JDN_Newsletter_January_2025

ABOUT US. 1
JANUARY 2025
I S S U E 3 0 T H
JUNIOR DOCTORS LEADERSHIP JUNIO 2023-2024 2
EDITORIAL TEAM 2023 – 2024 3
WORDS OF CHAIR 2024/2025, JUNIOR DOCTORS NETWORK- WMA 4
WORDS OF IMMEDIATE PAST CHAIR 5
WORDS FROM THE INCOMING PUBLICATIONS DIRECTOR 6
MTRO.JOSE LUIS FUNES: ONE HEALTH 9
DR. ANKUSH K. BANSAL: CLIMATE CHANGE AND ITS IMPACT 17
SATHI INITIATIVE: ADDRESSING UNMET SURGICAL NEEDS IN 27
TRANSGENDER MENTAL HEALTHCARE IN PAKISTAN 31
LIKE TOBACCO, FOSSIL FUELS ARE A HEALTH HAZARD WE 39
BRIDGING GAPS IN PATIENT SAFETY: INSIGHTS FROM ALGERIA 45
THE EVOLUTION OF TELEHEALTH AND THE ROLE OF JUNIOR 51
WHO CAN BECOME A JDN MEMBER? 56
JUNIOR DOCTORS NETWORK MEMBERSHIP CENSUS 2024 35
TABLE OF CONTENTS
THE VIEWS AND OPINIONS EXPRESSED IN THIS NEWSLETTER ARE SOLELY THOSE OF THE AUTHORS
AND DO NOT NECESSARILY REFLECT THE OFFICIAL POSITIONS OR POLICIES OF THE JUNIOR
DOCTORS NETWORK (JDN) OR THE WORLD MEDICAL ASSOCIATION (WMA).
ISSN (PRINT) 2415-1122
ISSN (ONLINE) 2312-220X
SPECIAL FOCUS:
SPECIAL FOCUS:
About Us.
What is the JDN?
The Junior Doctors Network (JDN) serves as an international platform for junior doctors to facilitate an open
dialogue of global events and activities that are relevant to their postgraduate training and the World Medical
Association (WMA).
It was created at the 61st WMA General Assembly (October 2010) in Vancouver, Canada and the inaugural
JDN meeting was held at the 62nd WMA General Assembly (October 2011) in Montevideo, Uruguay. The
network, which started from a few motivated junior doctors, now has a total of over 500 members from more
than 90 countries from all regions of the world.
Junior doctors are defined as physicians, within 10 years after their medical graduation or who are still in an
ongoing postgraduate medical education program.
What is the mission?
The purpose of the JDN is to empower young physicians to work together towards a healthier world through
advocacy, education, and international collaboration.
What do we do?
Networking:
During the regular JDN meetings, members get to know each other, discuss global health issues, share
challenges, and start collaborations on global health issues. The JDN meets on several occasions during the
year, both in-person and via online teleconferences:
Biannual meetings in conjunction with the Council Meeting and the General Assembly of the WMA (April
& October).
Monthly general membership and management team teleconferences
Ad-hoc online and webinars organized by the JDN
1
DR. MARIE-CLAIRE WANGARI
CHAIR PERSON
DR. BALKISS ABDELMOULA
DEPUTY CHAIR PERSON
DR. DEENA MARIYAM
SECRETARY
DR. FRANCISCO FRANCO PÊGO
SOCIO-MEDICAL AFFAIRS OFFICER
DR. MERLINDA SHAZELLENNE
MEDICAL EDUCATION DIRECTOR
DR.SHIV JOSHI
MEDICAL ETHICS DIRECTOR
DR. PABLO ESTRELLA
MEMBERSHIP DIRECTOR
DR. JEAZUL PONCE H.
PUBLICATIONS DIRECTOR
DR. SAZI NZAMA
COMMUNICATIONS DIRECTOR
DR. UCHECHUKWU ARUM
IMMIEDIATE PAST CHAIR
DR. LWANDO MAKI
IMMIDIATE PAST DEPUTY CHAIR
2
DR.DOUAA ROUFIA ATTABI DR. ARSALAN NADEEM DR. CAROL KANGETHE DR. SHRAVAN R. DAVE
DR. AMANUEL Y. NEGASH DR. JAMIE COLLOTY DR. MAYMONA CHOUDRY DR. MICHAEL JOHNSON
MAHA AWAN DR. JEANETTE GODINEZ YAHAYA DR. AQSA SHAFIQUE
DR. LUIS MIGUEL ALFONSO
FERNÁNDEZ GUTIÉRREZ
EDITOR-IN-CHIEF AND
RESPONSIBLE FOR THIS EDITION:
DR. JEAZUL PONCE HERNÁNDEZ
EMAIL: JEAZULPONCE@GMAIL.COM
COMMUNICATIONS.JDN@WMA.NET
LOCATION: SALAMANCA, SPAIN
POSTAL CODE: 37006
3
WORDS OF CHAIR 2024/2025, JUNIOR DOCTORS NETWORK- WMA
PABLO ESTRELLA PORTER (MD, MPH),
CHAIR 2024/2025
JUNIOR DOCTORS NETWORK
ECUATOR/SPAIN.
WORLD MEDICAL ASSOCIATION
Dear JDN colleagues,
As the newly elected Chair of the Junior Doctors Network (JDN), I am honored to share a few
words of gratitude and encouragement in this milestone 30th edition of our newsletter, which
focuses on the impact of climate change on global health.
This edition is particularly special, not only because it highlights one of the most pressing issues of
our time, how climate change is directly influencing global health, but also because it marks the
culmination of the past term’s extraordinary efforts. It serves as a document to the dedication and
commitment of our publications team and our members, whose hard work has brought to life
insightful discussions that shape and inspire our profession.
As we celebrate this 30th edition, let us recognize the importance of fostering spaces for dialogue
and collaboration. These exchanges are vital as we grow into ethical, compassionate, and skilled
health professionals, ready to address the global challenges of our generation.
Thank you for your ongoing dedication to the principles of the JDN community. Together, let us
continue to make an impact, building on the foundation laid by this edition and driving forward our
mission to strengthen global health.
Warm regards,
Dr. Pablo Estrella Porter
Chair 2024-25, Junior Doctors Network World Medical Association
4
Dear JDN alumni and members,
As we come to the final edition of our Junior Doctors Network (JDN) newsletter, I find myself
reflecting on the incredible journey we have taken together. Serving as the Chair of this dynamic
network has been one of the most fulfilling experiences of my career. It has been a journey filled with
learning, growth, collaboration, and an unwavering commitment to the betterment of junior doctors
worldwide.
Throughout my time as Chair, I have had the privilege of working alongside a dedicated team of
passionate doctors from diverse corners of the world. Together, we have championed the voices of
junior doctors, ensuring that our concerns are heard on global platforms such as the World Medical
Association (WMA), and advocating for better working conditions, professional development
opportunities, and equitable access to health resources for our patients.
This final edition symbolizes both a conclusion and a beginning. As we close this chapter, we
celebrate the remarkable milestones we have achieved—successful advocacy efforts, impactful
meetings, and the creation of an inclusive space where junior doctors can engage with one another.
We have tackled complex global health challenges, from mental health to climate change, and I am
proud of how we have risen to these challenges with determination and resilience.
But beyond the accomplishments, what stands out most to me is the sense of community we have
built. The JDN has become more than just a network; it is a family of professionals bound by a shared
purpose to improve healthcare systems, uphold medical ethics, and foster collaboration across
borders. I am grateful for the friendships forged, the mentorship exchanged, and the encouragement
we have provided one another through the highs and lows of this noble profession.
As we wrap up the 2023/24 mandate, I do so with immense gratitude and optimism for the future. The
junior doctors of today are the leaders of tomorrow, and I have full confidence that our network will
continue to thrive and grow.
To those who will carry the torch forward, remember that our collective strength lies in our unity, our
empathy, and our relentless pursuit of excellence.
Thank you all for your dedication, your contributions, and your trust. Let us continue to support one
another, advocate for meaningful change, and most importantly, take care of ourselves as we care for
others.
In solidarity and with warm regards,
Dr. Marie-Claire Wangari
2024/25 Immediate past chair, Junior Doctors Network World Medical Association
WORDS OF IMMEDIATE PAST CHAIR
DR. MARIE-CLAIRE WANGARI
IMMEDIATE PAST CHAIR 2023/2024,
JUNIOR DOCTORS NETWORK
KENYA
WORLD MEDICAL ASSOCIATION
5
WORDS OF FORMER PUBLICATIONS DIRECTOR
WORDS FROM THE FORMER PUBLICATIONS DIRECTOR (2023/2024) AND
EDITOR-IN-CHIEF OF THE JDN NEWSLETTER 30TH ISSUE
DR. JEAZUL PONCE
FORMER PUBLICATIONS DIRECTOR
2023/2024,
COMMUNICATIONS DIRECTOR 2024/2025
JUNIOR DOCTORS NETWORK
MEXICO/SPAIN
WORLD MEDICAL ASSOCIATION
Dear JDN and WMA community,
As part of the 30th edition of the Junior Doctors Network (JDN) newsletter, I want to close this cycle as
Publications Director by reflecting on one of the greatest challenges to global health: air pollution. As
healthcare professionals, our duty is not only to treat diseases but also to advocate for a healthier
environment that prevents the causes of those diseases.
The WMA Declaration on the Prevention and Reduction of Air Pollution to Improve Air Quality
emphasizes that air pollution is one of the main threats to global health, directly linked to respiratory
and cardiovascular diseases, cancer, and increased premature mortality. According to the WHO, nine
out of ten people breathe polluted air every day. This fact serves as a stark reminder of how the
environment impacts the health of our communities, especially the most vulnerable.
As healthcare professionals, we have the responsibility to lead change from our trenches: educating our
patients about the risks associated with air pollution, supporting mitigation policies, and, most
importantly, engaging in local and global initiatives that promote environmental sustainability.
Collaboration across disciplines and sectors is key to addressing this issue. We must recognize that
health and the environment are inseparable.
As I bid farewell to this role, I want to express my deepest gratitude to the publications team and editors
of the 2023-2024 period. Your dedication and efforts have been fundamental to the success of our
initiatives. I encourage you to continue submitting articles and actively engaging in the policies of the
World Medical Association (WMA). Do not limit yourselves to understanding them; work on their
development and adapt these guidelines into strategies applicable to your own environments.
Furthermore, I am pleased to announce that I will take on the responsibility of managing our social
media as communications director 2024/2025. I invite you to follow us and stay updated with the latest
developments. also I encourage you to continue addressing topics like air pollution from a
comprehensive and proactive perspective. Together, we can turn words into actions and make a
tangible difference in the health of our communities and the planet.
Let us keep moving forward with passion and commitment toward a future where air quality is not a
privilege but a fundamental human right.
Dr. Jeazul Ponce, MPH, MSc, PhD.
Former Publications Director of JDN 2023/2024,
Editor-in-Chief of the JDN Newsletter 30th Issue
Communications Director 2024/2025
Junior Doctors Network
6
WORDS FROM THE INCOMING PUBLICATIONS DIRECTOR 2024/2025
Dear Colleagues,
As the newly elected Publications Director for the WMA Junior Doctors Network (JDN), it is my
great pleasure to address the future contributors and readers of our esteemed newsletter. The
WMA JDN newsletter serves as an unique platform connecting young doctors worldwide,
disseminating knowledge and fostering dialogue on public health issues.
Writing and publishing are indispensable tools for young doctors. They not only enhance our
professional growth but also elevate our voice in the global medical community. Our newsletter,
read across the globe, offers a unique opportunity to share insights, research findings, and
perspectives. This is not just publication; it’s a declaration of our commitment to advancing
healthcare on an international scale.
This upcoming year, I am thrilled to announce that we are planning two special editions—one
focusing on Antimicrobial Resistance and the other on Non-Communicable Diseases. These
editions aim to highlight the pressing challenges and innovative solutions in these critical areas of
health. Apart from our special editions, we will continue to bring you regular newsletters that
capture a wide range of topics pertinent to medical science and public health.
I strongly encourage each one of you to seize this opportunity. Submit your research, insightful
opinions, and thought-provoking viewpoints. Let your voices be heard on a platform that celebrates
the diversity and expertise of junior doctors around the world.
Together, we can contribute to a body of knowledge that not only addresses the challenges of
today but also paves the way for healthier futures worldwide.
Warm regards,
Dr. Venkatesh Karthikeyan
Publications Director (2024-25),
World Medical Association – Junior Doctors Network,
4852012@gmail.com
DR VENKATESH KARTHIKEYAN MD,
SENIOR RESIDENT,
COMMUNITY AND FAMILY MEDICINE,
PUBLICATIONS DIRECTOR 2024/2025
JUNIOR DOCTORS NETWORK
INDIA
WORLD MEDICAL ASSOCIATION
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ARTICLES BASED ON
INTERVIEWS
8
MTRO.JOSE
LUIS FUNES
O N E H E A L T H
L A I N T E R S E C C I Ó N E N T R E L A S A L U D
P Ú B L I C A , Z O O N O S I S Y L A
C O N S E R V A C I Ó N D E L O S E C O S I S T E M A S
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El concepto de One Health ha cobrado relevancia en las últimas décadas debido a la creciente conciencia
sobre cómo la salud humana, la salud animal y la salud de los ecosistemas están intrínsecamente
interconectadas. José Luis Funes, abogado ambientalista y presidente de la Fundación Saving Our Sharks,
ha dedicado más de 30 años a abordar temas ambientales y de vida silvestre, trabajó en la Comisión de
Cooperación Ambiental (CCA) de América del Norte como consultor del Comité Consultivo Público Conjunto;
subrayando que la ruptura del equilibrio ecológico tiene implicaciones directas y graves en la salud global.
Zoonosis: Una amenaza cada vez más presente
La zoonosis, o enfermedades que se transmiten de animales a humanos, no es un fenómeno nuevo. Sin
embargo, lo que ha cambiado en las últimas décadas es la escala y la velocidad con la que estas
enfermedades han emergido. Según datos del Programa de las Naciones Unidas para el Medio Ambiente
(PENUMA), el 75% de las enfermedades emergentes provienen de la fauna silvestre. Este dato alarmante
refleja el impacto de la actividad humana sobre el entorno natural (1).
Los patógenos han existido en la naturaleza durante millones de años, coexistiendo en un equilibrio casi
perfecto en ecosistemas intactos. No obstante, la intervención humana, especialmente a través de la
deforestación y la comercialización de animales silvestres, rompe ese equilibrio y propicia que virus,
bacterias y otros agentes infecciosos, que antes no suponían una amenaza para los humanos, crucen la
barrera entre especies. Los mercados húmedos en Asia, por ejemplo, han sido señalados como el origen
probable de la pandemia de COVID-19. Según Funes, la teoría más aceptada es que el virus surgió a raíz de
la destrucción de ecosistemas en el sudeste asiático, donde ciertos animales fueron extraídos de sus
hábitats naturales para ser comercializados en mercados, como los de Wuhan, China (2,3).
Estos mercados, denominados “wet markets”, presentan un riesgo significativo, ya que agrupan especies
silvestres en condiciones insalubres, debilitando sus sistemas inmunológicos y facilitando la propagación de
patógenos entre los animales y hacia los humanos. A través de estos mecanismos, el ser humano queda
expuesto a una gama de enfermedades infecciosas con potencial pandémico. Es así como el COVID-19, el
SARS y otras enfermedades emergentes han encontrado su camino hacia la población humana, desatando
crisis de salud pública a nivel global (3).
Destrucción de ecosistemas y la expansión de las zoonosis
MTRO. JOSÉ LUIS FUNES
DIRECTOR DE SAVING OUR SHARKS
FOUNDATION.
MEXICO/UNITED STATES OF AMERICA
ONE HEALTH: LA INTERSECCIÓN ENTRE LA SALUD PÚBLICA, ZOONOSIS
Y LA CONSERVACIÓN DE LOS ECOSISTEMAS
La intervención humana en los ecosistemas no se limita solo a la vida terrestre. Funes subraya que la vida
marina también está siendo gravemente afectada, en particular los tiburones, que son especies clave para
mantener el equilibrio en los ecosistemas marinos. Los tiburones, al igual que los lobos en los ecosistemas
terrestres, controlan la población de especies herbívoras y carnívoras, ayudando a preservar la
biodiversidad. Su desaparición, impulsada por la sobrepesca y la demanda de aletas en mercados asiáticos,
ha provocado que los ecosistemas marinos estén cada vez más desequilibrados (4).
10
Un ecosistema desequilibrado es un caldo de cultivo para la propagación de patógenos. El principio de
dilución, que Funes describe, es clave para entender este fenómeno: en un ecosistema saludable y diverso,
los patógenos se mantienen bajo control gracias a la variedad de especies que interactúan y regulan su
entorno. Cuando el ser humano destruye esos ecosistemas, las especies que quedan —tanto silvestres como
domésticas— están más expuestas y vulnerables, aumentando el riesgo de que los patógenos crucen la
barrera de especies y afecten a los humanos(5).
One Health: Una solución integral
El concepto de One Health busca ofrecer una solución a este desafío interconectado. Según Funes, la idea
central es que la salud del ser humano está directamente vinculada con la salud animal y la de los
ecosistemas. No podemos abordar problemas de salud global de manera aislada, pues la emergencia de
pandemias, el cambio climático y la pérdida de biodiversidad están entrelazados en una red compleja que
exige una respuesta coordinada (2).
Desde el punto de vista de One Health, es imperativo proteger los pocos ecosistemas intactos que quedan y
restaurar aquellos que han sido degradados. La creación de áreas naturales protegidas, tanto marinas como
terrestres, es una de las estrategias más efectivas para lograrlo. Funes señala que México ha tomado
importantes pasos en esta dirección, como la creación del Parque Nacional Revillagigedo en el Pacífico, una
de las áreas marinas protegidas más grandes del mundo. Sin embargo, como advierte, declarar un área
protegida no es suficiente; es necesario aplicar la ley de manera efectiva para garantizar la conservación de
estas áreas y prevenir la explotación ilegal de los recursos naturales (2,5).
El impacto del cambio climático
El cambio climático agrava estos problemas de conservación. En los ecosistemas marinos, los arrecifes de
coral, que son fundamentales para la biodiversidad, han sufrido un blanqueamiento masivo debido al
aumento de las temperaturas del océano. Este fenómeno no solo afecta a los corales, sino a todas las
especies que dependen de ellos para su supervivencia. Además, Funes menciona la presencia de un
patógeno conocido como “síndrome blanco” que ha devastado colonias de corales en el Caribe, matando
más del 90% de algunas especies formadoras de arrecifes (4).
ONE HEALTH: LA INTERSECCIÓN ENTRE LA SALUD PÚBLICA, ZOONOSIS
Y LA CONSERVACIÓN DE LOS ECOSISTEMAS
El vínculo entre cambio climático y biodiversidad es innegable. En las últimas conferencias de las partes
(COP), los países han comenzado a reconocer la necesidad de abordar el cambio climático y la pérdida de
biodiversidad de manera conjunta. Sin embargo, aún queda mucho por hacer. La sobreexplotación de
especies marinas, como los tiburones, se ve exacerbada por el cambio climático, que desplaza a muchas
especies de sus hábitats naturales. Esto ha generado fenómenos como la sustitución de especies en
productos alimenticios, donde tiburones son vendidos como “bacalao” o “marlin”, afectando tanto la
biodiversidad como la salud humana (5).
MTRO. JOSÉ LUIS FUNES
DIRECTOR DE SAVING OUR SHARKS
FOUNDATION.
MEXICO/UNITED STATES OF AMERICA
11
La necesidad de políticas públicas integrales
José Luis Funes concluye que la implementación de One Health debe ser transversal a todas las políticas
públicas. El enfoque debe centrarse en la prevención de futuras pandemias mediante la protección de los
ecosistemas, la regulación de la vida silvestre y la promoción de prácticas sostenibles en la agricultura y la
pesca. Funes es claro al afirmar que la soberbia del ser humano, al creer que puede controlar todos los
aspectos de la naturaleza, ha sido una de las causas principales de la crisis ambiental y de salud que
enfrentamos.
No se trata solo de un imperativo ético hacia la naturaleza, sino de una cuestión de supervivencia humana.
Como lo demuestra la pandemia de COVID-19, la destrucción de los ecosistemas puede desencadenar crisis
globales que afectan no solo a la salud, sino también a las economías y a las estructuras sociales. Si no se
toman medidas inmediatas para restaurar y proteger los ecosistemas, la humanidad seguirá enfrentando
estos desafíos una y otra vez.
Conclusión
El enfoque de One Health subraya que la salud pública no puede desligarse de la conservación ambiental y
el bienestar animal. Las zoonosis, como el COVID-19, son solo un ejemplo de lo que puede suceder cuando
ignoramos esta conexión. A medida que enfrentamos los desafíos del cambio climático, la pérdida de
biodiversidad y la sobreexplotación de recursos naturales, es más urgente que nunca adoptar un enfoque
integral para garantizar un futuro saludable tanto para los humanos como para el planeta.
Entrevista realizada y redactada en conjunto con la Dra. Delta Jeazul Ponce Hernandez.
ONE HEALTH: LA INTERSECCIÓN ENTRE LA SALUD PÚBLICA, ZOONOSIS
Y LA CONSERVACIÓN DE LOS ECOSISTEMAS
MTRO. JOSÉ LUIS FUNES
DIRECTOR DE “SAVING OUR SHARKS
FOUNDATION”
MEXICO/UNITED STATES OF AMERICA
References
United Nations Environment Programme (UNEP). Preventing the Next
Pandemic: Zoonotic Diseases and How to Break the Chain of
Transmission. Nairobi, Kenya: UNEP; 2020. Available at:
https://www.unep.org
1.
World Health Organization (WHO). One Health: Joint Plan of Action
(2022–2026). Geneva: WHO; 2022. Available at: https://www.who.int
2.
Daszak P, Olival KJ, Li H. A strategy to prevent future epidemics similar to
the 2019-nCoV outbreak. Biosaf Health. 2020 Mar;2(1):6-8. doi:
10.1016/j.bsheal.2020.01.003. Epub 2020 Feb 5. PMID: 32562482;
PMCID: PMC7144510.
3.
Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem
Services (IPBES). Pandemics: Escaping the Era of Pandemics. Bonn:
IPBES Secretariat; 2020. Available at: https://ipbes.net
4.
Keesing F, Holt RD, Ostfeld RS. Effects of species diversity on disease
risk. Ecol Lett. 2006 Apr;9(4):485-98. doi: 10.1111/j.1461-
0248.2006.00885.x. PMID: 16623733.
5.
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PROF. JOSE
LUIS FUNES
O N E H E A L T H : T H E I N T E R S E C T I O N O F
P U B L I C H E A L T H , Z O O N O S E S , A N D
E C O S Y S T E M C O N S E R V A T I O N
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The concept of One Health has gained significant relevance in recent decades due to the growing awareness
of the intrinsic connections between human health, animal health, and ecosystem health. José Luis Funes, an
environmental lawyer and president of the Saving Our Sharks Foundation, has dedicated over 30 years to
addressing environmental and wildlife issues. He worked as a consultant for the Joint Public Advisory
Committee of the North American Commission for Environmental Cooperation (CEC), emphasizing that the
disruption of ecological balance has direct and severe implications for global health.
Zoonoses: An Increasingly Present Threat
Zoonoses, or diseases transmitted from animals to humans, are not a new phenomenon. However, what has
changed in recent decades is the scale and speed at which these diseases emerge. According to data from
the United Nations Environment Programme (UNEP), 75% of emerging diseases originate from wildlife. This
alarming figure highlights the impact of human activity on the natural environment(1).
Pathogens have existed in nature for millions of years, coexisting in near-perfect balance within intact
ecosystems. However, human intervention, especially through deforestation and wildlife trade, disrupts that
balance, allowing viruses, bacteria, and other infectious agents that were previously harmless to humans to
cross the species barrier. Wet markets in Asia, for example, have been identified as the likely origin of the
COVID-19 pandemic. According to Funes, the most accepted theory is that the virus emerged due to
ecosystem destruction in Southeast Asia, where certain animals were removed from their natural habitats for
trade in markets like those in Wuhan, China(2,3).
These markets, commonly referred to as “wet markets,” pose a significant risk as they bring together wild
species in unsanitary conditions, weakening their immune systems and facilitating the spread of pathogens
among animals and to humans. Through such mechanisms, humans become exposed to a range of infectious
diseases with pandemic potential. This is how COVID-19, SARS, and other emerging diseases have made
their way into human populations, triggering global public health crises (3).
Ecosystem Destruction and the Spread of Zoonoses
Human intervention in ecosystems is not limited to terrestrial life. Funes emphasizes that marine life is also
gravely affected, particularly sharks, which are key species in maintaining balance in marine ecosystems.
Sharks, much like wolves in terrestrial ecosystems, control populations of herbivorous and carnivorous
species, helping to preserve biodiversity. Their disappearance, driven by overfishing and the demand for
shark fins in Asian markets, has increasingly destabilized marine ecosystems (4).
An unbalanced ecosystem becomes a breeding ground for pathogen proliferation. The dilution principle,
described by Funes, is key to understanding this phenomenon: in a healthy and diverse ecosystem,
pathogens are kept in check by the variety of species interacting and regulating their environment. When
humans destroy these ecosystems, the remaining species—both wild and domestic—are more exposed and
vulnerable, increasing the risk of pathogens crossing the species barrier and affecting humans (5).
ONE HEALTH: THE INTERSECTION OF PUBLIC HEALTH, ZOONOSES, AND
ECOSYSTEM CONSERVATION
PROF. JOSÉ LUIS FUNES
PRESIDENT SENIOR CEO OF “SAVING
OUR SHARKS FOUNDATION”
MEXICO/UNITED STATES OF AMERICA
14
One Health: A Holistic Solution
The One Health concept seeks to provide a solution to this interconnected challenge. According to Funes, the
central idea is that human health is directly linked to animal health and ecosystem health. Global health
issues cannot be addressed in isolation, as the emergence of pandemics, climate change, and biodiversity
loss are intertwined in a complex web requiring a coordinated response(2).
From a One Health perspective, it is imperative to protect the few remaining intact ecosystems and restore
those that have been degraded. Establishing protected natural areas, both marine and terrestrial, is one of
the most effective strategies to achieve this. Funes notes that Mexico has taken significant steps in this
direction, such as creating the Revillagigedo National Park in the Pacific, one of the world’s largest marine
protected areas. However, as he warns, declaring a protected area is not enough; effective law enforcement
is necessary to ensure the conservation of these areas and prevent the illegal exploitation of natural
resources (2,5).
The Impact of Climate Change
Climate change exacerbates these conservation challenges. In marine ecosystems, coral reefs, which are
essential for biodiversity, have suffered massive bleaching due to rising ocean temperatures. This
phenomenon affects not only corals but all species that rely on them for survival. Additionally, Funes
highlights the presence of a pathogen known as “white syndrome,” which has devastated coral colonies in the
Caribbean, killing over 90% of some reef-building species (4).
The link between climate change and biodiversity is undeniable. At recent Conferences of the Parties (COP),
countries have begun to recognize the need to address climate change and biodiversity loss together.
However, much work remains. The overexploitation of marine species, such as sharks, is exacerbated by
climate change, which displaces many species from their natural habitats. This has led to phenomena like
species substitution in food products, where sharks are sold as “cod” or “marlin,” impacting both biodiversity
and human health (5).
The Need for Comprehensive Public Policies
José Luis Funes concludes that implementing One Health must be integrated across all public policies. The
focus should be on preventing future pandemics by protecting ecosystems, regulating wildlife, and promoting
sustainable practices in agriculture and fishing. Funes is clear in stating that human arrogance, in believing
we can control all aspects of nature, has been a primary cause of the environmental and health crises we
face.
ONE HEALTH: THE INTERSECTION OF PUBLIC HEALTH, ZOONOSES, AND
ECOSYSTEM CONSERVATION
PROF. JOSÉ LUIS FUNES
PRESIDENT SENIOR CEO OF “SAVING
OUR SHARKS FOUNDATION”
MEXICO/UNITED STATES OF AMERICA
15
This is not merely an ethical imperative toward nature but a matter of human survival. As the COVID-19
pandemic has demonstrated, ecosystem destruction can trigger global crises that affect not only health but
also economies and social structures. Without immediate action to restore and protect ecosystems, humanity
will continue to face these challenges repeatedly.
Conclusion
The One Health approach underscores that public health cannot be separated from environmental
conservation and animal welfare. Zoonoses, such as COVID-19, are just one example of what can happen
when this connection is ignored. As we confront the challenges of climate change, biodiversity loss, and the
overexploitation of natural resources, adopting a holistic approach is more urgent than ever to ensure a
healthy future for both humans and the planet.
Interview Conducted and Co-Written with Dr. Delta Jeazul Ponce Hernandez
ONE HEALTH: THE INTERSECTION OF PUBLIC HEALTH, ZOONOSES, AND
ECOSYSTEM CONSERVATION
PROF. JOSÉ LUIS FUNES
PRESIDENT SENIOR CEO OF “SAVING
OUR SHARKS FOUNDATION”
MEXICO/UNITED STATES OF AMERICA
References
United Nations Environment Programme (UNEP). Preventing the Next Pandemic: Zoonotic Diseases and
How to Break the Chain of Transmission. Nairobi, Kenya: UNEP; 2020. Available at: https://www.unep.org
1.
World Health Organization (WHO). One Health: Joint Plan of Action (2022–2026). Geneva: WHO; 2022.
Available at: https://www.who.int
2.
Daszak P, Olival KJ, Li H. A strategy to prevent future epidemics similar to the 2019-nCoV outbreak.
Biosaf Health. 2020 Mar;2(1):6-8. doi: 10.1016/j.bsheal.2020.01.003. Epub 2020 Feb 5. PMID: 32562482;
PMCID: PMC7144510.
3.
Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES). Pandemics:
Escaping the Era of Pandemics. Bonn: IPBES Secretariat; 2020. Available at: https://ipbes.net
4.
Keesing F, Holt RD, Ostfeld RS. Effects of species diversity on disease risk. Ecol Lett. 2006 Apr;9(4):485-
98. doi: 10.1111/j.1461-0248.2006.00885.x. PMID: 16623733.
5.
16
DR. ANKUSH K.
BANSAL, MD, FACP,
FACPM, SFHM
C L I M A T E C H A N G E A N D I T S I M P A C T O N
H E A L T H : R E F L E C T I O N S A N D L E S S O N S
F R O M C O P 2 9 I N B A K U
”
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17
Climate change has firmly established itself as one of the most pressing threats to global health in the 21st
century. The recent United Nations Climate Change Conference (COP29) held in Baku, Azerbaijan, not only
highlighted environmental challenges but also emphasized the profound impact of this crisis on public health.
During this event, global leaders and experts explored the intersection of health and climate change, with Dr.
Ankush K. Bansal, head of the World Medical Association (WMA) delegation, providing key insights into the
critical role of healthcare professionals in tackling this issue.
COP29: Progress and Agreements
COP29 concluded with a historic commitment: nearly 200 countries agreed to triple climate financing for
developing nations, reaching $300 billion annually by 2035. This increase aims to support vulnerable nations
in mitigating climate change effects and adapting to phenomena such as droughts, storms, and floods.
Despite this progress, critics argue that the funding remains insufficient to address the global scale of the
crisis.
From a health perspective, Dr. Bansal highlighted how climate change directly affects patients through
heatwaves, air pollution, and extreme weather events that exacerbate respiratory, cardiovascular, and chronic
diseases. “The health case for climate action is growing stronger with every COP,” he remarked (1).
Air Pollution and Respiratory Health
One of the most significant health risks associated with climate change is air pollution, particularly fine
particulate matter (PM2.5), which can penetrate deep into the lungs and bloodstream. These particles are
linked to conditions such as asthma, chronic obstructive pulmonary disease (COPD), and lung cancer. They
also contribute to higher mortality rates from cardiovascular and respiratory diseases. According to the World
Health Organization (WHO), approximately 4.2 million premature deaths in 2016 were attributed to air
pollution (2,3).
Dr. Bansal underscored the crucial role of healthcare professionals in addressing these challenges. “We can
collect data, conduct research, and provide scientific evidence showing how extreme climate events worsen
health outcomes. This evidence is vital for educating patients, communities, and policymakers,” he explained.
The Role of Healthcare Professionals in Climate Action
Healthcare professionals are not only on the frontlines of treatment but also at the forefront of advocacy and
climate action. According to Dr. Bansal, their responsibilities include educating patients about the health
impacts of climate change, advocating for evidence-based policies, and collaborating with communities to
implement sustainable solutions.
CLIMATE CHANGE AND ITS IMPACT ON HEALTH: REFLECTIONS AND
LESSONS FROM COP29 IN BAKU
DR. ANKUSH K. BANSAL, MD, FACP,
FACPM, SFHM.
FUNDADOR, FLORIDA CLINICIANS FOR
CLIMATE ACTION.
PRESIDENTE DEL GRUPO DE TRABAJO
SOBRE MEDIO AMBIENTE DE LA WMA
ASOCIACIÓN MÉDICA MUNDIAL.
18
Dr. Bansal also stressed the importance of integrating climate change into medical education. “It’s not a
standalone course. Climate change is a cross-cutting issue that affects every healthcare system and should
be part of the core medical curriculum worldwide,” he stated.
Key Lessons from Baku
One of the major takeaways from COP29 is the transformative power of youth in driving climate action.
“Young people, including junior doctors, are the most powerful force for change globally. They are more
affected by climate change and, therefore, more motivated to act,” Dr. Bansal affirmed.
Another critical lesson is the need to build resilient and sustainable healthcare systems. This means not
only reducing the sector’s carbon footprint but also ensuring operational capacity during climate disasters
such as hurricanes, floods, or wildfires (4).
CLIMATE CHANGE AND ITS IMPACT ON HEALTH: REFLECTIONS AND
LESSONS FROM COP29 IN BAKU
DR. ANKUSH K. BANSAL, MD, FACP,
FACPM, SFHM.
FOUNDER, FLORIDA CLINICIANS FOR
CLIMATE ACTION.
CHAIR – WORKGROUP ON ENVIRONMENT
OF WMA
WORLD MEDICAL ASSOCIATION
Photo
Dr. Ankush K. Bansal (right) alongside Dr. Jeazul Ponce Hernández (left) at the
Baku Stadium during COP29. November, 2024
19
JDN at the COP29
During the COP29, the participation of the only representative in person from the Junior Doctors Network
(JDN), Dr. Delta Jeazul Ponce Hernández, stood out as she attended the conferences organized by the WHO
Pavilion. These sessions showcased the active role of Youth Council members as speakers and organizers,
providing a clear example of how youth can engage in high-impact events. Dr. Ponce Hernández emphasized
the importance of not only attending such spaces in the future, also actively participating in the organization of
activities, such as side events or even creating a pavilion led by the World Medical Association (WMA).
Initiatives like these would strengthen political inclusion and the leadership of younger generations, ensuring
their contributions to shaping key strategies to address climate change and its effects on global health.
Conclusion
COP29 marked significant progress toward climate action, but challenges remain. The financial commitments,
while encouraging, must translate into concrete actions that prioritize both climate mitigation and public health
protection.
As Dr. Bansal aptly stated: “If not us, then who? It is our responsibility as doctors, leaders, and citizens to
ensure a healthy and sustainable future for the next generations.”
Interview Conducted and Co-Written with Dr. Delta Jeazul Ponce Hernandez
CLIMATE CHANGE AND ITS IMPACT ON HEALTH: REFLECTIONS AND
LESSONS FROM COP29 IN BAKU
DR. ANKUSH K. BANSAL, MD, FACP,
FACPM, SFHM.
FOUNDER, FLORIDA CLINICIANS FOR
CLIMATE ACTION.
CHAIR – WORKGROUP ON ENVIRONMENT
OF WMA
WORLD MEDICAL ASSOCIATION
References
United Nations Framework Convention on Climate Change. Outcomes of COP29:
Climate finance commitment tripled for developing nations [Internet]. UNFCCC; 2024
[cited 2024 Dec 10]. Available from https://unfccc.int/
1.
World Health Organization. Air pollution and its health effects [Internet]. WHO; 2016
[cited 2024 Dec 10]. Available from: https://www.who.int/news-room/fact-
sheets/detail/ambient-(outdoor)-air-quality-and-health
2.
Schraufnagel DE, Balmes JR, De Matteis S, Hoffman B, Kim WJ, Pérez-Padilla R, et
al. Health benefits of air pollution reduction. Ann Am Thorac Soc. 2019;16(12):1478-
87. DOI: 10.1513/AnnalsATS.201907-538CME
3.
Watts N, Amann M, Arnell N, Ayeb-Karlsson S, Beagley J, Belesova K, et al. The
2020 report of The Lancet Countdown on health and climate change: Responding to
converging crises. Lancet. 2021;397(10269):129-70. DOI: 10.1016/S0140-
6736(20)32290-X
4.
20
DR. ANKUSH K.
BANSAL, MD, FACP,
FACPM, SFHM
E L C A M B I O C L I M Á T I C O Y S U I M P A C T O
E N L A S A L U D : R E F L E X I O N E S Y
L E C C I O N E S D E L A C O P 2 9 E N B A K Ú
P
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21
El cambio climático se ha consolidado como una de las amenazas más urgentes para la salud global en el
siglo XXI. La reciente Conferencia de las Naciones Unidas sobre el Cambio Climático (COP29), celebrada en
Bakú, Azerbaiyán, no solo destacó los desafíos ambientales, sino también el profundo impacto de esta crisis
en la salud pública. Durante este evento, líderes y expertos globales exploraron la intersección entre la salud
y el cambio climático, con el Dr. Ankush K. Bansal, jefe de la delegación de la Asociación Médica Mundial
(WMA), proporcionando perspectivas clave sobre el papel crucial de los profesionales de la salud en abordar
este problema.
COP29: Progresos y acuerdos
La COP29 concluyó con un compromiso histórico: cerca de 200 países acordaron triplicar la financiación
climática para las naciones en desarrollo, alcanzando los 300 mil millones de dólares anuales para 2035.
Este aumento tiene como objetivo apoyar a los países vulnerables en la mitigación de los efectos del cambio
climático y la adaptación a fenómenos como sequías, tormentas e inundaciones. A pesar de este progreso,
los críticos argumentan que la financiación sigue siendo insuficiente para abordar la magnitud global de la
crisis.
Desde una perspectiva de salud, el Dr. Bansal destacó cómo el cambio climático afecta directamente a los
pacientes a través de olas de calor, contaminación del aire y eventos climáticos extremos que agravan
enfermedades respiratorias, cardiovasculares y crónicas. “El argumento de la salud a favor de la acción
climática se fortalece con cada COP”, comentó (1).
Contaminación del aire y salud respiratoria
Uno de los mayores riesgos para la salud asociados con el cambio climático es la contaminación del aire,
particularmente las partículas finas (PM2.5), que pueden penetrar profundamente en los pulmones y el
torrente sanguíneo. Estas partículas están vinculadas a afecciones como el asma, la enfermedad pulmonar
obstructiva crónica (EPOC) y el cáncer de pulmón, además de contribuir a mayores tasas de mortalidad por
enfermedades cardiovasculares y respiratorias. Según la Organización Mundial de la Salud (OMS),
aproximadamente 4.2 millones de muertes prematuras en 2016 se atribuyeron a la contaminación del aire
(2,3).
El Dr. Bansal subrayó el papel crucial de los profesionales de la salud en la atención de estos desafíos.
“Podemos recopilar datos, realizar investigaciones y proporcionar evidencia científica que muestre cómo los
eventos climáticos extremos empeoran los resultados de salud. Esta evidencia es vital para educar a los
pacientes, las comunidades y los responsables de políticas”, explicó.
El rol de los profesionales de la salud en la acción climática
Los profesionales de la salud no solo están en la primera línea del tratamiento, sino también a la vanguardia
de la defensa y la acción climática. Según el Dr. Bansal, sus responsabilidades incluyen educar a los
pacientes sobre los impactos del cambio climático en la salud, abogar por políticas basadas en evidencia y
colaborar con las comunidades para implementar soluciones sostenibles.
EL CAMBIO CLIMÁTICO Y SU IMPACTO EN LA SALUD: REFLEXIONES Y
LECCIONES DE LA COP29 EN BAKÚ
DR. ANKUSH K. BANSAL, MD, FACP,
FACPM, SFHM.
FUNDADOR, FLORIDA CLINICIANS FOR
CLIMATE ACTION.
PRESIDENTE DEL GRUPO DE TRABAJO
SOBRE MEDIO AMBIENTE DE LA WMA
ASOCIACIÓN MÉDICA MUNDIAL.
22
El Dr. Bansal también destacó la importancia de integrar el cambio climático en la educación médica. “No es
un curso independiente. El cambio climático es un tema transversal que afecta a todos los sistemas de salud
y debe formar parte del currículo médico básico a nivel mundial”, afirmó.
Lecciones clave desde Bakú
Uno de los aprendizajes más importantes de la COP29 es el poder transformador de la juventud para
impulsar la acción climática. “Los jóvenes, incluidos los médicos en formación, son la fuerza más poderosa
para el cambio a nivel global. Son los más afectados por el cambio climático y, por ende, los más motivados
para actuar”, aseguró el Dr. Bansal.
Otra lección crucial es la necesidad de construir sistemas de salud resilientes y sostenibles. Esto implica no
solo reducir la huella de carbono del sector, sino también garantizar la capacidad operativa durante
desastres climáticos como huracanes, inundaciones o incendios forestales (4).
EL CAMBIO CLIMÁTICO Y SU IMPACTO EN LA SALUD: REFLEXIONES Y
LECCIONES DE LA COP29 EN BAKÚ
DR. ANKUSH K. BANSAL, MD, FACP,
FACPM, SFHM.
FUNDADOR, FLORIDA CLINICIANS FOR
CLIMATE ACTION.
PRESIDENTE DEL GRUPO DE TRABAJO
SOBRE MEDIO AMBIENTE DE LA WMA
ASOCIACIÓN MÉDICA MUNDIAL.
Foto
Dr. Ankush K. Bansal (derecha) junto con la Dr. Jeazul Ponce Hernández
(izquierda) en el estadio de Baku durante la COP29. Noviembre, 2024
23
JDN en la COP29
Durante la COP29, destacó la participación presencial de la única representante de la Junior Doctors
Network (JDN), la Dra. Delta Jeazul Ponce Hernández, quien asistió a las conferencias organizadas por el
WHO Pavilion. En estas conferencias, se evidenció el papel activo de los miembros del Youth Council como
ponentes y organizadores, mostrando un claro ejemplo de cómo la juventud puede involucrarse en eventos
de alto impacto. La Dra. Ponce Hernández subrayó la importancia de que, en el futuro, los jóvenes médicos
no solo asistan a estos espacios, sino que también participen activamente en la organización de actividades
como “side events” o incluso la creación de un pavilion liderado por la Asociación Médica Mundial (WMA).
Este tipo de iniciativas fortalecerían la inclusión política y el liderazgo de las nuevas generaciones,
asegurando su contribución en la definición de estrategias clave para abordar el cambio climático y sus
efectos en la salud global.
Conclusión
La COP29 marcó un progreso significativo hacia la acción climática, pero los desafíos persisten. Los
compromisos financieros, aunque alentadores, deben traducirse en acciones concretas que prioricen tanto la
mitigación del cambio climático como la protección de la salud pública.
Como afirmó el Dr. Bansal: “Si no somos nosotros, ¿entonces quién? Es nuestra responsabilidad como
médicos, líderes y ciudadanos garantizar un futuro saludable y sostenible para las próximas generaciones.”
Entrevista realizada y redactada en conjunto con la Dra. Delta Jeazul Ponce Hernández
EL CAMBIO CLIMÁTICO Y SU IMPACTO EN LA SALUD: REFLEXIONES Y
LECCIONES DE LA COP29 EN BAKÚ
DR. ANKUSH K. BANSAL, MD, FACP,
FACPM, SFHM.
FUNDADOR, FLORIDA CLINICIANS FOR
CLIMATE ACTION.
PRESIDENTE DEL GRUPO DE TRABAJO
SOBRE MEDIO AMBIENTE DE LA WMA
ASOCIACIÓN MÉDICA MUNDIAL.
Referencias
United Nations Framework Convention on Climate Change. Outcomes of
COP29: Climate finance commitment tripled for developing nations [Internet].
UNFCCC; 2024 [cited 2024 Dec 10]. Available from https://unfccc.int/
1.
World Health Organization. Air pollution and its health effects [Internet]. WHO;
2016 [cited 2024 Dec 10]. Available from: https://www.who.int/news-room/fact-
sheets/detail/ambient-(outdoor)-air-quality-and-health
2.
Schraufnagel DE, Balmes JR, De Matteis S, Hoffman B, Kim WJ, Pérez-Padilla
R, et al. Health benefits of air pollution reduction. Ann Am Thorac Soc.
2019;16(12):1478-87. DOI: 10.1513/AnnalsATS.201907-538CME
3.
Watts N, Amann M, Arnell N, Ayeb-Karlsson S, Beagley J, Belesova K, et al.
The 2020 report of The Lancet Countdown on health and climate change:
Responding to converging crises. Lancet. 2021;397(10269):129-70. DOI:
10.1016/S0140-6736(20)32290-X
4.
24
JDN’S VOICES: KEY
ARTICLE
CONTRIBUTIONS
25
MEHR MUHAMMAD
ADEEL RIAZ
ELELETA SURAFEL
26
Introduction
On June 20, 2024, Primary Health Care working group arranged a webinar to discuss a pilot
project on addressing unmet surgical needs in LMICs through Primary Health Care providers
capacity building and investing at prevention. The webinar was presented by Prof. Rahul M.
Jindal, MD, PhD, MBA, FRCS, FACS, from Uniformed Services University Bethesda, USA.
The webinar focused on addressing the critical unmet surgical needs in low- and middle-
income countries (LMICs) through primary health care. The session highlighted the challenges
in accessing safe surgical care, the role of task-shifting, and the need for global and local
collaborations to enhance surgical volumes and quality of care.
The key topics discussed during the webinar are summarized as follows:
1. Surgical care is an essential component of a functioning health system, yet access is
severely limited in LMICs. Many LMICs have surgical volumes significantly below the Lancet
Commission’s benchmark of 5000 procedures per 100,000 population, averaging only 877
surgeries annually. This highlights a pressing need for scalable solutions to expand surgical
capacity.
2. The Lancet Commission on Global Surgery established the importance of integrating
surgery within the global health agenda. To meet global surgical demands, the Commission
has set a target of performing 5,000 surgical procedures per 100,000 population annually.
Achieving this goal is crucial for addressing the vast unmet surgical needs in LMICs [1].
3. Research has revealed significant disparities in surgical needs between urban slums and
rural or tribal areas, with unmet needs often higher in urban environments. These issues
highlight the complexity of surgical care delivery in different settings . [2].
4. Key barriers preventing patients in LMICs from receiving needed surgical care include
financial difficulties, fear of surgery, lack of social support, and a deficit of trust in medical
systems. Overcoming these challenges is essential for expanding access to surgical services
and improving health outcomes in resource-limited settings [3].
MEHR MUHAMMAD ADEEL RIAZ
PUNJAB MEDICAL COLLEGE,
FAISALABAD, PAKISTAN
ELELETA SURAFEL
THE UNIVERSITY OF EDINBURGH
SATHI INITIATIVE: ADDRESSING UNMET
SURGICAL NEEDS IN LMICS THROUGH
COMMUNITY ENGAGEMENT AND TASK SHIFTING
27
5. Task shifting, a strategy where certain tasks are transferred from highly specialized health
workers to those with more general qualifications, has emerged as a practical approach to
mitigate the shortage of healthcare professionals in LMICs. This model has proven particularly
effective for addressing common surgical conditions, optimizing the use of available human
resources to meet patient needs in underserved areas.
6. The SATHI (Surgical Accredited & Trained Healthcare Initiative) – a pilot project to address
the unmet surgical needs of communities in urban slums at primary healthcare level through
training of community health workers with the skills to identify and refer patients requiring
surgical care. Through task shifting and community engagement, SATHI builds trust between
healthcare providers and marginalized communities while improving access to surgical
services [4].
Conclusion
The webinar emphasized the critical need to address the gap in surgical care access in LMICs
through innovative solutions like task shifting, community health worker programs, and
international collaborations. Ensuring surgical care is accessible and affordable is vital for
achieving Universal Health Coverage (UHC) and meeting Sustainable Development Goals
(SDGs).
Key Takeaways
The SATHI Initiative demonstrates the power of task shifting and community engagement in
addressing unmet surgical needs in LMICs at primary healthcare level. By training community
members to provide essential surgical care and fostering trust within underserved
communities, the initiative has improved access to life-saving procedures. The success of this
model underscores the importance of innovative, community-based approaches in enhancing
surgical care in resource-limited settings, offering valuable lessons for stakeholders seeking to
address similar challenges elsewhere.
MEHR MUHAMMAD ADEEL RIAZ
PUNJAB MEDICAL COLLEGE,
FAISALABAD, PAKISTAN
ELELETA SURAFEL
THE UNIVERSITY OF EDINBURGH
SATHI INITIATIVE: ADDRESSING UNMET
SURGICAL NEEDS IN LMICS THROUGH
COMMUNITY ENGAGEMENT AND TASK SHIFTING
28
References:
The Lancet, 2015; 386:569 (https://www.thelancet.com/journals/lancet/article/PIIS0140-
6736(15)60160-X/fulltext)
1.
Surgical Unmet Need in a Low-Income Area of a Metropolitan City in India: A Cross-
Sectional Study (https://link.springer.com/article/10.1007/s00268-020-05502-5)
2.
Trust Deficit in Surgical Systems in an Urban Slum in India (https://www.ssph-
journal.org/articles/10.3389/ijph.2022.1604924/full)
3.
SATHI: Surgical Accredited and Trained Healthcare Initiative for Task Shifting in India
(https://academic.oup.com/jsprm/article/2022/3/snac018/6672907)
4.
Further Reading and Recommended Resources:
The Lancet Commission on Global Surgery
(https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60160-X/fulltext)
1.
Are LMICs Achieving the Lancet Commission Global Benchmark for Surgical Volumes? A
Systematic Review (https://link.springer.com/article/10.1007/s00268-020-05502-5)
2.
Community Participation in Global Surgery (https://gh.bmj.com/content/6/4/e005044)
3.
MEHR MUHAMMAD ADEEL RIAZ
PUNJAB MEDICAL COLLEGE,
FAISALABAD, PAKISTAN
ELELETA SURAFEL
THE UNIVERSITY OF EDINBURGH
SATHI INITIATIVE: ADDRESSING UNMET
SURGICAL NEEDS IN LMICS THROUGH
COMMUNITY ENGAGEMENT AND TASK SHIFTING
29
MEHR MUHAMMAD
ADEEL RIAZ
I N C O M E S O C I O – M E D I C A L A F F A I R S O F F I C E R
2 0 2 4 / 2 0 2 5 ( F A I S A L A B , P A K I S T A N )
30
Transgenders are among one of Pakistan’s most marginalized communities, encountering
severe mental health issues exacerbated by systemic discrimination, state-led violence, and
socio-economic marginalization. (1) Despite the Transgender Persons Act of 2018′ (2) being a
major advancement in the legal recognition of transgender people’s rights, gender recognition
s gender “X” instead of gender male (M) or female /F), and existence, it has not resulted in
broad societal acceptance or equitable access to necessary medical care, including mental
health services. (3)
Transgender communities experience high rates of physical violence, social exclusion and
economic marginalization (1) that may lead to trauma, anxiety, and depression. (4) As most
transgenders are forced to leave their houses in childhood by their parents, the only available
option for them to sustain themselves economically is to work with fellow transgenders as
dancers or sex workers. The growing effects of climate change exacerbate these problems
even further. Droughts, heatwaves, and flooding are among the increasingly extreme climate
disasters that Pakistan has been facing. (5) Gender and Sexual minorities like transgender
communities, are disproportionately affected by these occurrences, which exacerbate their
mental health issues by displacing them, taking away their means of subsistence, and
obstructing their access to mental healthcare. (5)
Often, junior doctors in primary healthcare are the first point of contact for transgender
individuals seeking care in the healthcare system hierarchy. However, the current training or
thereof lack of transgenders care curriculum and resources available to junior doctors are
insufficient to address the complex mental health needs arising from the intersection of gender
discrimination and lack of understanding of climate-induced stressors. This inadequacy leaves
transgender individuals without the comprehensive, empathetic care they need to navigate
their unique challenges.
MEHR MUHAMMAD ADEEL RIAZ
PUNJAB MEDICAL COLLEGE,
INCOME SOCIO-MEDICAL AFFAIRS
OFFICER 2024/2025
JUNIOR DOCTORS NETWORK
WORLD MEDICAL ASSOCIATION
FAISALABAD, PAKISTAN
TRANSGENDER MENTAL HEALTHCARE
IN PAKISTAN: THE CRUCIAL ROLE OF
JUNIOR DOCTORS AT THE PRIMARY
LEVEL AMID CLIMATE CHANGE BURDEN
31
Recommendations:
1. Improved Education for Junior Physicians: Undergraduate and graduate programs for junior
doctors should include a comprehensive, inclusive curriculum that addresses the effects of
climate change and its impact on transgender healthcare. Understanding gender dysphoria
and the particular mental health issues that transgender people confront as a result of sexual
assault, in addition to the psychological effects of climate change and basic terminology like
eco-anxiety, solastalgia etc, should be covered in this curriculum. Role-playing exercises and
case studies of actual patients can support the development of empathy and useful skills for
meeting these requirements. Transgender-specific comprehensive care protocols should be
developed and implemented by health institutions and the domestic health ministry. These
protocols ought to contain instructions for trauma-informed care, mental health assessments,
and psychological stress management.
3. Integration of Mental Health Services into Primary Treatment: Providing comprehensive
treatment requires the integration of mental health services into primary care settings. As part
of this integration, primary care physicians will receive training on how to identify and handle
mental health concerns affected by climate change. They will also set up referral processes
for more specialized care as necessary. Transgender patients can obtain prompt and efficient
interventions if mental health assistance is a regular feature of primary care.
4. Community Involvement and Support Systems: Establishing robust community support
systems for transgender people can offer supplementary forms of assistance beyond health
care. Health programs should work with neighborhood associations to provide advocacy, peer
support, and counseling services. These networks can assist with more general social support
difficulties as well as emergency mental health requirements.
5. Advocacy for Policy Change: It’s critical to push for legislative reforms that take into
account the concerns of transgender people in the context of climate change. This entails
advocating for laws that guarantee persons impacted by climate disasters fair access to social
services, healthcare, and financial assistance. Bringing up the unique difficulties that the
transgender community faces when interacting with legislators can spur systemic
improvements that enhance well-being in general.
TRANSGENDER MENTAL HEALTHCARE
IN PAKISTAN: THE CRUCIAL ROLE OF
JUNIOR DOCTORS AT THE PRIMARY
LEVEL AMID CLIMATE CHANGE BURDEN
MEHR MUHAMMAD ADEEL RIAZ
PUNJAB MEDICAL COLLEGE,
INCOME SOCIO-MEDICAL AFFAIRS
OFFICER 2024/2025
JUNIOR DOCTORS NETWORK
WORLD MEDICAL ASSOCIATION
FAISALABAD, PAKISTAN
32
In conclusion, a comprehensive strategy is needed to address the mental health needs of
transgender people in Pakistan. As front-line medical professionals, junior doctors play a
critical role in providing high-quality treatment. Domestic governments and state medical
licensing and curriculum agencies can attempt to lessen the mental health burden
experienced by this vulnerable population amid the ongoing challenges of climate change by
improving their training, creating comprehensive care protocols, integrating mental health
services, cultivating community support, and advocating for policy changes.
References :
1- Shah, H. B. U., Rashid, F., Atif, I., Hydrie, M. Z., Fawad, M. W. B., Muzaffar, H. Z.,
Rehman, A., Anjum, S., Mehroz, M. B., Haider, A., Hassan, A., & Shukar, H. (2018).
Challenges faced by marginalized communities such as transgenders in Pakistan. The Pan
African medical journal, 30, 96. https://doi.org/10.11604/pamj.2018.30.96.12818
2- Transgender Persons Act 2018 see
https://na.gov.pk/uploads/documents/1526547582_234.pdf
3- Riaz MMA, Awan MM. Transgender rights in Pakistan: implications of Federal Shariat Court
ruling. Lancet Psychiatry. 2023 Aug;10(8):e20. doi: 10.1016/S2215-0366(23)00191-8. PMID:
37479343.
4- Ridley M, Rao G, Schilbach F, Patel V. Poverty, depression, and anxiety: Causal evidence
and mechanisms. Science. 2020;370(6522):eaay0214. doi:10.1126/science.aay0214.
Available from: https://economics.mit.edu/sites/default/files/2022-09/poverty-depression-
anxiety-science.pdf
5- UNHCR-IOM Pakistan. Flash update #28 on arrest and detention/flow monitoring (15
September 2023 – 7 September 2024). ReliefWeb. Available from:
https://reliefweb.int/country/pak
TRANSGENDER MENTAL HEALTHCARE
IN PAKISTAN: THE CRUCIAL ROLE OF
JUNIOR DOCTORS AT THE PRIMARY
LEVEL AMID CLIMATE CHANGE BURDEN
MEHR MUHAMMAD ADEEL RIAZ
PUNJAB MEDICAL COLLEGE,
INCOME SOCIO-MEDICAL AFFAIRS
OFFICER 2024/2025
JUNIOR DOCTORS NETWORK
WORLD MEDICAL ASSOCIATION
FAISALABAD, PAKISTAN
33
PABLO ESTRELLA
PORTER
W M A F O R M E R M E M B E R S H I P D I R E C T O R , J D N
C H A I R 2 0 2 4 / 2 0 2 5 ( V A L E N C I A , S P A I N ) .
34
Understanding membership data in a platform like the Junior Doctors Network (JDN) is
essential to track its evolution and respond to changes over time. Membership data not only
reflects the reach and inclusivity of the network but also provides critical insights for informed
decision-making that supports the strategic direction of the JDN.
In the recently conducted Membership Census of September 2024, the JDN recorded an
impressive 979 members, marking a significant rise from previous years—515 members in
2022 and 763 members in 2023. This remarkable growth, a 28% increase from 2023,
underscores the growing relevance and appeal of our network, as junior doctors worldwide
recognize the value of joining and contributing to this vibrant community.
Regional Representation: Diversity Across the Globe
The JDN is a global network, not bound by geographical borders, and this is clearly reflected
in the diversity of its membership. As of the 2024 Census, there are members from 113
different countries, representing 63% of the world’s nations. The highest representation was
from the South-East Asian Region, which accounted for 32.8% of total membership, followed
by the African Region (18.9%), the Region of the Americas (16.8%), and the Eastern
Mediterranean Region (14.9%).
PABLO ESTRELLA PORTER (MD, MPH),
PUBLIC HEALTH RESIDENT AND
JUNIOR DOCTORS NETWORK – WMA
CURRENT CHAIR AND FORMER
MEMBERSHIP DIRECTOR (VALENCIA,
SPAIN).
JUNIOR DOCTORS NETWORK
MEMBERSHIP CENSUS 2024: A
SNAPSHOT OF GROWTH AND DIVERSITY
35
The strong representation across most regions shows that the JDN continues to attract
members from a wide range of countries. However, some regions still show potential for
growth, particularly the Western Pacific Region, which currently represents only 4.1% of the
total membership, with 33% of its countries represented.
Figure 1. Membership Census 2024
JUNIOR DOCTORS NETWORK
MEMBERSHIP CENSUS 2024: A
SNAPSHOT OF GROWTH AND DIVERSITY
Key Challenges and Responsibilities
As the Membership Director over the past two terms, I have been tasked with managing this
growing and diverse membership base. My responsibilities include maintaining an up-to-date
membership database, coordinating with the World Medical Association (WMA) Secretariat,
and engaging both new and prospective members. In this role, I’ve faced several challenges,
including:
Incomplete Applications: A high rate of incomplete applications has historically been a
problem. However, in the 2023-2024 term, we’ve successfully reduced this issue by
providing clearer application instructions.
Limited Contact with National JDNs: Engaging some National JDNs has been difficult,
limiting communication and collaboration.
Low Post-Joining Engagement: Despite high membership numbers, keeping members
actively engaged after they join remains a challenge.
Institutional Memory: The need for better continuity from previous terms has been evident,
as a lack of structured transition processes hinders institutional memory.
PABLO ESTRELLA PORTER (MD, MPH),
PUBLIC HEALTH RESIDENT AND
JUNIOR DOCTORS NETWORK – WMA
CURRENT CHAIR AND FORMER
MEMBERSHIP DIRECTOR (VALENCIA,
SPAIN).
36
These challenges highlight the importance of not just growing our membership but ensuring
ongoing involvement and engagement within the network.
Looking Ahead: Strengthening Engagement
Our membership data paints a compelling picture of growth and diversity within the JDN. Yet,
numbers alone cannot define our success. We invite all members to actively participate in
JDN activities, whether through joining working groups, representing the network in
international delegations, attending online events, or contributing to member consultations.
Your active involvement is essential to sustaining the strength and dynamism of the Junior
Doctors Network.
By fostering greater engagement, we can ensure that the JDN continues to be a platform that
empowers junior doctors around the world, giving them the tools and support to make a
meaningful impact on global health.
PABLO ESTRELLA PORTER (MD, MPH),
PUBLIC HEALTH RESIDENT AND
JUNIOR DOCTORS NETWORK – WMA
MEMBERSHIP DIRECTOR (VALENCIA,
SPAIN).
JUNIOR DOCTORS NETWORK
MEMBERSHIP CENSUS 2024: A
SNAPSHOT OF GROWTH AND DIVERSITY
37
CAROLINE
LEE
S Y D N E Y , A U S T R A L I A
38
When doctors sound the alarm on climate change, we are not talking about what will happen
in the future, but what is happening right now. Halfway through 2024, we have witnessed
alarming climate related events including heat waves and extreme weather events. July 2024
was the warmest July on record in 175 years and the 14th consecutive month of record-
highest temperatures [1].
Climate change is a health emergency and fossil fuels, the key driver of climate change, are
health hazards. This has been declared in a recent report by Doctors for the Environment
Australia, calling on governments, private sector, and individuals to take urgent action to
address the harms of fossil fuels on our health and environment (Table 1) [2]. Likened to
tobacco, fossil fuels are an addiction that humanity must urgently quit. The impacts of climate
change are already occurring globally, and are unequally and unjustly experienced far distal to
the places where largest consumptions occur [3].
There are a myriad of ways in which fossil-fuel related climate change harms health (Figure 1)
[2]. Extreme heat and heatwaves cause contribute to cardiovascular disease and strokes,
mental illness, and increased domestic and community violence. An estimated 5 billion people
worldwide experienced extreme heat in June 2024 [4]. Those most vulnerable in our
community are particularly susceptible to heat, including elderly people, those with chronic
health conditions and disability, pregnant people, young children, and those with limited
access to cool environments for housing, work and transport [2]. There is increasing
recognition of the impacts of climate change on mental health, including direct impacts such
as extreme weather events, and indirect impacts such as eco-anxiety, drought and food and
water insecurity [5, 6].
An estimated 5 to 10 million premature deaths are estimated to occur due to fossil fuel air
pollution every year [7]. Fossil fuel burning produces pollutants including participate matters
less than 10 micrometres (PM10), carbon monoxide, nitrogen oxides, sulphur dioxides, and
heavy metals [2]. These exacerbate respiratory conditions such as asthma and chronic
obstructive pulmonary disease, cardiovascular disease, and cancer.
CAROLINE LEE, MD MPHTM
INFECTIOUS DISEASES REGISTRAR
DOCTORS FOR THE ENVIRONMENT
AUSTRALIA, SYDNEY, AUSTRALIA
LIKE TOBACCO, FOSSIL FUELS ARE A
HEALTH HAZARD WE MUST QUIT
39
Biodiversity loss is an under-recognised consequence of climate change with serious health
harms [2]. Climate change drives biodiversity loss through several pathways including
temperature changes, extreme weather events, and subsequent impacts on insect
populations, pollination, biodiversity, and threatened ecosystems. The implications for human
health range from threatened food security and water quality, to increased risk of zoonotic
events, infectious diseases and risk of future pandemics.
CAROLINE LEE, MD MPHTM
INFECTIOUS DISEASES REGISTRAR
DOCTORS FOR THE ENVIRONMENT
AUSTRALIA, SYDNEY, AUSTRALIA
LIKE TOBACCO, FOSSIL FUELS ARE A
HEALTH HAZARD WE MUST QUIT
Figure 1: Fossil Fuel life cycle analysis, Doctors for the Environment Australia, 2024 (2)
40
Stakeholder
Recommended actions
Government
Ban all new fossil fuel projects and accelerate
investment in renewables
Stop financial subsidies to fossil fuel industries
and redirect them to carbon-free initiatives
Ban fossil fuel advertising and industry
sponsorship
Ban single use and non-recyclable plastics and
switch to reusable and/or compostable products
Protect biodiversity and ban native forest logging
Prepare healthcare and the wider community for
what we can no longer avoid
Private sector
Be leaders in the transition to carbon free
technologies, including the health sector
Divestment from fossil fuels
Mitigation and adaptation options in buildings,
energy, transport, trees, electronics and
reduce/reuse/recycle
Individuals
Use active and public transport
Electrify homes and transport with renewable
energy
Reduce meat consumption and transition to plant
based diets
Divestment from fossil fuels
Advocacy with elected representatives
CAROLINE LEE, MD MPHTM
INFECTIOUS DISEASES REGISTRAR
DOCTORS FOR THE ENVIRONMENT
AUSTRALIA, SYDNEY, AUSTRALIA
LIKE TOBACCO, FOSSIL FUELS ARE A
HEALTH HAZARD WE MUST QUIT
Table 1: Actions to phase out fossil fuels, adapted from Doctors for the Environment
Australia, 2024 [2]
41
Actions and conclusions.
Urgent action to phase out fossil fuels is necessary to avert the current and ongoing threats
caused by climate change.
Junior doctors are the front line workforce of current and future. We cannot serve and
advocate for the health of our patients and communities yet ignore the intrinsic
interconnectedness between climate change and health.
Junior doctors can contribute to progress on climate change and health in several ways [2, 8].
These include education of students and health professionals about climate change and
health – whether through formal or informal avenues [9]. We can contribute to advocacy
globally through networks such as the World Medical Association working groups and
attendance at relevant meetings, and locally through community and not for profit
organisations. Junior doctors can contribute to growing research on climate change and health
including healthcare sustainability (e.g. low carbon healthcare, carbon foot printing
healthcare) [10]. We can also advocate for changes within our place of work and study,
including climate change and disaster preparedness and response, advocating for leadership
to transition away from fossil fuels (e.g. electrification of hospitals, divestment), and local
sustainability actions. Other examples of individual actions that junior doctors can take to
contribute on an individual level include preventing over-investigation and its associated
carbon costs, promoting strong preventative health measures (including immunisation), and
antibiotic stewardship. Regardless of the actions taken, collaboration is important to establish
community and maximise influence.
Though the task is daunting, there is no other alternative so long as we wish to realise a
liveable future in this world. Rather than being weighed down by pessimism or despair, I argue
there are multiple actions we can all take. If we have historically failed to imagine a healthier,
sustainable future, then that is something we can change.
CAROLINE LEE, MD MPHTM
INFECTIOUS DISEASES REGISTRAR
DOCTORS FOR THE ENVIRONMENT
AUSTRALIA, SYDNEY, AUSTRALIA
LIKE TOBACCO, FOSSIL FUELS ARE A
HEALTH HAZARD WE MUST QUIT
42
References
National Oceanic and Atmospheric Administration (NOAA) National Centers for
Environmental Information [Internet]. [place unknown]: NOAA; 2024. National Monthly
Global Climate Report for July 2024, published online August 2024 [cited 2024 Sep 6];
Available from: https://www.ncei.noaa.gov/access/monitoring/monthly-
report/global/202407.
1.
Doctors for the Environment Australia (DEA). Fossil fuels are a health hazard. Australia.
DEA, 2024 [August 2024, cited 2024 Sep 6]. Available from:
https://www.dea.org.au/fossil_fuels_are_a_health_hazard_report
2.
Taconet N, Méjean A, Guivarch C. Influence of climate change impacts and mitigation
costs on inequality between countries. Climatic Change. 2020 May;160(1):15-34.
3.
Climate Central. [Place unknown]: Climate Central, 2024. Analysis: Global extreme heat in
June 2024 strongly linked to climate change, published online June 19, 2024 [cited 2024
Sep 6]; available from https://www.climatecentral.org/report/global-heat-review-june-2024
4.
Thompson R, Lawrence EL, Roberts LF, et al. Ambient temperature and mental health: a
systematic review and meta-analysis. The Lancet Planetary Health. 2023;7(7):e580-e589.
https://doi.org/10.1016/S2542-5196(23)00104-3
5.
Hayes K, Blashki G, Wiseman J, Burke S, Reifels L. Climate change and mental health:
risks, impacts and priority actions. International Journal of Mental Health Systems.
2018;12(1). https://doi.org/10.1186/s13033-018-0210-6
6.
Lelieveld J, Haines A, Burnett R, Tonne C, Klingmüller K, Münzel T, Pozzer A. Air pollution
deaths attributable to fossil fuels: observational and modelling study. bmj. 2023 Nov
29;383.
7.
Ho T. The drive for sustainable healthcare must be led by students and junior doctors BMJ
2022; 377 :o896 doi:10.1136/bmj.o896
8.
Maxwell J, Blashki G. Teaching about climate change in medical education: an opportunity.
Journal of public health research. 2016 Apr 26;5(1):jphr-2016.
9.
McGain F, Kayak E. [Place unknown]:MJA Insight. Hospital environmental sustainabillity:
End of the beginning, published 2021 May [cited 2024 Sep 6]; available from
https://insightplus.mja.com.au/2021/19/hospital-environmental-sustainability-end-of-the-
beginning/
10.
CAROLINE LEE, MD MPHTM
INFECTIOUS DISEASES REGISTRAR
DOCTORS FOR THE ENVIRONMENT
AUSTRALIA, SYDNEY, AUSTRALIA
LIKE TOBACCO, FOSSIL FUELS ARE A
HEALTH HAZARD WE MUST QUIT
43
DOUAA ROUFIA
ATTABI
M D . A L G E R I A
44
World Patient Safety Day is particularly significant for Algerian physicians as it highlights both
the progress and ongoing challenges in ensuring patient safety within the country.
Patient Safety Day holds a special significance for me as a primary care physician from
Algeria, currently furthering my education and experience in the United States. This day is a
reminder of our commitment to ensuring the highest standards of care and safety for patients
worldwide.
Significance in My Country
In Algeria, patient safety is a critical issue that we continually strive to address. My
involvement in scientific associations in Algeria highlighted the importance of public health
education and patient awareness. These organizations focus on various health issues,
including metabolic syndrome, blood pressure, diabetes, and infectious diseases like AIDS
and sexually transmitted infections (STIs) [1]. We worked closely with teachers and professors
to provide free patient visits on special days, educating the community about symptoms,
prevention, and the importance of proper medical practices.
For instance, we emphasized the risks associated with unclean hairstyling tools and the
necessity of sterilizing equipment to prevent infections. Additionally, educating patients about
drug interactions and the dangers of self-medication, particularly the risk of antibiotic-resistant
bacteria was a key part of our outreach.
Experience in the United States
After moving to the United States, I continued my commitment to patient safety as a volunteer
in the Emergency Department at Good Samaritan Hospital in San Jose, California. Here, I
gained hands-on experience in providing patient support, comfort, and comprehensive
services crucial for patient safety. My role included assisting with administrative tasks,
facilitating patient admissions, and ensuring effective communication between patients and
healthcare providers.
DR.DOUAA ROUFIA ATTABI. MD. ALGERIA
WORLD MEDICAL ASSOCIATION
COMPLETION, SAN JOSÉ STATE UNIVERSITY
STUDENT IN THE PUBLIC HEALTH PROGRAM
AT SAN JOSÉ STATE UNIVERSITY SAS, SJSU
BRIDGING GAPS IN PATIENT SAFETY:
INSIGHTS FROM ALGERIA AND THE U.S
45
This experience has been invaluable in understanding and contributing to patient care quality
and satisfaction.
“Safety is a promise we make every day to our patients, and this award stands as a testament
that we keep our promise,” said Tomi Ryba, CEO of Good Samaritan Hospital (as cited in
Good Samaritan Hospital, n.d.). [ 2 ]
Patient Safety Statistics and Gaps in Algeria:
The biggest gaps in Algeria are healthcare associated infection and maternal and child health
issues.
Healthcare-Associated Infections: Studies indicate that a significant percentage of infections
in Algerian hospitals are healthcare-associated, with these infections contributing to increased
mortality and morbidity rates. The need for better infection control practices is crucial to
improving patient outcomes. “ This first molecular epidemiology study of VRE in Algeria was
useful in delimiting an outbreak involving three of the four HAI cases and revealed rarely
encountered genotypes. Considering the threat and burden of VRE infections worldwide,
particularly in the USA, and the late emergence in Algeria, our study supports the urgent need
for improved and early adequate infection control measures to avoid VRE spread in North
African hospitals.” (Benammar S et al.2018) [3] . Nevertheless, the prevalence of urinary
infection demonstrates an upward trend from 2001 to 2005. “ The prevalence of urinary tract
infection was 0.7% and 4.5% in two studies from Algeria and Senegal, respectively,11,15
while
A retrospective study from Nigeria reported a frequency of 12.3%.18 The study from Algeria
reported that the prevalence of UTI decreased from 3% to 0.7% in 2001 and 2005,
respectively, following an infection control intervention.”( Bagheri et al.2011). [4]
DR.DOUAA ROUFIA ATTABI. MD. ALGERIA
WORLD MEDICAL ASSOCIATION
COMPLETION, SAN JOSÉ STATE UNIVERSITY
STUDENT IN THE PUBLIC HEALTH PROGRAM
AT SAN JOSÉ STATE UNIVERSITY SAS, SJSU
BRIDGING GAPS IN PATIENT SAFETY:
INSIGHTS FROM ALGERIA AND THE U.S
46
2. Maternal and Child Health: Although Algeria has made strides in reducing maternal and
child mortality rates, inconsistencies in care quality, especially in rural areas, pose ongoing
challenges. The maternal mortality rate, although improved, still points to gaps in ensuring
consistent, high-quality care across the country . Nevertheless, the mortality rate experienced
a downward trend from 1998 to 2017 “According to recent updates on the maternal mortality
ratio in Algeria — it has gradually dropped from 179 deaths per 100,000 live births in 1998 to
112 deaths per 100,000 live births in 2017” .[5]
In Algeria, several initiatives have been implemented to promote patient safety across the
population. One of the key initiatives is the Carte Shifa program, which provides citizens with
a health insurance card that ensures timely access to healthcare services, accurate record-
keeping, and financial protection, all of which are crucial for patient safety. Additionally, the
government has introduced a National Patient Safety Policy that establishes guidelines for
healthcare providers on best practices, helping to reduce the risk of medical errors.
Furthermore, various public awareness campaigns have been launched to educate the
population on health and safety practices, empowering patients to take an active role in their
healthcare and improve overall safety outcomes.
According to an announcement by the Minister of Labor, Employment, and Social Security, Mr.
Fayçal Bentaleb, the second version of the Carte Chifa has been launched in Algeria. This
new version increases the reimbursement per prescription from 3,000 DA to 5,000 DA (Algerie
Eco, 2023) .[6]
Our Call to Action as Physicians to Improve Patient Safety
In my country, the healthcare system is often stretched thin, with nurses and healthcare staff
facing heavy workloads and limited resources. As physicians, one of our critical roles in
improving patient safety is to alleviate this pressure by promoting and participating in auxiliary
missions, such as volunteer services and patient support initiatives.
DR.DOUAA ROUFIA ATTABI. MD. ALGERIA
WORLD MEDICAL ASSOCIATION
COMPLETION, SAN JOSÉ STATE UNIVERSITY
STUDENT IN THE PUBLIC HEALTH PROGRAM
AT SAN JOSÉ STATE UNIVERSITY SAS, SJSU
BRIDGING GAPS IN PATIENT SAFETY:
INSIGHTS FROM ALGERIA AND THE U.S
47
By encouraging volunteer services, we can mobilize medical students, community members,
and even ourselves to provide additional hands-on support within hospitals and clinics. This
can involve tasks like patient education, administrative assistance, and direct patient comfort
services, which free up nurses and other medical professionals to focus on critical care tasks.
Additionally, engaging in patient services initiatives allows us to bridge communication gaps
between patients and healthcare providers, ensuring that patients are well-informed about
their care plans and are more likely to adhere to safety protocols. In a broader context, by
setting this example and advocating for these supportive roles, we can create a culture where
the community becomes more involved in healthcare, ultimately leading to a safer and more
resilient healthcare system. This approach is not only vital in our country but can also serve
as a model for other regions facing similar challenges.
As a physician, I am actively working to implement telehealth solutions in our healthcare
system. This initiative will help facilitate remote consultations, reduce the burden on urban
healthcare facilities, and ensure continuous care for patients in isolated regions. My
experience as a primary care physician in Biskra, known as “The Door of the Desert,”
highlighted the challenges faced by patients who live far from the hospital. I noticed that many
could benefit from having their initial consultations via telemedicine, allowing them to receive
timely advice and care without the need for immediate travel. In urgent cases, they can be
advised to visit the hospital, and after discharge, telehealth can ensure continuous follow-up,
especially for vulnerable groups like mothers and newborns.
Furthermore, integrating artificial intelligence (AI) into telehealth can enhance diagnostic
accuracy and streamline workflows, making it easier for doctors to provide high-quality care
efficiently. By championing telemedicine and AI, we can revolutionize healthcare delivery in
Algeria, making it more accessible, efficient, and safe for all patients, regardless of their
geographic location. This effort aligns with our broader goals of improving patient outcomes
and promoting a culture of safety and innovation in healthcare.
DR.DOUAA ROUFIA ATTABI. MD. ALGERIA
WORLD MEDICAL ASSOCIATION
COMPLETION, SAN JOSÉ STATE UNIVERSITY
STUDENT IN THE PUBLIC HEALTH PROGRAM
AT SAN JOSÉ STATE UNIVERSITY SAS, SJSU
BRIDGING GAPS IN PATIENT SAFETY:
INSIGHTS FROM ALGERIA AND THE U.S
48
References:
1/ IFMSA-Algeria. HIV and AIDS advocacy [Internet]. IFMSA; 2024 [cited 2024 Aug 1].
Available from: https://ifmsa.org/hiv-and-aidsvocacy-ifmsa-algeria/
2/ Good Samaritan Hospital. Good Samaritan Hospital recognized for excellence in patient
safety [Internet]. San Jose: Good Samaritan Hospital; [cited 2024 Jul 29]. Available from:
https://goodsamsanjose.com/about/newsroom/good-samaritan-hospital-recognized-for-
excellen ce-in-patient-safety
3/ Benammar S, Pantel A, Aujoulat F, Benmehidi M, Courcol R, Lavigne JP, Romano-Bertrand
S, Marchandin H. First molecular characterization of related cases of healthcare-associated
infections involving multidrug-resistant Enterococcus faecium vanA in Algeria. Infect Drug
Resist. 2018 Sep 17;11:1483-1490. doi: 10.2147/IDR.S164487. PMID: 30271181; PMCID:
PMC6149901
4/ Bagheri Nejad S, Allegranzi B, Syed SB, Ellis B, Pittet D. Health-care-associated infection
in Africa: a systematic review. Bull World Health Organ. 2011 Oct 1;89(10):757-65. doi:
10.2471/BLT.11.088179. Epub 2011 Jul 20. PMID: 22084514; PMCID: PMC3209981.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3209981/#:~:text=The%20study%20from%20Al
g eria%20reported%20that%20the,c
5/ Shreeya Sharma, MATERNAL HEALTHCARE IN ALGERIA: 4 FACTS EVERYONE
SHOULD KNOW,borgen project, https://borgenproject.org/maternal-healthcare-in-algeria/ 6 /
Algerie Eco. (2023, December 12). Lancement de la deuxième version de la carte Chifa.
Retrieved from

Lancement de la 2e version de la carte Chifa, le plafond des remboursements passe à 5000 Da par ordonnance

DR.DOUAA ROUFIA ATTABI. MD. ALGERIA
WORLD MEDICAL ASSOCIATION
COMPLETION, SAN JOSÉ STATE UNIVERSITY
STUDENT IN THE PUBLIC HEALTH PROGRAM
AT SAN JOSÉ STATE UNIVERSITY SAS, SJSU
BRIDGING GAPS IN PATIENT SAFETY:
INSIGHTS FROM ALGERIA AND THE U.S
49
KALAIVANE
KANNADASAN
S Y D N E Y , A U S T R A L I A
50
Telehealth is an evolving and rapidly expanding service that is transforming how healthcare is
delivered globally. Its adoption surged during the COVID-19 pandemic in 2020 when physical
access to healthcare was limited. Since then, telehealth has grown significantly, playing a
critical role in achieving Universal Health Coverage (UHC) by enhancing equity and access to
healthcare services. But what exactly is telehealth? To fully grasp its benefits, it’s essential to
understand its various components and how each contributes to the remote delivery of
healthcare.
Telehealth refers to delivering healthcare services remotely using advanced technologies in
communication, health informatics, and medical devices. It has evolved from basic phone
consultations to sophisticated apps on smartphones, tablets, and computers. Telehealth
encompasses a broad range of services, equivalent to conventional healthcare, though its
implementation often faces challenges such as differing departmental practices and
governance. The complexity is further compounded by the need for collaboration among
various stakeholders, including healthcare providers, IT specialists, and policymakers1.
Van Dyk’s framework classifies telehealth into key components, including eHealth, telecare,
mHealth, and telemedicine. While telemedicine focuses on therapeutic care, telehealth
expands to preventive, promotive, and curative services. Telecare involves remote patient
monitoring, while mHealth emphasizes the use of mobile technologies. Previous research
shows that telehealth improves health outcomes by enabling early intervention and patient
education through digital consultations2.
KALAIVANE KANNADASAN,MBBS (AIMST), MPH
(HONS)(MALAYA) MEDICAL OFFICER,
UNIVERSITY OF MALAYA KUALA LUMPUR,
MALAYSIA
THE EVOLUTION OF TELEHEALTH AND
THE ROLE OF JUNIOR DOCTORS IN
SHAPING ITS FUTURE
Figure 1 Scope of telehealth
Source: Van Dyk, L. (2014). A Review of Telehealth Service
Implementation Frameworks. International Journal of
Environmental Research and Public Health, 11(2), 1279-
1298. https://doi.org/10.3390/ijerph110201279
51
Telehealth’s significance lies in its ability to extend healthcare services to underserved and
rural populations, reducing the need for travel and lowering healthcare costs. During the
COVID-19 pandemic, telehealth played a pivotal role in ensuring the continuity of care while
minimizing infection risks. Even beyond emergencies, telehealth is crucial for managing
chronic conditions, providing mental health support, and delivering preventive care, thereby
contributing to better overall health outcomes3.
Telehealth services are appreciated for its convenience and effectiveness. However, some
challenges remain. Users have expressed dissatisfaction with the lack of effective
communication with healthcare professionals on telehealth platforms, indicating the need for
more interactive and responsive tools. Additionally, older populations often struggle with
navigating these platforms, suggesting that they may not be user-friendly for all age groups. In
contrast, telehealth is well-received by younger patients and those employed in the private
sector, who appreciate its flexibility and compatibility with their busy lifestyles.
Moving Forward: Enhancing Telehealth Services
To improve telehealth, it’s important to fix key issues. Making communication clearer and
interfaces easier to use, especially for older adults, will help patients. Adding language
options and offline access can make it more accessible. Personalizing care and connecting
with wearable devices can keep patients more engaged. Offering 24/7 support, including AI
chatbots, will ensure access for all. Strengthening security and providing affordable devices
and public telehealth stations will make the service more inclusive. Working with healthcare
teams and involving caregivers can improve outcomes and satisfaction.4
Contribution of Junior Doctors to Telehealth
As junior doctors, there are several ways to contribute to improving telehealth services while
advancing our careers in healthcare technology. Developing digital health skills through online
courses or certifications in areas like telemedicine, health informatics, and electronic health
records is crucial. This knowledge will help us work more effectively with telehealth platforms
and contribute to their improvement.
KALAIVANE KANNADASAN,MBBS (AIMST), MPH
(HONS)(MALAYA) MEDICAL OFFICER,
UNIVERSITY OF MALAYA KUALA LUMPUR,
MALAYSIA
THE EVOLUTION OF TELEHEALTH AND
THE ROLE OF JUNIOR DOCTORS IN
SHAPING ITS FUTURE
52
Participating in quality improvement (QI) projects focused on telehealth is another way to get
involved. By assessing how telehealth services are functioning, identifying areas for
improvement, and developing new protocols, we can enhance patient care and system
efficiency. Engaging in hospital telehealth committees or task forces and sharing frontline
experiences allows us to influence telehealth policies and practices.
Participating in quality improvement (QI) projects focused on telehealth is another way to get
involved. By assessing how telehealth services are functioning, identifying areas for
improvement, and developing new protocols, we can enhance patient care and system
efficiency. Engaging in hospital telehealth committees or task forces and sharing frontline
experiences allows us to influence telehealth policies and practices.
Research is another avenue through which we can make an impact. Conducting studies on
patient satisfaction, telehealth accessibility, or the effectiveness of telemedicine can not only
improve telehealth systems but also build our academic profiles. Publishing research or
presenting findings at conferences opens new career opportunities in digital health.
Advocating for better telehealth policies is important, too. By raising concerns and suggesting
improvements in hospital meetings, we can help drive changes that make telehealth more
user-friendly for both patients and doctors. Over time, exploring specialized career paths in
telemedicine, such as clinical informatics, can combine medicine and technology in a fulfilling
way. In addition, we can play a key role in educating others. Training fellow healthcare
workers and patients to use telehealth effectively will improve the overall experience for
everyone involved. By doing this, we can make a direct impact on the success of telehealth
while gaining a deeper understanding of the system.
KALAIVANE KANNADASAN,MBBS (AIMST), MPH
(HONS)(MALAYA) MEDICAL OFFICER,
UNIVERSITY OF MALAYA KUALA LUMPUR,
MALAYSIA
THE EVOLUTION OF TELEHEALTH AND
THE ROLE OF JUNIOR DOCTORS IN
SHAPING ITS FUTURE
53
Telehealth has revolutionized healthcare delivery by offering a flexible, remote solution that is
particularly beneficial for underserved populations. Addressing the challenges of usability,
communication, and accessibility will ensure that telehealth continues to improve and evolve.
Junior doctors have a unique opportunity to contribute to this field, enhancing telehealth
services and shaping the future of healthcare technology.
References
1. Totten AM, McDonagh MS, Wagner JH. AHRQ Methods for Effective Health Care. The
Evidence Base for Telehealth: Reassurance in the Face of Rapid Expansion During the
COVID-19 Pandemic. Rockville (MD): Agency for Healthcare Research and Quality (US);
2020.
2. Van Dyk L. A Review of Telehealth Service Implementation Frameworks. International
Journal of Environmental Research and Public Health. 2014;11(2):1279-98.
3. Haleem A, Javaid M, Singh RP, Suman R. Telemedicine for healthcare: Capabilities,
features, barriers, and applications. Sens Int. 2021;2:100117.
4. Arriaga Criscuoli de Farias F, Matté Dagostini C, de Assunção Bicca Y, Falavigna V,
Falavigna A. Remote Patient Monitoring: A Systematic Review. Telemedicine and e-Health.
2019;26.
KALAIVANE KANNADASAN,MBBS (AIMST), MPH
(HONS)(MALAYA) MEDICAL OFFICER,
UNIVERSITY OF MALAYA KUALA LUMPUR,
MALAYSIA
THE EVOLUTION OF TELEHEALTH AND
THE ROLE OF JUNIOR DOCTORS IN
SHAPING ITS FUTURE
54
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