{"id":12441,"date":"2019-04-12T15:01:24","date_gmt":"2019-04-12T14:01:24","guid":{"rendered":"https:\/\/www.wma.net\/wp-content\/uploads\/2019\/04\/JDN_15NL_FinalVersionForWMA_11Apr20191.pdf"},"modified":"2019-04-12T15:01:24","modified_gmt":"2019-04-12T14:01:24","slug":"jdn_15nl_finalversionforwma_11apr20191-2","status":"inherit","type":"attachment","link":"https:\/\/www.wma.net\/es\/jdn_15nl_finalversionforwma_11apr20191-2\/","title":{"rendered":"JDN_15NL_FinalVersionForWMA_11Apr2019[1]"},"author":17,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"acf":[],"description":{"rendered":"

JDN_15NL_FinalVersionForWMA_11Apr2019[1]<\/a><\/p>\n

JUNIOR DOCTORS
\nNETWORK
\nempowering young physicians to work together towards a healthier
\nworld through advocacy, education, and international collaboration
\nPublished by the Junior Doctors Network of the World Medical Association
\nThe information, perspectives, and opinions expressed in this publication do not
\nnecessarily reflect those of the World Medical Association or the Junior Doctors
\nNetwork. WMA and WMA-JDN do not assume any legal liability or responsibility
\nfor the accuracy, completeness or usefulness of any information presented.
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nISSN (print) 2415-1122
\nISSN (online) 2312-220X
\nJunior Doctors Leadership 2018-2019
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nDr Chukwuma
\nOraegbunam
\nNigeria
\nDr Yassen Tcholakov
\nCanada
\nDr Sydney Mukuka
\nChileshe
\nZambia
\nDr Mike Kalmus
\nEliasz
\nUnited Kingdom
\nDr Audrey Chloe
\nFontaine
\nFrance
\nDr Lwando Maki
\nSouth Africa
\nDr Helena Chapman
\nDominican Republic
\nDr Chiaki Mishima
\nJapan
\nDr Anthony
\nChukwunonso Ude
\nNigeria
\nDr Caline Mattar
\nLebanon
\nDr Paxton Bach
\nCanada
\nCHAIR
\nDEPUTY
\nCHAIR
\nSECRETARY
\nSOCIO-MEDICAL
\nAFFAIRS
\nOFFICER
\nEDUCATION
\nDIRECTOR
\nMEDICAL
\nETHICS
\nOFFICER
\nMEMBERSHIP
\nDIRECTOR
\nPUBLICATIONS
\nDIRECTOR
\nCOMMUNICATIONS
\nDIRECTOR
\nIMMEDIATE
\nPAST
\nCHAIR
\nIMMEDIATE
\nPAST
\nDEPUTY
\nCHAIR
\nDr Konstantinos
\nRoditis
\nGreece
\nDr Jeazul Ponce H.
\nMexico
\nDr Mariam Parwaiz
\nNew Zealand
\nDr Vandrome Nakundi
\nKakonga
\nDemocratic Republic
\nof the Congo
\nDr Suleiman A. Idris
\nNigeria
\nDr Ricardo Correa
\nUnited States
\nDr Victor Animasahun
\nNigeria
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nEditorial Team 2018-2019
\nTable of Contents
\nTEAM OF OFFICIALS\u2019 CONTRIBUTIONS
\n05 Words from the Chair
\nBy Dr Chukwuma ORAEGBUNAM (Nigeria)
\n06 Words from the Communications Director
\nBy Dr Anthony Chukwunonso UDE (Nigeria)
\n07 Words from the Publications Director
\nBy Dr Helena CHAPMAN (Dominican Republic)
\nHISTORICAL PERSPECTIVES
\n08 Snake and Staff as Medical Symbols
\nBy Dr Anthony Chukwunonso UDE (Nigeria)
\nJUNIOR DOCTORS\u2019 COMMUNITY REFLECTIONS
\n11 Why Doctors Need to be at the Centre of Primary Health Care
\nBy Dr Lyndah KEMUNTO (Kenya)
\n14 Rural India: The Need for a Change
\nBy Dr Aashish Kumar SINGH (India)
\nJUNIOR DOCTORS\u2019 ACTIVITIES
\n16 Medical Graduates Reciting the Hippocratic Oath at Hippocrates\u2019 Birthplace: International
\nCollaboration and Medical Ethics
\nBy Dr Konstantinos RODITIS (Greece) and Dr. Konstantinos LOUIS (Greece)
\n20 Junior Doctors\u2019 Challenges of Advocacy for Physicians\u2019 Well-being in Japan
\nBy Dr Kazuhiro ABE (Japan)
\n24 Innovative Workshop: Developing Critical Inquiry in the Dominican Republic
\nBy Dr Helena CHAPMAN (Dominican Republic)
\n27 JDN in Nigeria \u2013 Bridging the Gap and Impacting Lives
\nBy Dr Anthony Chukwunonso UDE (Nigeria)
\n29 JDN-SCHOMOS MMA Penang Declaration 2018
\nBy Dr Vijay GANASAN (Malaysia)
\nINTERNATIONAL CONFERENCES
\n31 Empowering Junior Doctors
\nBy Dr Benny LOO (Singapore)
\n32 Prince Mahidol Award Conference 2019
\nBy Dr Mariam PARWAIZ (New Zealand), Dr Lyndah KEMUNTO (Kenya), Dr Hasan AL HAMEEDI
\n(Iraq), Dr Jade LIM (Australia)
\nWORKING GROUPS
\n36 World Antibiotic Awareness Week 2018
\nBy Dr Mariam PARWAIZ (New Zealand), Dr Steen FAGERBERG (Denmark), Dr Ian PEREIRA
\n(Canada), Dr Helena CHAPMAN (Dominican Republic)
\n40 Safe Surgery and Anaesthesia for All: Let\u2019s Take Action Now!
\nBy Dr Manon PIGEOLET (Belgium)
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nOver the past eight years, we have seen a growing interest in the Junior Doctors Network
\n(JDN) from colleagues all over the world. This is a reflection of the progress that we have
\nmade over the years, ensuring that the JDN remains an avenue for young doctors to gain
\nthe capacity to achieve their professional goals in medicine and public health leadership.
\nWe are appreciative for the World Medical Association (WMA) leadership, which continues
\nto support the JDN activities, including our attendance and ability to represent the WMA at
\nvarious high-level international meetings. As the JDN membership continues to grow, JDN
\nmembers are able to become more involved in the decisions that shape our future as well
\nas the health and well-being of our patients.
\nInternally, we continue striving to utilize approaches that can increase JDN member
\nparticipation in JDN meetings and activities. We now have an operational \u2018Terms of
\nReference\u2019 and at the last stages of adopting our \u2018Strategic Plan\u2019, which will help our future
\ngenerations to understand where we have come from and the direction we are headed. We
\nalso regularly track the completion of JDN officers\u2019 and work groups\u2019 tasks in order to
\nrecord improvements as well as encountered challenges.
\nAs our meetings are experiencing increased attendance and participation, we are gradually
\nimplementing changes that enhance JDN member involvement. In efforts to strengthen our
\nleadership capacity in the future, we have adopted the theme, Building the Next Generation
\nof Physician Leaders, for our JDN meeting (April 2019) in Santiago, Chile.
\nFinally, our progress and direction reflect our stated mission: \u201cEmpowering young
\nphysicians to work towards a healthier world through advocacy, education, and
\ninternational collaboration\u201d. Increased collaboration and feedback from all our JDN
\nmembers will allow us to maintain and improve on our past and present accomplishments,
\nwhich will dually benefit our future medical leadership and growing patient populations
\nacross the world. I look forward to seeing many of you in Santiago!
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nWords from the Chair
\nTEAM OF OFFICIALS\u2019 CONTRIBUTIONS
\nChukwuma Oraegbunam, MBBS MWACP MRCPsych
\nChair (2018-2019)
\nJunior Doctors Network
\nWorld Medical Association
\nDear colleagues from around the world,
\nI am delighted to welcome you to the 15th issue of the Junior Doctors Network (JDN)
\nNewsletter. It is our editorial hallmark as we work together towards a healthier world
\nthrough advocacy, education, and international collaboration.
\nThe newsletter aims to educate, inform, and entertain junior doctors worldwide, where the
\nnext generation of junior doctors can share their stories, become inspired, raise awareness,
\nand find opportunities to better themselves and their communities. Each topic is relevant to
\njunior doctors across the world.
\nI offer my special appreciation to the Publications Team, led by Dr Helena Chapman, for
\ntheir priceless role in ensuring a contemporary, sound, and near impeccable JDN
\nNewsletter. I am incredibly proud of what the Publications Team has created and curated
\non the pages that follow.
\nI hope that these articles will stimulate informed debate and a lively exchange of ideas. We
\nlook forward to receiving your feedback on this issue. We also encourage your input on
\ntopics to be covered in future issues, especially those local and global subjects that directly
\nimpact the work of junior doctors across the world.
\nStay with us, enjoy the read, and expect more!
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nWords from the Communications Director
\nTEAM OF OFFICIALS\u2019 CONTRIBUTIONS
\nAnthony Chukwunonso Ude, MBBS MWACS
\nCommunications Director (2018-2019)
\nJunior Doctors Network
\nWorld Medical Association
\nDear colleagues,
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nWords from the Publications Director
\nTEAM OF OFFICIALS\u2019 CONTRIBUTIONS
\nOn behalf of the Publications Team (2018-2019) of the Junior Doctors Network (JDN), we
\nare honored to present and share the 15th issue of the JDN Newsletter to junior doctors
\nacross the world.
\nThe 14th issue of the JDN Newsletter, published in October 2018, included contributions
\nfrom junior doctors representing Belgium, Canada, Greece, Italy, Japan, Kenya, Lebanon,
\nNigeria, Sudan, Tanzania, Venezuela, and the United States. These articles provided
\nreports and updates on essential global health topics, international health conferences, and
\nother JDN activities.
\nLikewise, this 15th issue of the JDN Newsletter incorporates additional articles from junior
\ndoctors representing Australia, Belgium, Canada, Denmark, Dominican Republic, Greece,
\nIndia, Iraq, Japan, Kenya, Malaysia, New Zealand, Nigeria, Singapore, and the United
\nStates. These articles included reports and updates on JDN activities, narrative pieces on
\nglobal health topics, and reflections on their community health experiences.
\nThe JDN Newsletter serves as an important international platform for the global community
\nof junior doctors. We hope that junior doctors will continue to share their professional
\nexperiences in the JDN Newsletter, which can showcase their global health leadership,
\ninspire other junior doctors across the world, and promote communication between World
\nMedical Association (WMA) and JDN members. By facilitating an open dialogue among
\njunior doctors, they can collaborate and develop innovative strategies to better understand
\nthe health risks that directly influence health and well-being of our local, national, and
\nregional communities.
\nWe wish to thank all editors of the JDN Publications Team 2018-2019 for their enthusiasm
\nand dedicated efforts to finalize this 15th issue. We also appreciate the continued support of
\nthe JDN Management Team and WMA leadership for the dissemination of this essential
\njunior doctors\u2019 resource. We hope that you enjoy reading the articles in this 15th issue!
\nHelena Chapman, MD MPH PhD
\nPublications Director (2018-2019)
\nJunior Doctors Network
\nWorld Medical Association
\nDear JDN colleagues,
\nby origin and symbolism. The Caducaeus (or staff of Hermes) is a winged staff with two
\nserpents wound around it, and the Rod of Asclepius (or Asklepian) is a staff with a single
\nserpent. Although the Caduceus is the more commonly used symbol of medicine by most
\nhealth ministries, departments, and agencies, there is an increasing consciousness and
\nacknowledgement that it is a false symbol and has no historical substantiation as an
\nemblem of medicine. Consequently, this has led to changes of the logo by many global
\nacademic and medical institutions. Based on historical texts, debate continues about the
\norigins and usage of these two symbols. This article briefly explores these perspectives by
\nlaying credence to an ancient account that has been lost under a misapprehension so that
\nphysicians will pay homage only to the true depiction and symbol of medicine.
\nTHE CADUCAEUS
\nIn Greek mythology, the Caducaeus described the staff of the Greek god Hermes (Roman,
\nMercury) and of related undertakings. Hermes was the messenger of the gods and is often
\nportrayed as wearing winged sandals, a winged hat, and bearing a winged, golden
\nCaducaeus, entwined with snakes.
\nAmong the Greeks, the Caduceus is thought to have originally been a herald\u2019s staff, and
\nHermes was the herald, or messenger, of the gods. The staff of the herald is thought to
\nhave developed from a shepherd\u2019s crook, in the form of a forked olive branch, which for this
\npurpose has been adorned first with two fillets of wool, then with white ribbons, and finally
\nwith two snakes intertwined. Many people take for granted that the Caducaeus is the
\nsymbol of medicine, and many medics still employ it. The staff of Hermes is not the symbol
\nof medicine, but was erroneously adopted in the late 19th century in North America, and
\nhas persisted until today (1).
\nThe staff of Hermes, the Caducaeus, is still used as a symbol by the United States Army
\nMedical Corps, who, it is alleged, adopted it as a symbol in 1902, leading to its widespread
\nacceptance into medical culture (2,3). The Oxford Illustrated Companion to Medicine puts it
\nbest, \u201cThough the Caduceus has long been accepted as a device to represent medicine, it
\nis the staff and serpent at Asclepius which has the more ancient and authentic claim to be
\nthe emblem of medicine\u201d (4).
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nSnake and Staff as Medical Symbols
\nHISTORICAL PERSPECTIVES
\nAnthony Chukwunonso Ude, MBBS MWACS
\nCommunications Director (2018-2019)
\nJunior Doctors Network
\nWorld Medical Association
\nThe snake and staff have become synonymous with medicine and
\nthe healing arts worldwide. Today, they have two variations, distinct
\nTHE ROD OF ASCLEPIUS
\nThe traditional medical symbol, the rod of Asclepius, has only a single snake and no wings.
\nIn Greek mythology, Asclepius was the god of medicine, one of the gods sworn by in the
\noriginal Hippocratic Oath (5). Asclepius represents the healing aspect of the medical arts;
\nhis daughters are Hygieia (\u201cHygiene\u201d), Laso (\u201cMedicine\u201d), Aceso (\u201cHealing\u201d), Aglaea
\n(\u201cHealthy Glow\u201d), and Panacea (\u201cUniversal Remedy\u201d).
\nThe rod of Asclepius is an ancient symbol associated with medicine and healing, consisting
\nof a serpent entwined around a staff. His attributes, the snake and the staff, sometimes
\ndepicted separately in antiquity, are combined in this symbol. Hippocrates himself was a
\nworshipper of Asclepius (6). The symbolism has been explained that sometimes the
\nshedding of skin and renewal was emphasized as symbolizing rejuvenation. Another
\nexplanation, however, centers on the serpent as a symbol that unites and expresses the
\ndual nature of the work of the physician, who deals with life and death, sickness and health
\n(7). A third explanation is that the staff was a walking stick associated with itinerant
\nphysicians.
\nAsclepius derived his name from healing soothingly and deferring the withering that comes
\nwith death. For this reason, therefore, they gave him a serpent as an attribute, indicating
\nthat those who avail themselves of medical science undergo a process similar to the
\nserpent. As such, they grow young again after illnesses and slough off old age, since the
\nserpent is a sign of attention and required in medical treatments (8).
\nAnother accepted alternative explanation of origin is the Jewish Nehustan, the bronze
\nserpent on the pole, which God told Moses to form in the Bible\u2019s Book of Numbers
\n(Numbers 21:6-9, English Standard Version): \u201cMake a fiery serpent and set it on a pole,
\nand everyone who is bitten, when he sees it, shall live\u201d. This was the antidote to the
\nvenomous bites from a plague of serpents. The rod and snake have thus been associated
\nwith healing and the healing arts.
\nA less supported explanation is the worm theory, which purports in ancient times parasitic
\nworms, such as the guinea worm (Dracuculus medinensis), were common and extracted
\nfrom beneath the skin by winding them slowly around a stick (9). According to this theory,
\nphysicians might have advertised this common service by using a sign depicting a worm on
\na rod.
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nHISTORICAL PERSPECTIVES
\nDISCREPANCIES IN USE
\nThe rod of Asclepius is the dominant symbol for health care professionals and
\nassociations, although due to the long-standing error, many private facilities use the
\nCaducaeus. One survey in the United States found that 62% of health care professionals
\nused the rod of Asclepius, while 76% of commercial health care organizations used the
\nCaduceus (1). However, it should be emphasized that the Rod of Asclepius has a
\nsignificance more congruent with the principles and philosophy of medicine.
\nCONCLUSION
\nNumerous hospitals and medical schools may have changed their emblems after realizing
\nthe false impression. However, the purpose of the article is not to unduly critique the choice
\nof the Caduceus as a medical symbol, but rather to correct an erroneous impression and
\nregain a part of the rich patrimony, tradition, and heritage of health care. It is not the
\nintention of the author that institutions, which have invested so much goodwill and effort in
\nestablishing a well-recognized logo with good public perception, change them or adopt a
\nnew one. The author aims to correct a false presumption and provide a historical
\nperspective.
\nReferences
\n1) Friedlander WJ . The golden wand of medicine: a history of the Caduceus symbol in medicine. New York,
\nNY: Greenwood Press; 1992.
\n2) Tyson SL. The Caduceus. The Scientific Monthly. 1932;34:492-498.
\n3) Engle B. The use of Mercury’s caduceus as a medical emblem. The Classical Journal. 1929;25:204-208.
\n4) Bohigian GM. The staff and serpent of Asclepius. Mo Med. 1997; 94:210-211.
\n5) Wilcox RA, Whitham EM. The symbol of modern medicine: why one snake is more than two. Ann Intern
\nMed. 2003;138:673-677.
\n6) Miles SH. The Hippocratic Oath and the ethics of medicine. 1st ed. Oxford, UK: Oxford University Press;
\n2005.
\n7) Jones KB. The staff of Asclepius: a new perspective on the symbol of medicine. WMJ. 2008;107:115-116.
\n8) Edelstein EJ, Edelstein L. Asclepius: collection and interpretation of the testimonies. Baltimore, MD; The
\nJohns Hopkins Press; 1945.
\n9) Hinek A, Backstein R. The magic wands of medicine. Univ Toronto Med J. 2004;82:68-70.
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nHISTORICAL PERSPECTIVES
\nDevelopment Goals. Health experts and leaders from around the globe reaffirmed the
\nvision on having high-quality, safe, comprehensive, integrated, accessible, available, and
\naffordable PHC services. These services are provided with compassion, respect, and
\ndignity by health professionals who are well-trained, skilled, motivated, and committed (1).
\nAs governments and various stakeholders commit to building sustainable PHC, doctors
\nworking in lower- and middle-income countries (LMICs) should strategize and align their
\ncommitment towards the delivery of PHC.
\nThe role of doctors in PHC has been marginal in most LMICs. In Sub-Saharan Africa, PHC
\nis led by mostly nurses or non-physician clinicians, whereas doctors provide curative care
\nin secondary and tertiary hospitals (2). This is different in developed countries, where
\ngeneral practitioners or family physicians are the first contact in primary care. The
\nsubstitution of middle-level cadres or non-physician clinicians for doctors as PHC providers
\nhas been the result of perennial shortage of doctors, long training periods, and higher
\ntraining costs of doctors and specialists. This shortage has been further worsened by the
\nbrain drain, as more doctors have migrated to developed countries to seek economic
\nopportunities or to escape conflict zones and achieve job satisfaction. However, non-
\nphysician clinicians have fewer entry requirements and shorter training times, after which
\nthey are assigned to technical and non-technical tasks. Therefore, they are regarded as a
\nstopgap, a cheap, temporary option to providing primary care (2,3).
\nAlthough the shortage of doctors still exists, there has been a remarkable increase in the
\nnumber of medical training institutions and highly trained and skilled health care workers in
\nSub-Saharan Africa. In Kenya, the number of registered doctors has increased from 908
\ndoctors at its independence in 1963 to 8,753 doctors in 2018 (4). Factoring in population
\ngrowth, the doctor-patient ratio has increased from 1 doctor to 9,811 persons in 1963 to 1
\ndoctor to 5,678 persons in 2018. To further improve these metrics, governments should
\nreinforce strategies to train, recruit, develop, motivate, and retain doctors and other health
\ncare providers.
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nWhy Doctors Need to be at the Centre of Primary Health Care
\nJUNIOR DOCTORS\u2019 COMMUNITY REFLECTIONS
\nLyndah Kemunto, MBChB
\nGeneral Practitioner, Kisii County Government
\nKisii, Kenya
\nIn October 2018, the Global Conference on Primary Health Care took
\nplace in Astana, Kazakhstan, in a bid to renew the commitment to
\nPrimary Health Care (PHC) as an important building block towards
\nachieving universal health coverage and the Sustainable
\nAs more doctors are being trained, they should be open to taking up jobs in rural areas and
\nlower tier PHC facilities. Statistics show that 80% of people\u2019s health needs can be
\naddressed by effective PHC (5). Therefore, doctors should offer their expertise where they
\nare needed most, in PHC, as opposed to concentrating on providing services in the
\nsecondary- and tertiary-level hospitals. Furthermore, it is necessary to integrate essential
\nservices into PHC, services that were previously considered as specialized. In response to
\nthe changing demographic and global health priorities, doctors and specialists are
\ncompelled to provide these specialized services such as mental health, basic surgical care,
\ntrauma, and emergency medicine care at primary care facilities. A comprehensive and
\ninclusive PHC system is crucial in achieving better outcomes.
\nIn addition, having doctors in PHC increases the diversity of skills, knowledge, and offered
\nservices. This diversity allows for the division of tasks and the ability to provide a wide
\nrange of procedures and surgical interventions. This, in turn, reduces the number of
\nreferrals to secondary- and tertiary-level hospitals, which are often located far away, and
\nhence reduces the financial burden on patients. Also, the public health system benefits
\nfrom reduced costs of referral and ambulance services and decongestion of tertiary-level
\nfacilities, further improving the quality of care in these higher tier specialized centres.
\nBy providing leadership, good stewardship, and technical input, continuous participation in
\nthe formulation and implementation of strategies and policies at local and national levels
\nfurther strengthens the PHC journey (6). Investing in well-trained and highly skilled
\nprofessionals will go a long way in enhancing public confidence in PHC. Whether it is a
\ndoctor-led or supported by a doctor primary care team approach, it is clear that the added
\nvalue of doctors in PHC cannot be understated.
\nGovernments should therefore commit to ensuring that there is a doctor \u2013 general
\npractitioner or family physician \u2013 in every PHC facility or team. The example of Cuba is
\nevidence that PHC is achievable even for LMICs (7). Training institutions need to
\nadequately prepare doctors with the necessary skills to respond to the holistic health needs
\nof individuals, families, and communities. Doctors, on the other hand, must proactively
\nengage and collaborate with other stakeholders to reduce health inequalities, strengthen
\nprimary care, and create a healthier society.
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nJUNIOR DOCTORS\u2019 COMMUNITY REFLECTIONS
\nBeyond clinical expertise, doctors contribute critical thinking,
\ncollaboration, and capacity building as well as act as advocates
\nand change agents for sustainable PHC.
\nReferences
\n1) World Health Organization; United Nations Children\u2019s Fund. Global conference on primary health care:
\nDeclaration of Astana. WHO\/HIS\/SDS\/2018.61. 2018 [cited 2018 Dec 29].
\n2) Mullan F, Frehywot S. Non-physician clinicians in 47 Sub-Saharan African countries. Lancet.
\n2007;370:2158-2163.
\n3) Dovlo D. Using mid-level cadres as substitutes for internationally mobile health professionals in Africa. A
\ndesk review. Hum Resour Health. 2014;2:7.
\n4) Kenya medical practitioners and dentists board. Doctors\u2019 retention register. 2019 [cited 2018 Dec 29].
\n5) The Lancet. The Astana Declaration: the future of primary health care? Lancet. 2018;392:1369.
\n6) Mash R, Almeida M, Wong WCW, Kumar R, von Pressentin KB. The roles and training of primary care
\ndoctors: China, India, Brazil and South Africa. Hum Resour Health. 2015;13:93.
\n7) World Health Organization. Cuba\u2019s primary health care revolution: 30 years on. 2011 [cited 2018 Dec 27].
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nJUNIOR DOCTORS\u2019 COMMUNITY REFLECTIONS
\nthe country. A total of nearly 70% of the population resides in small towns and villages (1),
\nworking predominantly in agriculture, daily wage labor, and animal husbandry. Generation
\nafter generation, only few migrate to cities, preferring the ancestral tradition of living in large
\njoint families and working in the agricultural field.
\nWith a low per capita national income, rural communities face limited economic
\ndevelopment, often live below the poverty line, and struggle to provide basic necessities for
\ntheir families. Cardiovascular, chronic obstructive pulmonary, and cerebrovascular
\ndiseases describe the top three causes of mortality, followed by lower respiratory
\ninfections, diarrheal, tuberculosis, and neonatal disorders (2,3). Despite the government
\nexpenditure of billions of dollars for rural health care services in India, health care
\nstandards have not improved, and socioeconomic and health disparities persist.
\nIn the remote area of Rajasthan, one medical officer, Dr Amit Tiwari, has provided care to
\nthe underserved community for the past three years, learning about the social determinants
\nof health that negatively influence health outcomes (Photos 1-2). For the duration of one
\nmonth, I had the opportunity to assist him with rural health service delivery in a remote
\nvillage of about 1,000 residents.
\nThis village has been characterized by high morbidity and mortality in adults and children,
\ninfluenced by several factors. First, low education levels among adult community members
\ncan hinder how they fully understand health risks associated with communicable and non-
\ncommunicable diseases. Second, delayed health-seeking behaviors can increase risk of
\ndisease complications or lead to missed immunizations. Third, poor hygiene and sanitation
\npractices in the household and community can increase environmental exposure of
\ninfectious pathogens. Additionally, despite the allocation of national resources, many
\nprimary health centers still lack basic equipment (e.g., electrocardiogram, x-ray,
\nultrasonography) and medications (e.g., adrenaline, atropine, benzodiazepines), which
\nchallenge how physicians can treat and manage life-threatening medical emergencies.
\nWithout these resources, physicians can only refer patients to the closest tertiary-level
\nhealth center, which may take around two hours to reach by ambulance.
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nRural India: The Need for a Change
\nJUNIOR DOCTORS\u2019 COMMUNITY REFLECTIONS
\nAashish Kumar Singh, MBBS
\nGeneral Physician, Ri-Bhoi Pharmacy
\nNongpoh, India
\nIndia, the world\u2019s second most populated nation with 1.3 billion (2018),
\ncontinues to experience rapid population growth with depleting
\nresources, corruption, and limited health and education infrastructure.
\nOver the past centuries, rural India continues to represent the heart of
\nWorking as a doctor in rural India can be both rewarding and extremely challenging. Hence,
\nthe moral obligation of health professionals is to serve as a community leader and
\nenlighten, encourage, and educate community members. The common phrase, \u201cRome was
\nnot built in a day\u201d, reflects the real-time situation of rural India as these communities
\ncontinue to face daily challenges to meet necessities and maintain physical and
\npsychosocial health status.
\nAt the same time, authorities can implement appropriate policies to prioritize and advance
\neducation and health care services in rural communities. With concrete steps towards
\nfurther investment in health care, all communities can be equipped with primary health
\ncenters, tertiary-level medical services, and trauma centers. I see the future of rural
\ncommunities across India with optimism, which might lead to my follow-up article, entitled,
\n\u201cRural India: The Change did Occur!\u201d
\nReferences
\n1) Chandramouli C. Rural urban distribution of population, 2011. 2011 [cited 2019 Feb 10].
\n2) University of Washington, Institute for Health Metrics and Evaluation. India. 2018 [cited 2019 Feb 10].
\n3) UNICEF. Under-five mortality. 2018 [cited 2019 Feb 10].
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nJUNIOR DOCTORS\u2019 COMMUNITY REFLECTIONS
\nPhoto 1. Dr Amit Tiwari (far right) and two other
\nhealth workers supervise the nutrition program
\nfor malnourished children.
\nCredit: Aashish Kumar Singh.
\nPhoto 2. Health workers educate community
\nmembers about the importance of proper
\nsanitation and hygiene practices.
\nCredit: Aashish Kumar Singh.
\nBy promoting leadership and perseverance to reform the health
\nsystem, physicians can lead health teams to care for and protect
\ncommunity members of rural India.
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nMedical Graduates Reciting the Hippocratic Oath at Hippocrates\u2019
\nBirthplace: International Collaboration and Medical Ethics
\nJUNIOR DOCTORS\u2019 ACTIVITIES
\nKonstantinos Roditis, MD MSc
\nVascular Surgery Resident
\nHellenic Red Cross Hospital
\nAthens, Greece
\nChair, JDN-Hellas
\nPast Secretary 2015-2018, JDN-WMA
\nKonstantinos Louis, MD PhD
\nObstetrician-Gynecologist
\n\u201cAttikon\u201d University Hospital
\nNational and Kapodistrian University
\nAthens, Greece
\nDeputy Chair, JDN-Hellas
\nThe Hippocratic Oath (\u0399\u03c0\u03c0\u03bf\u03ba\u03c1\u03b1\u03c4\u03b9\u03ba\u03cc\u03c2 \u038c\u03c1\u03ba\u03bf\u03c2 in Greek) or the Oath of Hippocrates of Kos,
\noriginally written in ionic Greek between the 3rd and 5th century BC, is one of the most
\nwidely known pieces of Greek medical literature and is considered the earliest expression
\nof medical ethics in the Western World. It is believed to be the work of Hippocrates of Kos,
\nson of the physician Heraclides (descendant of Asclepius, the Greek god of Medicine), a
\nrenowned physician of ancient Greece and founder of the Hippocratic School of Medicine
\non the Greek island of Kos in the Southeastern Aegean Sea, that completely revolutionized
\nand modernized the practice of Medicine in ancient world and prepared the field for it to
\nbecome a profession.
\nHippocrates, recognized as the \u201cFather of Medicine\u201d, established in this oath, many ethical
\nprinciples such as confidentiality and non-maleficence for the first time. He also strongly
\nbound the student to his teacher and the greater community of physicians with
\nresponsibilities similar to that of a family member. Over the centuries, it has been rewritten
\noften in order to suit the values of different cultures influenced by Greek medicine (1,2).
\nContrary to popular belief, the Hippocratic Oath is not required by most modern medical
\nschools, although some have adopted modern versions, such as the Declaration of
\nGeneva by the World Medical Association (WMA) (3).
\nFor three consecutive years, the Panhellenic Medical Association (PhMA), member of the
\nWMA, and the International Hippocratic Foundation of Kos (IHFK) – a public benefit
\norganisation, founded in 1960 to honor the \u201cFather of Medicine\u201d, offering a broad spectrum
\nof activities aimed at disseminating the teachings and legacy of Hippocrates and ancient
\nGreek Medicine \u2013 have co-organized in partnership with the Medical Chamber of Kos, a
\nreenactment ceremony of reciting the Hippocratic oath at the Asclepieion of Kos. Medical
\ngraduates from all seven medical schools of Greece who graduated with a distinction,
\ntake the oath in front of their Deans, local authorities, family members, and the Press
\n(Photo 1). The event usually coincides with a scientific session on continuous medical
\neducation and the medical profession in general with the participation of renowned
\nspeakers and members of the Academia from Greece, Europe, and the rest of the world.
\nThe idea of further opening the event to Europe and the rest of the world, inviting
\ninternational medical graduates to join their Greek colleagues and take part in this unique
\ncelebration of medical ethics has been strongly supported by the organizers for years now,
\nas the Hippocratic principles have always been globally relevant and necessary to be
\nrespected and considered in our clinical practice. JDN-Hellas, representing the voices and
\ninterests of Greek junior doctors, was present at the event for two consecutive years, in
\n2017 and 2018, and has been involved in the discussion since the very beginning, offering
\nour ideas and suggestions for creating a long-lasting strategic plan for this international
\nevent to become a reality (Photo 2).
\nAs we envision this event as a global one, we could not think of a more appropriate partner
\nto ensure its continuity for years to come, than the WMA, its members – National Medical
\nAssociations (NMAs) and its Junior Doctors Network (JDN-WMA). Following up on those
\nfirst deliberations, we presented a draft project proposal at the JDN Meeting (Chicago,
\nIllinois, USA) in October 2017, which included information on the event, proposed duration,
\nfunding, logistics, and content, as well as the selection process, overseen by the WMA,
\nneeded to ensure annual participation of a diverse group of medical graduates (Table 1).
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nJUNIOR DOCTORS\u2019 ACTIVITIES
\nPhoto 1. Participants at the reenactment ceremony
\nof reciting the Hippocratic Oath, Asclepieion, Kos,
\nGreece, September 2017.
\nCredit: Konstantinos Roditis.
\nPhoto 2. JDN-Hellas\u2019 Deputy Chair, Dr Konstantinos
\nLouis (left), with Athens Medical Association
\nPresident, Dr George Patoulis (middle), and local
\nauthorities at the event in Kos, September 2018.
\nCredit: Konstantinos Louis.
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nJUNIOR DOCTORS\u2019 ACTIVITIES
\nProject modules Description
\nOrganizers PhMA, IHFK, WMA (JDN-WMA), Kos medical
\nassociation, other stakeholders
\nDuration 2-3 days (Friday to Sunday)
\nPeriodicity Annually or biannually
\nAgenda \u2022 Friday: Arrival – Tour of Kos town,
\nHippocrates\u2019 famous plane tree, Asclepieion
\narchaeological site
\n\u2022 Saturday: Tour of Hippocratic Foundation
\npremises (morning), Hippocratic oath
\nCeremony (afternoon), Greek social program
\n(evening)
\n\u2022 Sunday: Departure
\nParticipants \u2022 1 or more graduates from each country
\n(participating NMA)
\n\u2022 1 graduate\/10.000.000 citizens (1 graduate
\nfor smaller countries) OR
\n\u2022 1 graduate\/1000 graduates OR
\n\u2022 1 graduate\/medical university, medical
\nschool
\nCosts Accommodation: 50 EUR\/night\/participant
\nBoarding: 50 EUR\/day\/participant
\nTransportation: 20 EUR\/day\/participant
\nTravel: 200-1000 EUR\/participant
\nBudget: 44.000-124.000 EUR for 100
\nparticipants
\nFunding \u25cf Total budget to be covered 100% by
\nparticipating NMAs OR
\n\u25cf Covered 50\/50 by participating NMAs and
\norganizers OR
\n\u25cf Covered 100% by the organizers OR
\n\u25cf Covered 50\/50 by WMA and NMAs OR
\n\u25cf Covered 100% by participants (unlikely)
\nSelection process \u25cf Each NMA could choose their participants
\naccording to their own standards OR
\n\u25cf Each NMA could ask their respective Medical
\nUniversities\/Schools to nominate their best
\ngraduates (e.g., those with highest grades)
\nFeedback and input of all Chicago
\nmeeting participants and JDN-WMA
\nmembership was also requested. We
\nhave further considered inviting the
\nEuropean Junior Doctors Association
\n(EJD) for their assistance and partnership
\nin approaching medical graduates and
\njunior doctors from the European
\ncontinent as participants, as well as other
\nEuropean medical organisations as
\npossible partners. For that reason, a
\ndetailed presentation will be delivered by
\nthe JDN-Hellas delegation at the next
\nEJD meeting (Edinburgh, UK) in May
\n2019.
\nThe rationale behind this idea of
\n\u201cinternationalizing\u201d this ceremonial event
\non the island of Kos, is that this would be
\nseen as a perfect opportunity for young
\ndoctors from all around the world to come
\ntogether to share a common, thrilling
\nexperience that would change them for
\nthe better. At the same time, they would
\nbe offered the chance to gain knowledge
\nand expertise by listening to a panel of
\nexperts during the parallel scientific
\nsymposium on medical education, ethics,
\nand the medical profession. Seen as a
\nwhole, this event could foster
\ninternational collaboration among the new
\ngeneration of physicians, as well as serve
\nas a forum for debate on controversial
\nand challenging issues on medical ethics,
\ndeontology, and continuous medical
\neducation.
\nTable 1. Proposed project specifics.
\nThe table shows suggestions made by
\nJDN-Hellas during the presentation of the
\nproject proposal at the JDN Meeting
\n(Chicago, Illinois, USA) in October 2017. It
\ndoes not reflect any opinions of the event
\norganizers, whatsoever.
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nJUNIOR DOCTORS\u2019 ACTIVITIES
\nThe next steps in the process of realizing the project entail finalizing the project
\nproposal, incorporating feedback given by JDN-WMA members, as well as bringing all
\nstakeholders together to further discuss the details of such an undertaking. The logistics
\nand funding needed for it to become a reality might seem huge, but this must not be
\nseen as an obstacle in our work, but rather more like a reason to try harder to achieve
\nour goal. We honestly believe that such an experience, like the reciting of the
\nHippocratic Oath, must be shared with the rest of the medical community and become a
\n\u201ccommon property\u201d of all junior doctors and young physicians.
\nReferences
\n1) National Institutes of Health; National Library of Medicine; History of Medicine Division. Greek
\nmedicine: \u201cI swear by Apollo physician\u2026\u201d: Greek Medicine from the gods to Galen. 2012 [cited 2019
\nJan 13].
\n2) Britannica. Hippocrates: biography, definition & facts. 2019 [cited 2019 Feb 29].
\n3) World Medical Association. WMA Declaration of Geneva: the physician\u2019s pledge. 2017 [cited 2019 Jan
\n13].
\nroles of the Junior Doctors Network (JDN) is to empower young physicians\u2019 voices to the
\nWMA from its mission. For example, the WMA statement on physician well-being, adopted
\nin 2015, was originally drafted by the JDN from many junior doctors\u2019 opinions all over the
\nworld (2). The junior doctors in the National Medical Association (NMA) might have a
\nsimilar role to the JDN in the WMA.
\nIn Japan, the Japan Medical Association (JMA) launched the Japan Medical Association
\nJunior Doctors Network (JMA-JDN) in 2012 (3). Its mission includes taking a survey of
\njunior doctors\u2019 opinions on related topics and advocating for them. In 2017, the first
\nadvocacy was conducted by JMA-JDN volunteers on the working condition reform. This
\narticle aims to share the challenges of advocacy by junior doctors in Japan and the lessons
\nlearned.
\nBackground of the Physicians\u2019 Working Conditions in Japan
\nSince 2016, the Japanese government has made forward steps to reform working in most
\nindustries (4). This expects to improve productivity and develop human resources in
\nworking places to maintain the economics against a relative decreasing working-age
\npopulation due to \u201csuper-aging\u201d and low birth rate in the population structure. Along this
\ncontext, the physicians\u2019 working condition reform has been started.
\nJapan’s Labor Standards Act regulates the upper limit of working hours, where there are
\neight working hours per day, 40 working hours per week, and one day off per week.
\nOvertime and holiday work periods are possible by contracting labor-management
\nagreements. If it is contracted, the upper limit of overtime work hours could reach 100
\nhours per month and 960 hours per year (5).
\nIn December 2016, Japan\u2019s Ministry of Health, Labour and Welfare (MHLW) aimed to
\nexamine physicians\u2019 working hours with their characteristics, including age, sex, medical
\nspecialties, and working styles (e.g., part-time employment), and conducted a survey with a
\nstratified random sample of physicians working in hospitals (6) (Figure 1).
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nJunior Doctors\u2019 Challenges of Advocacy for Physicians\u2019 Well-being in Japan
\nJUNIOR DOCTORS\u2019 ACTIVITIES
\nKazuhiro Abe, MD PhD
\nJapan Medical Association, Junior Doctors Network
\nDepartment of Public Health, Graduate School of Medicine
\nUniversity of Tokyo
\nTokyo, Japan
\nThe World Medical Association (WMA) advocates achieving the
\nhighest international standards in medical education, medical science,
\nmedical art, medical ethics, and health care for all people in the world
\nthrough the declarations, resolutions, and statements (1). One of the
\nAccording to the survey, Japanese physicians have been exposed to long working hours.
\nSome reasons caused this dangerous condition might be the stipulation in the Medical
\nPractitioners Act and self-sacrifice from excessive professionalism. The law states that
\nphysicians cannot refuse to see patients without physicians\u2019 absence or serious illness
\nwhenever and wherever patients request it (7). Established in 1948, it was necessary to
\nrapidly restructure a medical provision system after World War II. There were uninsured
\npeople until the universal health insurance system started in 1961 (8). The physicians\u2019
\nobligation was enacted for patients, who could not afford medical expenses by absolute
\npoverty, to have access to the medical treatment against some physicians who refused
\nthem. Over the past 70 years, the medical provision system in Japan has been enhanced,
\nand uninsured people have utilized the universal health care system. Currently, the
\nstipulation has obscured management of the physicians\u2019 working hours. Another cause of
\nphysicians\u2019 long working hours would be self-sacrifice from excessive professionalism. This
\nissue was pointed out in the WMA statement on physicians\u2019 well-being in 2015 (2).
\nIn August 2017, the MHLW launched the investigative commission on the physicians\u2019
\nworking condition reform to improve their labor conditions (9). Two junior doctors have
\nparticipated in this investigation. According to the survey, young physicians have worked
\nlonger hours than older physicians, and previous studies have shown that younger
\nphysicians tend to feel burnout (10,11). Therefore, more objective and representative
\nopinion of junior doctors as one of the main actors are required to improve the sustainability
\nof the health care system.
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nJUNIOR DOCTORS\u2019 ACTIVITIES
\nFor example, although the physicians\u2019 working
\nhours identified differences in their
\ncharacteristics, the average number of working
\nhours of 20- and 30-year-old male physicians
\nwas 75 hours per week, including 57 hours for
\nclinical practices, medical education, and
\nresearch, and 18 hours for the night shift and
\non-call. The average number of overtime work
\nhours of 20- and 30-year-old male physicians
\nwas about 140 hours per month and 1,680
\nhours per year. About 40% of physicians
\ngreatly exceeded these upper limits of over-
\ntime work hours.
\nFigure 1. Average of full-time physicians’ working
\nhours by age and sex in Japan (6).
\nChallenges of Junior Doctors in Japan
\nTo strengthen advocacy among junior doctors, JMA-JDN volunteers organized a three-hour
\nworkshop to describe the concept of advocacy and how junior doctors can advocate
\neffectively (12). This workshop was held in July 2017, with a total of 19 participants,
\nincluding nine junior doctors, eight medical students representing the International
\nFederation of Medical Students\u2019 Associations (IFMSA) in Japan, one MHLW official, and
\none public health researcher. The workshop agenda included the keynote lecture, \u201cWhat is
\nadvocacy?\u201d, presented by professor Masamine Jimba, president of the Japanese Society
\nof Health Education and Promotion. Then, the participants simulated making the strategic
\nplan for the effective advocacy by each small group, using the worksheet suggested by Dr
\nTrevor Shilton (13) (Photos 1-2). In addition, they leaned the following keys of success
\nadvocacy: dedicated, persistent, and \u201cpolitically-astute\u00bb leadership; mobilization of
\ncoalitions that are broad-based and well-coordinated; consensus on the most important
\nmeasures that will achieve the advocacy goal; commitment to a consensus on priority
\nactions; commitment to comprehensive operations; commitment to robust and long-term
\nimplementation; and persistence.
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nJUNIOR DOCTORS\u2019 ACTIVITIES
\nAt the workshop, most groups selected the
\ntheme related to the working condition re-
\nform. Thus, the Advocacy team of Young
\nMedical Doctors and Students (AYMDS)
\nwas set from the interested participants in
\nthe working condition reform. The AYMDS
\nincluded five junior doctors, three medical
\nstudents, and one researcher. In November
\n2017, the AYMDS disseminated the online
\nquestionnaire to examine the perspectives
\nof junior doctors and medical students on
\nthe current working conditions of
\nphysicians. With a total of 821 responses,
\nthe AYMDS summarized the results and
\nprepared a draft policy statement.
\nThe public comments were collected, and the draft was revised. In December 2017, the
\nAYMDS presented the policy statement in the investigative commission on the physicians\u2019
\nworking condition reform of MHLW (14). These actions showcased an essential step for
\nJapanese junior doctors as they delivered their voices to reforming health policy.
\nPhoto 1. Advocacy skills workshop, with instruction
\nfrom professor Masamine Jimba, where each small
\ngroup collaborated to develop the strategic plan for
\nadvocacy. Credit: Kazuhiro Abe.
\nplatform for junior doctors across Japan. These issues have created challenges in
\nmobilizing coalitions, reaching consensus, and ensuring sustainable commitments.
\nIn summary, there is a need for junior doctors in Japan to be more active in the JMA and
\nrepresent the junior doctors\u2019 voices. JMA-JDN can serve as a platform for junior doctors in
\nJapan to seek continued academic training and enhance productive and continuous
\nadvocacy skills. With WMA support, the JDN can promote the importance of global
\nleadership and advocacy as junior doctors. I hope that the voices of junior doctors across
\nthe world will facilitate open dialogue in health policy.
\nReferences
\n1) World Medical Association. Who we are. 2019 [cited Feb 14].
\n2) World Medical Association. WMA statement on physicians\u2019 well-being 2015. 2019 [cited 2019 Feb 14].
\n3) Japan Medical Association-Junior Doctors Network. JMA-JDN webpage. 2019 [cited 2019 Feb 14].
\n4) Japanese Ministry of Health, Labour and Welfare. The action plan for the realization of work style reform. 2017
\n[cited 2019 Feb 14]..
\n5) Japanese Ministry of Health, Labour and Welfare. Revised Labour Standards Act. 2010 [cited 2019 Feb 14].
\n6) Japanese Ministry of Health, Labour and Welfare. The survey of physicians’ working condition. 2017 [cited
\n2019 Feb 14].
\n7) Japanese Ministry of Health, Labour and Welfare. Doctor\u2019s duty of responding to call-up. 2018 [cited 2019 Feb
\n14].
\n8) Ikegami N, Yoo BK, Hashimoto H, et al. Japanese universal health coverage: evolution, achievements, and
\nchallenges. Lancet. 2011;378:1106-1115.
\n9) Japanese Ministry of Health, Labour and Welfare. The investigative commission on the physicians\u2019 working
\ncondition reform. n.d. [cited 2019 Feb 14].
\n10) Tateno M, Jovanovic N, Beezhold J, et al. Suicidal ideation and burnout among psychiatric trainees in Japan.
\nEarly Interv Psychiatry. 2017;12:1-3.
\n11) Thomas NK. Resident burnout. JAMA. 2004;292:2880-2889.
\n12) Abe K, Kato D, Sonoda K. Future perspectives on an advocacy skill workshop for junior doctors and medical
\nstudents in Japan. Japanese Journal of Health Education and Promotion. 2018;26:155-161.
\n13) Shilton T. Advocacy for non-communicable disease prevention; building capacity in Japan. Japanese Journal of
\nHealth Education and Promotion. 2016;24:102-114.
\n14) Advocacy team of young medical doctors and students. Statement from young medical doctors and medical
\nstudents on legal regulations of physicians’ long working hours. 2017 [cited 2019 Feb 14].
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nJUNIOR DOCTORS\u2019 ACTIVITIES
\nPhoto 2. Participants of the advocacy skills workshop.
\nCredit: Kazuhiro Abe.
\nLessons Learned
\nLooking back at the case as compared to the
\nkeys of success advocacy, there were two main
\nissues. First, junior doctors are not formally
\ntrained in advocacy, and hence, are unfamiliar
\nwith practical techniques to advocate on critical
\nhealth issues. Second, although effective
\nadvocacy should have a robust framework to
\ncollect objective and representative viewpoints
\nfrom junior doctors, there was no representative
\nthroughout our medical education and training in the classroom and community setting. As
\njunior doctors engage in postgraduate medical training in diverse disciplines and
\ngeographies, we should lead efforts to advance scientific knowledge among medical
\nstudents regarding key health topics that affect local, national, and global communities. The
\nfollowing example in the Dominican Republic is a professional development workshop that
\nhighlights how junior doctors can encourage, train, and mentor medical students in
\nscientific inquiry for their clinical practice.
\nSupported by the Standing Committee on Medical Education (SCOME), the Organizaci\u00f3n
\nDominicana de Estudiantes de Medicina (ODEM), recognized as IFMSA-Dominican
\nRepublic, organized a four-hour academic workshop for medical students in February 2019.
\nThe workshop aimed to provide medical students with an understanding of scientific
\npublications, techniques to prepare a brief article or letter to an editor, and insight on the
\nimportance of interdisciplinary skills for medical training. The agenda of the activity was
\nprepared by SCOME National Officers, Ms Marla Pelletier (Universidad Nacional Pedro
\nHenriquez Ure\u00f1a, UNPHU) and Ms Camila Gonz\u00e1lez (UNPHU), and SCOME Local Officer,
\nMs Isamar Fern\u00e1ndez (Universidad Iberoamericana, UNIBE). An estimated 70 participants,
\nrepresenting six medical schools from the cities of Santo Domingo and Santiago, attended
\nthis event, which was held at UNIBE School of Medicine in Santo Domingo (Photos 1-2).
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nInnovative Workshop: Developing Critical Inquiry in the Dominican Republic
\nJUNIOR DOCTORS\u2019 ACTIVITIES
\nHelena Chapman, MD MPH PhD
\nPublications Director (2018-2019)
\nJunior Doctors Network
\nWorld Medical Association
\nAs Junior Doctor Network (JDN) members, we understand the
\nindispensable roles of professional development and mentorship
\nPhoto 1. ODEM members who participated in the academic workshop.
\nCredit: ODEM.
\nPhoto 2. ODEM logo.
\nCredit: ODEM.
\nWorkshop: Key Skills in Preparing Scientific Publications
\nDr Yessi Alc\u00e1ntara (UNPHU) and Dr Helena Chapman (UNIBE) coordinated this
\ncollaboration to highlight the value of scientific publications to enhance professional
\ndevelopment as health professionals. Dr Alc\u00e1ntara described the article formats required
\nfor the non peer-reviewed publication submission to the IFMSA\u2019s Medical Student
\nInternational and Diario Salud Dominicana\u2019s DiarioSalud Estudiantil (Dominican Republic)
\nand encouraged ODEM members to prepare their articles about ODEM community health
\nactivities and topics. She also presented two examples of published articles to serve as a
\ngeneral guide.
\nThen, Dr Chapman highlighted that participating in research projects and reviewing medical
\nliterature were ways to strengthen scientific expertise, critical analysis, and communication
\nskills. As a first step, she recommended that ODEM members consider the preparation of a
\nletter to an editor to a medical journal as a training opportunity. She provided a thorough
\nreview of two examples of published letters as models. After this technical portion of the
\nworkshop, Dr Chapman offered a gratuitous virtual mentorship practicum, where teams of
\ntwo ODEM members would follow a strict timeline over a four-month period in order to
\nprepare their letters to an editor to a medical journal.
\nPanel: Interdisciplinary Knowledge for Future Physicians
\nAs a complementary panel to the academic workshop, three experts shared key
\nperspectives from their individual disciplines as they relate to medical education. First, Ms
\nHaydeeliz Carrasco, economist and consultant for the World Bank, highlighted the low
\npublic health expenditure in the Dominican Republic (2.7% of gross domestic product,
\nGDP), when compared to the expenditure in Latin America (3.5% of GDP), from 2011 to
\n2015. She mentioned that the country could achieve efficiency gains and higher impacts of
\npublic expenditure, by allocating resources for priority health needs, designing evidence-
\nbased interventions, and strengthening monitoring and evaluation systems.
\nSecond, Mr Jamie Rudert, a veterans advocate attorney currently employed by Paralyzed
\nVeterans of America, emphasized that as health leaders, physicians should understand
\ntheir legal role in health service delivery, be prepared to document and evaluate
\noccupational exposures and other health concerns, and establish an appropriate medical
\nmanagement plan. For patients who are military veterans, he stated that through
\ncomprehensive medical evaluations, physicians can examine if the medical condition could
\nbe related to military service and provide documentation to the appropriate authorities. In
\nturn, the respective authorities can subsequently review these records and consider the
\nadjudication of veterans\u2019 benefits.
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nJUNIOR DOCTORS\u2019 ACTIVITIES
\nThese collective actions can encourage medical students to gain further scientific insight on
\ninterdisciplinary topics and enhance understanding of the research process, which may be
\nlimited in existing medical curricula.
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nJUNIOR DOCTORS\u2019 ACTIVITIES
\nPhoto 3. Ms Marla Pelletier, Dr Yessi Alc\u00e1ntara,
\nMs Haydeeliz Carrasco, Mr Jamie Rudert, Dr
\nHelena Chapman, Ms Genesis Familia, and Ms
\nCamila Gonz\u00e1lez (left to right). Credit: ODEM.
\nFinally, Dr Chapman, a public health physician
\nworking at the National Administration of
\nAeronautics and Space (NASA), introduced
\nthe \u201cOne Health\u201d concept, which promotes
\ntransdisciplinary collaborations to develop
\nstrategies that mitigate disease risks shared
\nbetween humans, animals, and the
\nenvironment. She described the value of the
\nuse of Earth observation data in health
\neducation, research, and practice, to better
\nunderstand the dynamic processes of the
\necosystem and its influence on human, animal,
\nand environmental health.
\nJDN members should be motivated to be actively engaged in
\ndeveloping academic workshops and panels with medical students
\nin their communities, so that they can foster medical students\u2019
\ninnovation and critical analysis on diverse scientific health topics.
\neducate community members living in low-resource areas through the development of
\ncommunity health initiatives. Current members are junior doctors working in all levels of
\nhealth care delivery across the 36 Nigerian states in six geo-political zones and the federal
\ncapital territory.
\nUsing social media technology to bridge communication among Nigerian junior doctors,
\nDTOF identifies community health needs of vulnerable populations and develops
\ncollaborative health activities to educate on essential health topics and mitigate disease
\nrisks. Junior doctors organize annual free medical evaluations, award scholarships to
\nchildren from educationally disadvantaged communities, and provide educational talks on
\nproper hygiene and sanitation practices. They also coordinate social programs within
\ncommunities, including showcasing musical events and distributing donated food and
\nmodest financial contributions. Funding for these health and social programs are through
\nDTOF donations, which illustrates positive social responsibility. As an African nation,
\ncitizens must provide a means of taking care of the health and well-being of vulnerable
\npopulations.
\nUsing the theme, The Resident Doctor and Financial Planning \u2013 Medical Entrepreneurship,
\nMyth or Reality, junior doctors commemorated DTOF\u2019s third anniversary throughout five
\nNigerian geo-political zones and the federal capital territory (Photos 1-2). Between June
\n11-17, 2018, community health initiatives were coordinated across the country in line with
\nthe DTOF\u2019s mission and vision (Table 1).
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nJDN in Nigeria \u2013 Bridging the Gap and Impacting Lives
\nJUNIOR DOCTORS\u2019 ACTIVITIES
\nPhoto 1. DTOF volunteers after
\ndeworming campaign at a primary school
\nin Ibadan, Nigeria. Credit: DTOF.
\nPhoto 2. DTOF volunteers at an
\norphanage in Umuahia, South-East
\nNigeria. Credit: DTOF.
\nAnthony Chukwunonso Ude, MBBS MWACS
\nCommunications Director (2018-2019)
\nJunior Doctors Network
\nWorld Medical Association
\nDoctors Time Out Family (DTOF) is a charitable, non-governmental
\norganization managed by Nigerian junior doctors that was founded in
\nJune 2015 by Dr. Anthony Chukwunonso Ude. The mission is to
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nJUNIOR DOCTORS\u2019 ACTIVITIES
\nIn his closing remarks, Dr. Francis
\nFaduyile, the National President of the
\nNigerian Medical Association (NMA),
\ncommended DTOF for the dynamism and
\nsagacity regularly displayed in their
\ncommunity initiatives. He hinted that his
\nteam would be devising ways to maximize
\ninteractions among junior doctor members
\nand promote all-inclusiveness in NMA
\nactivities.
\nWe sincerely appreciate everyone who
\nhas contributed to the successful activities
\nsurrounding the DTOF\u2019s third anniversary.
\nAs we prepare for the DTOF\u2019s fourth
\nanniversary in June 2019, the Nigerian
\njunior doctors encourage junior doctors
\nacross the world to bridge the gap and
\nimpact lives of their local community
\nmembers. By identifying gaps in
\nestablished health promotion activities in
\nlocal communities, junior doctors can
\ncollaborate and develop community health
\ninitiatives, carving out a niche where the
\nnext generation of junior doctors can
\nbecome inspired, raise public awareness,
\nand find opportunities to positively impact
\ntheir communities.
\nTogether, junior doctors can
\nchange the world and make it a
\nbetter place!
\nIf you are interested to learn more about
\nDTOF, please visit our website, follow on
\nTwitter (@familytimeout), email our team
\nor send a Whatsapp message
\n(+2348036680438).
\nZone
\nJunior Doctor
\nParticipants Activities
\nSouth-
\nSouth
\nARD University of
\nPort Harcourt
\nTeaching
\nHospital
\nARD Braithewaite
\nMemorial
\nSpecialist
\nHospital, Rivers
\nState
\n\u2751 Coordinated visits to orphanages
\nto deliver toiletry items (e.g.,
\ntissues, cleaning supplies), food
\n(e.g., yams, rice, spices, noodles,
\ncereals, beverages), and modest
\nfinancial contributions.
\n\u2751 Conducted health talks on proper
\nhygiene and sanitation practices.
\n\u2751 Organized a \u201cMarathon for Life\u201d to
\npromote physical activity.
\nSouth-
\nWest
\nARD Obafemi
\nAwolowo
\nUniversity
\nTeaching
\nHospital, Ile-Ife
\nOsun State
\n\u2751 Coordinated visits to orphanages
\nto deliver toiletry items, food, and
\nmodest financial contributions.
\n\u2751 Conducted health talks on proper
\nhygiene and sanitation practices.
\nSouth-
\nEast
\nARD Federal
\nMedical Centre,
\nUmuahia Abia
\nState
\n\u2751 Coordinated visits to orphanages
\nto deliver toiletry items, food, and
\nmodest financial contributions.
\n\u2751 Conducted health talks on proper
\nhygiene and sanitation practices.
\nNorth ARD Ahmadu
\nBello University
\nTeaching
\nHospital, Zaria
\n\u2751 Organized deworming campaign
\nfor 115 street children and
\nplanned for follow-up medical
\nservices in 4 locations in Zaria.
\n\u2751 Distributed toiletry items and
\nclothing.
\n\u2751 Conducted health talks on proper
\nhygiene and sanitation practices
\nat four primary schools.
\nCentral ARD University
\nCollege Hospital,
\nIbadan
\n\u2751 Conducted Deworm and Educate
\nthe Child Initiative (DECI) at the
\nIMG Primary School Oje Igosun
\nIbadan: Donated 400 copies of
\nDTOF customised exercise books
\nand anti-helminthic drugs for
\nfuture deworming campaigns.
\nConducted health talks on proper
\nhygiene and sanitation practices,
\nwhere prizes were awarded for
\nactive student participation.
\n\u2751 Coordinated visit to Jesus
\nChildren Mission Bodija
\norphanage: Donated 100 DTOF
\ncustomised books. Provided
\nmodest financial contributions to
\nlow-resource students.
\n\u2751 Conducted gratuitous medical
\nevaluations to professors.
\nTable 1. Junior doctors from the Association of Resident
\nDoctors (ARD) coordinated DTOF activities in June 2018.
\nAssociation (WMA) and globally. In Malaysia, JDN was formed by the Malaysian Medical
\nAssociation in 2017 and was placed under the Section Concerning House Officers, Medical
\nOfficers and Specialists (SCHOMOS), which is the section focused on the welfare of
\ngovernment doctors in Malaysia. JDN Malaysia was formed to allow Malaysian doctors to
\nparticipate in the JDN international network and look at the issues affecting Malaysian
\njunior doctors.
\nJDN Malaysia organised the first JDN meeting within the Confederations of Medical
\nAssociations in Asia and Oceania (CMAAO), preparing the first project, \u201cWorkplace
\nBullying and Harassment\u201d. In order to study the impact of this issue within Malaysia, we
\nprepared a JDN\/SCHOMOS online survey on the topics of workplace bullying and
\nharassment. With over 2,000 respondents, our survey results showed that the incidence of
\nworkplace bullying was highest amongst the junior doctors. Hence, we coordinated a
\nmeeting agenda to facilitate a dialogue on identifying real-time challenges, developing
\nsolutions to reduce these challenges, and proposing policies to be shared among
\nparticipating nations on these topics. A website was also launched to serve as a common
\nportal to update junior doctors on current news and events as well as efforts leading
\ntowards a more harmonious workplace environment.
\nThe CMAAO theme chosen for this inaugural meeting was, Leading the Way towards
\nMutual Respect \u2013 The Role of Junior Doctors in Preventing Workplace Bullying. This
\nmeeting was attended by over 30 participants representing the different CMAAO member
\ncountries in Asia and Oceania. The majority of country delegates agreed that there was an
\nurgent need to define what constitutes bullying and harassment in the workplace and
\nacknowledged that it had affected all levels of health care, especially on the junior doctors.
\nClear guidelines on acceptable behaviour and responsibilities of health professionals
\nshould be made known to all health care workers.
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nJDN-SCHOMOS MMA Penang Declaration 2018
\nJUNIOR DOCTORS\u2019 ACTIVITIES
\nVijay Ganasan, MD
\nChairman, Malaysian Chapter
\nJunior Doctors Network
\nKuala Lumpur, Malaysia
\nThe Junior Doctors Network (JDN) was formed in Vancouver in
\nOctober 2010, with the aim of creating a platform for junior doctors
\nworldwide to ensure their voice was heard within the World Medical
\nThey agreed that strong high-level administrative leadership is required
\nto reform and enforce policies that confront workplace bullying.
\nThrough this dialogue, delegates provided three recommendations to strengthen legislation
\nregarding workplace bullying and harassment. First, policies and laws should exist to
\nprotect the victims, ensure just and prompt investigations into perpetrators, and sanction
\nthose individuals who are found guilty of bullying and harassment. Second, the victim\u2019s
\nanonymity and confidentiality should be maintained, and adequate physical protection or
\npsychological support should be provided to the victims of bullying and harassment. Third,
\nall levels of staff should undergo training in leadership and soft skills to ensure the
\nformation of a conducive environment for junior doctors to be nurtured and grow into
\nleaders of tomorrow.
\nAt the end of the meeting, the JDN SCHOMOS MMA Penang Declaration 2018 was signed
\nby attendees at the first CMAAO JDN Meeting on September 14, 2018, on the sidelines of
\nthe 33rd CMAAO General Assembly (Photos 1-2). This solidified a commitment from all
\nparticipating countries to work towards ending workplace bullying and harassment.
\nOur guest of honor, Dr. Mohd Fikri bin Ujang, a senior official within the Malaysian Ministry
\nof Health, stated that the declaration would be tabled at the next Head of Department\u2019s
\nmeeting at the Malaysian Ministry of Health. He also expressed the need to work together
\nfor a healthier workplace environment.
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nJUNIOR DOCTORS\u2019 ACTIVITIES
\nPhoto 1. The Declaration Team at the closing ceremony
\nof the JDN-CMAAO Meeting 2019. Credit: CMAAO2018.
\nPhoto 2. JDN Section Concerning House Officers,
\nMedical Officers, and Specialists (SCHOMOS)
\nMalaysian Medical Association (MMA) Penang
\nDeclaration 2018. Credit: CMAAO2018.
\nthe Icelandic Medical Association (IMA) office. It was my privilege to attend the meeting on
\nbehalf of the Singapore Medical Association (SMA) Doctors in Training (DIT) Committee,
\nfor I was able to renew the bonds formed during the 2015 JDN meeting held in Oslo,
\nNorway, and also make new acquaintances with representatives from other parts of the
\nworld.
\nThe JDN was formed in Vancouver in October 2010 to create a platform for junior doctors
\nworldwide and to ensure that their voices are heard both within the WMA and globally. Its
\nmission is to empower young physicians to work together towards a healthier world through
\nadvocacy, education, and international collaboration. This is very much in line with the
\npurpose of SMA\u2019s DIT Committee, which is to provide a platform for local junior doctors
\nacross all training institutes to collaborate towards a better training environment, both intra-
\ninstitutional and on a national level.
\nAt this JDN meeting, delegates from 16 countries across the globe came together to
\ndiscuss the new trends in postgraduate medical education. The IMA shared that until 2015,
\nthey have had a limited postgraduate training structure, and that most trainees have to
\ncomplete their higher specialist training abroad. The Canadian Medical Association (CMA)
\nexplained their system of competency-based curriculum. A representative from the
\nFoundation for Advancement of International Medical Education and Research also
\npresented on a potential collaboration with JDN to offer international exchanges for
\nresidents to further their training.
\nAnother topic covered was on the well-being of junior doctors and combating burnout. The
\nCMA shared survey results on burnout among their residents and the approach to
\nrecognising the signs and degrees of burnout. They also highlighted the importance and
\nmethods of training resilience in junior doctors. The meeting concluded with an \u201cideas cafe\u201d
\nsession to improve the JDN and an election for the next working committee.
\nIt was a very refreshing experience as I was greatly inspired by the passion of the fellow
\nJDN delegates. I also received many interesting ideas on how to better serve my
\nSingaporean junior doctors. Last but not least, I wish the newly elected working committee
\nall the best in their future endeavours.
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nEmpowering Junior Doctors
\nINTERNATIONAL CONFERENCES
\nBenny Loo, MBBS
\nChairperson, Doctors in Training Committee
\nSingapore Medical Association
\nThe Junior Doctors Network (JDN) meeting, under the World Medical
\nAssociation (WMA), was recently held in conjunction with the WMA
\nGeneral Assembly in Reykjavik, Iceland, from October 1-2, 2018, at
\n*Editorial note: The Singapore
\nMedical Association (SMA) has
\nauthorized the reprint of this
\nSMA News article in the 15th
\nissue of the JDN Newsletter.
\nThe Prince Mahidol Award Conference (PMAC) is an annual global health conference held
\nin late January, in Bangkok, Thailand. It is co-hosted by the Prince Mahidol Award
\nFoundation, the Thai Ministry of Public Health, Mahidol University, and a range of major
\nglobal health organisations, including the World Health Organization (WHO) and the World
\nBank. The theme for 2019 was The Political Economy of Non-Communicable Diseases: A
\nWhole of Society Approach.
\nThe conference highlighted that non-communicable diseases (NCDs)
\ncause the highest global disease burden and are rooted in social,
\neconomic, environmental, and commercial determinants of health.
\nThe prestigious conference focusing on policy-related health issues is an invite-only event.
\nThis year, four members of the Junior Doctors Network (JDN) of the World Medical
\nAssociation (WMA) were fortunate to attend PMAC 2019 as part of the tickets allotted to
\nthe Thai JDN delegation. In this article, we share some of the key messages and highlights
\nof the conference.
\nThe first three days (January 29-31, 2019) were pre-conference sessions, including side
\nmeetings and field trips. JDN members enjoyed the field trip sessions, where we had the
\nopportunity to see first-hand the various Thai initiatives taking place at local and national
\nlevel to accelerate implementation of NCD prevention and control.
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nPrince Mahidol Award Conference 2019
\nINTERNATIONAL CONFERENCES
\nMariam Parwaiz, MBChB MPH (Hons)
\nPublic Health Medicine Registrar
\nCounties Manukau District Health Board
\nAuckland, New Zealand
\nLyndah Kemunto, MBChB
\nGeneral Practitioner, Kisii County Government
\nKisii, Kenya
\nHasan Al Hameedi, MBChB
\nMD Register, Consultant WHO
\nBaghdad, Iraq
\nJade Lim, MD MPH
\nPaediatric Trainee, South Australia Health
\nAdelaide, Australia
\nOne of the field trip sites visited was the Thai Health Promotion Foundation, an
\nautonomous government agency that focuses on health promotion. Thai Health is a good
\nexample of how sin taxes can be used to promote health in a population. Their annual
\nbudget of US$120 million is drawn from the 2% surcharge on alcoholic beverages and
\ntobacco products. The visit gave participants a practical glimpse into their day-to-day
\nactivities, including physical exercise sessions that can be done in any office.
\nAnother group participated in a field trip to the Kaeng Khoi District, Saraburi Province to
\nlearn more about the Ministry of Public Health\u2019s policy on District Health System (DHS), a
\npolicy aimed at decentralizing health care decision-making and management. This was
\nlaunched in 2013 to create more unity in the health care sector, share resources, and
\npromote community participation at the district level. The participants visited two sites:
\nfirstly, Kaengkhoi Hospital, where local stakeholders presented their efforts in managing
\nNCDs within the District Health System; and secondly, a local primary school, where
\nparticipants could see the implementation of health promotion within the education system.
\nThe main conference (February 1-3, 2019) had four plenary sessions, 15 parallel sessions,
\nand many special events and e-poster presentations. In total, there were 1,090 participants
\nfrom 77 countries.
\nPlenary 0, Political Economy of NCDs: Players, Powers, and Policy Processes, set the
\nscene for the entire conference. Professor Michael Reich praised the organizers of PMAC
\n2019 for pushing boundaries and organizing the first global health conference on political
\neconomy. He provided a simple and clear definition of political economy: \u201chow the
\nallocation of political resources and economic resources affects who gets what, when, and
\nhow\u201d. Over the course of the event, we heard from many eminent global health leaders,
\nincluding Dr Margaret Chan, Professor Sir Michael Marmot, Dr Sania Nishtar, and
\nProfessor Boyd Swinburn.
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nINTERNATIONAL CONFERENCES
\nPhoto 1. WMA JDN delegation to PMAC2019:
\nDr Lyndah Kemunto, Dr Jade Lim, Dr Mariam
\nParwaiz, and Dr Hasan Al Hameedi (left to
\nright). Credit: PMAC2019.
\nPhoto 2. Members of WMA JDN delegation, Thai JDN
\ndelegation, and IFMSA delegation with Professor Sir Michael
\nMarmot: Dr Jade Lim, Dr Mariam Parwaiz, Sir Michael
\nMarmot, Dr Saowaluk Noon Srikajornlarp, Mr Hung Wei Pin,
\nand Dr Hasan Al Hameedi (left to right). Credit: PMAC2019.
\nThe key debate at the conference was around the commercial determinants of NCDs. In
\n2016, Kickbusch et al. defined commercial determinants of health as the \u201cstrategies and
\napproaches used by the private sector to promote products and choices that are
\ndetrimental to health\u201d (1). Applied to the NCD sphere, these commercial determinants are
\nunhealthy commodities promoted by corporations, and include tobacco, alcohol, and
\nunhealthy foods. At PMAC 2019, there was broad agreement that we need to address the
\ncommercial determinants of health, but the focus of the debate was on exactly how to
\naddress them, and what should be the role of the industries themselves. Perspectives
\nranged from those who viewed industries as part of the solution to NCDs, to those who felt
\nthat industries cannot be trusted but merely regulated. These debates were largely focused
\non the food and beverage industry, and to a lesser extent the alcohol industry; the tobacco
\nindustry was universally condemned.
\nA key message for junior doctors is to appreciate the broader factors
\nthat contribute to the growing burden of NCDs around the world,
\nincluding the commercial determinants of health.
\nProfessor Sir Michael Marmot, Past President of the WMA, was inspiring as always, and
\ndiscussed the importance of addressing the fundamental drivers of ill health given the rising
\nhealth inequalities around the world. One of the highlights was when he described how
\nIFMSA medical students and WMA-JDN junior doctors have passionately supported the
\ncause of improving social determinants of health for all. He also mentioned the report that
\nwas produced during his Presidency of the WMA, Doctors for Health Equity, an excellent
\nresource for junior doctors to use when advocating for health equity (2).
\nOver the course of conference, we heard from many academics, policy-makers, politicians,
\nand representatives from key global health institutions. However, we did not hear much
\nfrom civil society, particularly from those people living with NCDs. Kwanele Asante, a
\nlawyer, bioethicist, and cancer equity activist, was one of the few voices speaking on behalf
\nof people living with NCDs. She was a panelist for Plenary 3, Governance of the NCD
\nResponse: Who is in Control?, and she eloquently and powerfully called for a reshaping of
\nthe global health narrative to one where people are put at the centre. This was one of the
\ntwo plenaries where a member of the non-alcohol beverage industry was also a panelist,
\nand her presence was an issue of debate amongst the attendees. Ms Asante challenged
\nthe industry speaker on the harms that their products create and reminded everyone of the
\nUnited Nations right to health as a fundamental human right. The Bangkok Statement on
\nthe Political Economy of NCDs, produced at the end of the conference, rightfully began by
\nreaffirming this human right (3).
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nINTERNATIONAL CONFERENCES
\nOn a lighter and brighter side of the conference, PMAC 2019 had a number of initiatives to
\nwalk the talk when it came to addressing NCDs. These included nutritional food labels and
\nwarning signs for food high in fat, salt, or sugar; standing desks; massage and meditation
\nzones; and a physical activity segment at the start of each session. The food warning signs
\nhad a mixed response from the attendees, but most appreciated the other initiatives. It was
\ndefinitely fun to be exercising to the \u201cBaby Shark\u201d song along with esteemed global health
\nleaders!
\nThe JDN delegation engaged with the attendees in person and on Twitter (#PMAC2019).
\nWe thoroughly enjoyed our time, learned more about the challenges in addressing NCDs,
\nparticularly the political economy factors, and engaged with new and old friends and
\ncolleagues. For more information about PMAC 2019, including the synthesis of the
\nconference, please visit the conference website. The conference theme for PMAC 2020 is
\nAccelerating Progress towards Universal Health Coverage. We anticipate JDN members
\nwill have an opportunity to attend next year, and we highly recommend it.
\nAcknowledgements: We would like to extend our greatest thanks to the Thai JDN for
\ninviting us and to the PMAC organisers for hosting us.
\nReferences
\n1) Kickbusch I, Allen L, Franz C. The commercial determinants of health. Lancet Global Health. 2016;4:e895-
\ne896.
\n2) Institute of Health Equity and World Medical Association. Doctors for health equity: the role of the World
\nMedical Association, national medical associations and doctors in addressing the social determinants of
\nhealth and health equity. 2016 [cited 2019 Mar 11].
\n3) Prince Mahidol Award Conference. Statement on the political economy of non-communicable diseases: a
\nwhole of society approach. 2019 [cited 2019 Mar 11].
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nINTERNATIONAL CONFERENCES
\nPhoto 3. Closing session of PMAC2019.
\nCredit: PMAC2019.
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nWorld Antibiotic Awareness Week 2018
\nWORKING GROUPS
\nMariam Parwaiz, MBChB MPH (Hons)
\nPublic Health Medicine Registrar
\nCounties Manukau District Health Board
\nAuckland, New Zealand
\nSteen Fagerberg, MD MSc PhD
\nAnesthesiology and Intensive Care Medicine
\nResident
\nRegional Hospital of Northern Denmark
\nHj\u00f8rring, Denmark
\nIan Pereira, MD BASc
\nRadiation Oncology Resident
\nQueen\u2019s University
\nOntario, Canada
\nHelena Chapman, MD MPH PhD
\nPublications Director (2018-2019)
\nJunior Doctors Network
\nWorld Medical Association
\nFigure 1. A total of 10 million people may die from
\nantimicrobial resistance (AMR) by 2050 (1).
\nFrom the early 1900s, antimicrobials such as
\npenicillin helped improve the lives of millions
\nof patients worldwide. Since then, microbes
\nsuch as bacteria, viruses, fungi, and
\nparasites have evolved to evade these drugs
\nthrough a process called antimicrobial
\nresistance (AMR). Recent estimates suggest
\nthat AMR causes nearly 700,000 deaths
\nworldwide each year and up to 10 million by
\n2050 (Figure 1). It will become more fatal
\nthan cancer, diabetes, diarrheal diseases,
\nand road accidents, making AMR one of the
\nworld\u2019s most significant global health risks
\nimpacting the health of humans, animals, and
\nthe environment (1).
\n\u201cAntimicrobial resistance will take us back to a time when people
\nfeared common infections and risked their lives from minor surgery\u201d
\n-Dr. Tedros Ghebreyesus, Director-General of the WHO
\nThe World Health Organization (WHO) Global Action Plan on AMR was endorsed by
\nMember States at the 68th World Health Assembly. This formed the agenda of the High-
\nLevel Meeting at the United Nations (UN) General Assembly in 2016. Heads of state, non-
\ngovernmental organizations, civil society, the private sector, and academic institutions
\nadopted a resolution to collaboratively respond and established the Interagency
\nCoordination Group (IACG) (2). Although this meeting was instrumental in highlighting
\nAMR on a global scale, Member State engagement, especially from low- and middle-
\nincome countries (LMICs) has remained low. Only 20 of 194 countries responded to any
\nconsultations (3). By the WHO Global Action Plan\u2019s target of 2017, only 44% of countries
\nproduced surveillance data on prevalence, 20% had comprehensive action plans (Figure
\n2), and 14% had no plan at all (4).
\nNonetheless, endorsement of this plan by Member States reflected global consensus on
\nthe reality of AMR and need to work together to meet its objectives (5). One key objective
\nwas to improve awareness and understanding of AMR through effective communication,
\neducation, and training. This formed the basis of World Antibiotic Awareness Week.
\nMembers of the World Medical Association\u2019s (WMA) Junior Doctors Network (JDN) have
\nbeen working over the last few years through the JDN AMR Working Group to help develop
\nsolutions for AMR. More and more patients and their families are going online for health
\ninformation to platforms including Twitter and Facebook, while health care professionals
\nare doing the same to share scholarly research or clinical guidelines, build professional
\nnetworks, and advocate for positive change (6,7). This suggested an online opportunity.
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nWORKING GROUPS
\nFigure 2. The world lacks solutions for comprehensive national antimicrobial
\nresistance (AMR) action plans. This includes plans with identified funding
\nsources that are being implemented and have the relevant sectors involved with
\na defined monitoring and evaluation process in place (4).
\nEvery November, the WHO commemorates World Antibiotic Awareness Week with an
\nonline campaign to increase public awareness and promote adherence to the best clinical
\nand community practices. Under the WHO 2018 theme of Change Can\u2019t Wait, Our Time
\nwith Antibiotics is Running Out, the WMA JDN went online to combat AMR, by raising
\nawareness and work collaboratively to develop solutions.
\nA team from the JDN AMR Working Group led discussions on Twitter and Facebook
\nhighlighting key high-level policies, current statistics, and potential next steps to address
\nAMR. This included informational \u201ctweets\u201d, which were messages using the Twitter
\nplatform, authorized by the WMA as prompts for discussion. Junior doctors and the WMA
\nleadership provided trustworthy health information including best antimicrobial stewardship
\npractices for the general public and practitioners, dissected current scientific evidence, and
\nhelped develop solutions, such as leveraging existing resources including WMA campaigns
\nsuch as #PreventFlu (Figures 3-5).
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nWORKING GROUPS
\nFigure 3. Screenshot of a Twitter tweet. Figure 4. Screenshot of a Twitter tweet.
\nFigure 5. Screenshot of a Facebook message.
\nAMR continues to challenge scientists and practitioners in the human, animal, and
\nenvironmental disciplines. A key barrier may be silos. Overall awareness of the
\nconsequences of unnecessary use of antibiotics is needed at all levels of health care,
\nincluding patients, providers, and policy makers. The One Health approach encourages all
\nstakeholders to work together for better health outcomes (8). One of many platforms we
\nneed to use is social media. Acting as trusted sources of information for the general public
\nthrough social media has the potential to lower demand for unnecessary antibiotics.
\nNow more than ever before, health care professionals, scientists, private industry, and
\npolicy makers, including those from human, animal, and environmental industries, are
\naccessible to advance policies and guidelines. Working together across geographies and
\nsectors, we can develop and promote better antimicrobial stewardship practices.
\nThe JDN AMR Working Group looks forward to sharing more results from our work in future
\npublications, including the work we do to contribute to internal and external policy
\ndevelopment. We are also preparing to expand for the WHO World Antibiotic Awareness
\nWeek in 2019. If you are interested in joining the JDN AMR Working Group, please contact
\nour team (Dr Caline Mattar, Chair of the AMR Working Group) for further information.
\nReferences
\n1) O\u2019Neill J. The review on antimicrobial resistance. 2014 [cited 2019 Feb 16].
\n2) Davies OL. At UN, global leaders commit to act on antimicrobial resistance. 2016 [cited 2019 Feb 16].
\n3) ReAct Group. Member States engagement needed to shape future action on antibiotic resistance \u2013 2018
\n\u2013 ReAct. 2018 [cited 2019 Feb 16].
\n4) World Health Organization. Global database for antimicrobial resistance country self-assessment. 2017
\n[cited 2019 Feb 16].
\n5) World Health Organization. Global action plan on antimicrobial resistance. 2015 [cited 2019 Feb 16].
\n6) Gallo T. Twitter is trending in academic medicine. 2017 [cited 2019 Feb 16].
\n7) Fox S. The social life of health information. 2014 [cited 2019 Feb 16].
\n8) World Health Organization. One health. 2017 [cited 2019 Feb 16].
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nWORKING GROUPS
\nJunior doctors who are often the frontline practitioners not only
\nhave the most up-to-date real-world information, but are also
\nmore likely to have the skills to engage online.
\nhistory, ranging from the rise of human immunodeficiency virus (HIV) to the erroneous
\nperception that surgery is not cost-effective in low- and middle-income countries (LMICs).
\nOver the past five to 10 years, we observed an increase in attention given to surgery in
\nLMICs and universal health coverage at various global health. Various big players, like the
\nWorld Health Organization (WHO) and the World Bank, umped on board to support further
\ndevelopment of the emerging field of \u201cGlobal Surgery\u201d.
\nAs junior doctors, we believe that the World Medical Association (WMA), and the Junior
\nDoctors Network (JDN) should not stay behind, but rather, become actively involved in this
\nnew movement. At the JDN meeting in Iceland in October 2018, an introductory session to
\nGlobal Surgery was delivered, and consequently the idea for a new working group was
\nborn!
\nAt the moment, the Global Surgery working group represents 16 young doctors from 12
\ndifferent countries. What makes this working group so interesting is the variety of
\nprofessional backgrounds we represent. Aside from various surgical subspecialties and
\nanesthesia, we also have members working in pediatrics, public health, and general
\nmedicine. This variety is an absolute must, in order to best advocate for surgical patients in
\na holistic manner.
\nIf we want global surgery to become a local reality, we need the collaboration of health
\nprofessionals, irrespective of their professional qualifications. If we want universal health
\ncoverage to become a reality for all, access to timely, qualitative, and affordable surgical
\ncare should be integrated in health schemes around the world.
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nSafe Surgery and Anaesthesia for All: Let\u2019s Take Action Now!
\nWORKING GROUPS
\nManon Pigeolet, MD MA
\nUniversity Hospital Antwerp
\nDepartment of Orthopaedic Surgery
\nEdegem, Belgium
\nSurgery has historically been a neglected specialty in the global health
\nsphere. Various reasons can be named for this unfortunate course of
\nTogether, we can spread the word that surgery as a cost-
\neffective intervention can make a difference for patients with
\ncancers, non-communicable diseases, and musculoskeletal
\ntrauma, in LMICs and other low-resource settings.
\nLed by Dr Manon Pigeolet and Dr Victoria Von Salmuth, this Global Surgery working group
\naims to provide a platform for residents and young doctors alike to increase professional
\nnetworks, exchange essential information about global surgery, advocate for surgical
\npatients at the local level and effective surgical health systems at international meetings,
\nand provide opportunities for collaborations on policy or scientific papers on global surgery
\n(Photo 1).
\nTo contribute to existing efforts to achieve the vision of surgery and anesthaesia care for
\nall, various projects will be developed by this working Group. A WMA\/JDN policy paper on
\n\u201cAccess to Safe, Qualitative and Timely Surgery and Anesthaesia Care\u201d, an opinion piece
\non \u201cThe Role of Junior Doctors and Residents in Global Surgery\u201d, and an open letter about
\n\u201cMaternity Leave Regulations in Surgery around the World\u201d, are just a small selection of
\ntopics and projects that we will be working on in the near future.
\nIf you are interested in global surgery and would like to participate in upcoming activities,
\nplease contact our team (Dr Manon Pigeolet) to obtain more information.
\nJunior Doctors Newsletter
\nIssue 15
\nApril 2019
\nWORKING GROUPS
\nPhoto 1. Dr Manon Pigeolet and Dr Victoria Von
\nSalmuth are the co-chairs of the JDN Global Surgery
\nworking group. Credit: Manon Pigeolet.<\/p>\n"},"caption":{"rendered":"

JDN_15NL_FinalVersionForWMA_11Apr2019[1] JUNIOR DOCTORS NETWORK empowering young physicians to work together towards a healthier world through advocacy, education, and international collaboration Published by the Junior Doctors Network of the World Medical Association The information, perspectives, and opinions expressed in this publication do not necessarily reflect those of the World Medical Association or the Junior Doctors Network. […]<\/p>\n"},"alt_text":"","media_type":"file","mime_type":"application\/pdf","media_details":{},"post":null,"source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2019\/04\/JDN_15NL_FinalVersionForWMA_11Apr20191.pdf","_links":{"self":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/media\/12441"}],"collection":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/media"}],"about":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/types\/attachment"}],"author":[{"embeddable":true,"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/users\/17"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/comments?post=12441"}]}}