FRCP (Lon), FRCPCH (UK)
President of the World Medical Association 2003-2004