{"id":11444,"date":"2018-09-20T10:27:09","date_gmt":"2018-09-20T09:27:09","guid":{"rendered":"https:\/\/www.wma.net\/wp-content\/uploads\/2018\/09\/14th-issue-of-JDN-NL_P2.pdf"},"modified":"2018-09-20T10:27:09","modified_gmt":"2018-09-20T09:27:09","slug":"14th-issue-of-jdn-nl_p2-2","status":"inherit","type":"attachment","link":"https:\/\/www.wma.net\/fr\/14th-issue-of-jdn-nl_p2-2\/","title":{"rendered":"14th issue of JDN NL_P2"},"author":5,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"acf":[],"description":{"rendered":"

\"\"<\/a><\/p>\n

Junior Doctors Network
\nNewsletter
\nIndex
\nWorking conditions and
\nleadership education: the
\ntopics of JDN Meeting in
\nRiga …………………………. 1
\nReport from WMA
\nEuropean Region Meeting
\non End-of-Life Questions 4
\nA report of the WMA
\nAfrican region meeting on
\nEnd-of-Life Questions
\nhosted by the Nigerian
\nMedical Association in
\nAbuja, Nigeria from
\nFebruary 1-2, 2018…….. 7
\nReport from the WMA JDN
\npreWHA 2018 …………… 9
\nJDN at the 2018 Spring
\nMeeting of the European
\nJunior Doctors Permanent
\nWorking Group …………. 11
\nGlobal surgery: a new and
\nemerging field in global
\nhealth? …………………….. 12
\nA Word from the Chair . 17
\nOpportunities to talk to
\ndoctors around the world
\nacross generations …….. 18
\nMembers of the Junior Doctors
\nNetwork (JDN) of the World
\nMedical Association (WMA)
\ngathered for their April 2018
\nMeeting in Riga, Latvia, hosted by
\nthe Latvian Medical Association
\n(LMA). The meeting took place on
\nApril 25, 2018, at the LMA
\npremises in Riga, prior to the
\n209th Session of the WMA
\nCouncil also attended by JDN
\nrepresentatives. Around 15 junior
\ndoctors coming from Turkey,
\nFrance, Germany, the United
\nStates of America, Lebanon,
\nKuwait, Italy, Brazil, Nigeria,
\nJapan, Canada, Greece, Latvia,
\nand the United Kingdom
\n(European Junior Doctors
\nAssociation – EJD representative),
\nattended the meeting and
\ndiscussed current topics of interest
\nto junior doctors globally, as well
\nas relevant WMA policies to be
\naddressed at the Council Session
\nand forwarded for adoption at the
\nnext WMA General Assembly
\n(GA) in Reykjavik, later this year.
\nThe meeting started with a
\nwelcome speech by the JDN
\nChair, Dr. Caline Mattar, who
\nwelcomed everybody to the Riga
\nmeeting and briefly presented the
\nmeeting agenda, offering
\nbackground information especially
\nto newcomers. Each participant
\nthen took the floor and introduced
\nthemselves, presenting their role
\nOctober, 2018
\n14th issue
\nISSN (print) 2415-1122
\nISSN (online) 2312-220x
\nPicture 1. Participants at the JDN Riga Meeting 2018 with the WMA leadership.
\nWorking conditions and leadership education:
\nthe topics of JDN Meeting in Riga
\nKonstantinos Roditis, MD, MSc*
\nwithin JDN and\/or the junior
\ndoctors\u2019 organization in their
\nrespective countries, as well
\nas their expectations from the
\nmeeting.
\nInterestingly, as both the
\nWMA Council Session and
\nGA are organized in Europe
\nfor the year 2018, special
\nattention was given by the
\nparticipants to certain junior
\ndoctors\u2019 issues in Europe. The
\ndiscussion was further
\nenriched by the introduction
\ngiven by Dr. Kitty Mohan,
\nPresident of the European
\nJunior Doctors Association
\n(EJD) who was also present as
\na guest at the meeting,
\nfollowed by the
\nrepresentatives of the Latvian
\nJunior Doctors Association,
\nwho presented the challenges
\nthey are facing both in their
\npost-graduate medical
\neducation and training, along
\nwith exhausting working
\nhours and unsatisfactory
\nworking conditions.
\nThe meeting was honored by
\nthe presence of WMA
\nleadership, namely Prof.
\nYoshitake Yokokura, WMA
\nPresident, Dr. Ardis Hoven,
\nWMA Council Chair, and Dr.
\nOtmar Kloiber, WMA
\nSecretary General, who all
\ngreeted the participants,
\nwishing them a fruitful
\nmeeting and great outcomes,
\nand at the same time
\nwelcomed JDN at the 209th
\nWMA Council Session. All
\nparticipants were then split
\ninto three small working
\ngroups and addressed the
\nfollowing topics, under the
\nWMA leadership:
\n1. Building regional
\ncollaborations (Dr.
\nYokokura) – The CMAAO
\nexample and Japan
\nleadership role in its
\ndevelopment were
\nmentioned, with emphasis
\nin the historical
\nbackground and current
\nprogress. Dr. Yokokura
\nalso presented on the
\nChinese-Japanese medical
\nassociation and its
\nevolvement throughout
\nthe years, as an example
\nof regional partnership
\nbetween neighboring
\ncountries. He then
\nreceived questions by the
\nparticipants, specifically
\non how he envisions the
\nrole of smaller,
\nunderdeveloped nations in
\nthe proceedings of such
\nregional collaborative
\ninitiatives.
\n2. Healthcare systems
\nreforms – Primary
\nhealthcare (PHC) and the
\nrole of other health
\nprofessionals (Dr. Kloiber)
\n– A presentation was given
\non challenges arising from
\nintroducing nurse
\npractitioners and
\npharmacists into PHC
\nstructures, followed by
\ndiscussions on the
\nalienation between doctors
\nand patients due to super-
\nspecialization in medicine,
\ncertain PHC reforms and
\ndecapitation of physician
\ncare (being paid per
\ncapita), the introduction of
\npharmacies in super
\nmarkets and shopping
\nmalls, as well as the
\nprescription of
\nmedications and
\ndiagnostics by non-
\nphysicians and on the
\nrelated WMA position.
\n3. How to engage people to
\nwork in a certain field (Dr.
\nHoven) – Emphasis was
\ngiven on the example of
\nthe WMAAssociate
\nMembers targeting public
\nhealth physicians and
\nmedical ethics experts and
\nthe role of emotional
\ninfluence in increasing
\nindividual commitment to
\ncollaborative work by Dr.
\nHoven.
\nThe next point in the agenda
\nwas a brainstorming session
\n(splitting into smaller groups)
\ntackling:
\n-Structure of JDN meetings
\n(facilitators: K. Roditis and
\nA. Fontaine)
\n-JDN membership (facilitator:
\nC. Mishima)
\nA workshop led by Dr. Yassen
\n* Resident, Department of Vascular
\nSurgery, Korgialeneio-Benakeio
\nHellenic Red Cross Hospital,
\nAthens, Greece \/ Chair, JDN-
\nHellas \/ Secretary, Junior Doctors
\nNetwork , World Medical
\nAssociation
\nroditis.k@gmail.com\/
\nsecretary.jdn@wma.net
\n2
\nPicture 2. JDN participants socializing at a Riga pub.
\nCholakov on Climate Change
\nfollowed. First, he offered a
\nbrief presentation on United
\nNations Framework
\nConvention on Climate
\nChange (UNFCCC) history of
\nclimate change, mentioning
\nhealth in negotiations, working
\ntowards the Paris Agreement
\nand the role of WMA in
\nclimate change policy \/ JDN\u2019s
\ncontribution (revision of the
\nDelhi Declaration).
\nParticipants then were once
\nagain split into smaller groups
\nand went through the National
\nDetermined Contributions
\n(NDC) interim reports of all
\ndifferent signatory countries,
\nas listed on http:\/\/
\nwww4.unfccc.int\/ndcregistry\/
\nPages\/All.aspx. Then, there
\nwas a discussion about health,
\nair pollution, healthcare
\nresilience, and nutrition in the
\nreports, addressing various
\nreasons why these topics were
\nnot mentioned. Further ways
\nof engaging WMA\u2019s National
\nMedical Associations (NMAs)
\ninto contributing more
\nresources to Climate Change
\ntalks were also explored at the
\nend of the workshop.
\nAs the JDN meeting had no
\ncentral theme this time, the
\nparticipants focused on several
\nissues the JDN is currently
\nworking on, mainly the work
\nbeing done within JDN\u2019s
\nworking groups (WG).
\nThe future of JDN\u2019s WG on
\nWorking Conditions
\nmonopolized the discussion,
\nstarting with a brief
\nintroduction given by Dr.
\nCaline Mattar on the work
\ncompleted so far by the WG.
\nAll participants were engaged
\nin suggesting ways of moving
\nforward with the WG, in terms
\nof producing actual results and
\nachieving specific goals.
\nApproaching possible partners
\nfrom the Academia,
\nconducting a well-designed
\nsurvey on working conditions
\namong JDN members in
\ndifferent world regions,
\ncreating an online platform for
\nthe referral of violations of
\nworking conditions by JDN
\nmembers, writing an
\nintroductory article on existing
\nworking conditions regulatory
\nsystems around the globe to be
\npublished in the World
\nMedical Journal, organizing
\nsolidarity campaigns to
\nsupport our colleagues in
\ncountries with challenging
\nworking conditions, were
\namong the ideas mentioned by
\nthe participants.
\nThe meeting concluded with a
\nLeadership in Healthcare
\n3
\nPicture 3. JDN participants at the Opening Reception of the 209th WMA
\nCouncil Session.
\nPicture 4. JDN participants in front of the Livonian medieval Castle,
\njoining the post-meeting tour in the Latvian countryside town of Cecis.
\nworkshop, offered by Drs.
\nGreg Radu and Paul Kneath
\nJones, both experts in running
\nleadership workshops in
\ninternational conferences
\nworldwide. The participants
\nreceived a comprehensive
\npresentation on different
\nleadership theories and ways
\nand tools to build a strong
\nleadership profile in healthcare
\nsettings.
\nAll in all, the meeting was a
\nsuccess for JDN, as the
\nparticipants had the chance to
\nmeet again with colleagues
\nfrom all over the world,
\nexchange ideas, build strong
\nconnections, and enjoy the
\nLatvian culture, cuisine, and
\nnightlife! At this point, we
\nwould all like to thank our
\nLatvian hosts for their
\nhospitality, with our special
\nthanks going out to Ms. Maira
\nSudraba, who was always
\nthere to accommodate us. The
\nnext rendez-vous for the JDN
\nmembers will be the JDN
\nAnnual Meeting, taking place
\nin Reykjavik, Iceland in
\nOctober 2018. Until then\u2026
\nThe World Medical
\nAssociation (WMA) European
\nRegion Meeting on End-of-
\nLife Questions was held in the
\nVatican on November 16-17,
\n2017, which was hosted by the
\nGerman Medical Association
\nin collaboration with the
\nWMA and the Pontifical
\nAcademy for Life in the
\nVatican. This event included a
\nseries of regional workshops
\nthat focused on dynamic
\ndiscussions on euthanasia and
\nphysician-assisted dying and
\nits ethical dilemmas relating to
\nend-of-life issues. The
\ndiscussion was first started in
\nOslo, Norway, in April 2015,
\nin the 200th
\nWMA Council
\nSession, where WMA
\nreaffirmed the \u201cWMA
\nDeclaration on Euthanasia\u201d. It
\nwas then followed by the
\nregional meetings in Tokyo,
\nJapan in September 2017, the
\nVatican in November 2017,
\nand Abuja, Nigeria in
\nFebruary 2018.
\nThe End-of-Life discussions
\nseemed particularly important
\nin the European region,
\nbecause a variety of
\nstandpoints and legal settings
\ntowards euthanasia or
\nphysician-assisted suicide
\n(PAS) were observed among
\nthe European countries.
\nReferring to the result of
\nquestionnaires from 19 Asian
\ncountries at the End-of-Life
\nsymposium in Tokyo, Japan,
\nin September 2017, the
\nmajority of Asian countries
\nshowed negative attitudes
\ntoward \u201cactive euthanasia\u201d.
\nFurthermore, it was implied
\nthat the way of religion or the
\nview of life are involved in
\nthinking and decision-making
\nprocesses for end-of-life care
\n4
\nPicture 5. JDN folks having a great time at the 209th WMA Council
\nSession Reception.
\nReport from WMA European Region Meeting on End-of-Life Questions
\nMaki Okamoto, MD*
\n* Deputy Chair, Japan Medical As-
\nsociation Junior Doctors Network
\n(JMA-JDN)
\ndeputychair_internal@jmajdn.jp
\nin Asia. In contrast with this
\ntrend in Asian countries, the
\nEuropean region had different
\nreligious backgrounds, and
\neach country had its own
\nperspectives about euthanasia
\nor PAS. This emphasized the
\nfundamental significance of
\nhaving a regional conference
\nin Europe and attracted
\nattention from all participants
\nin the Vatican. For this two-
\nday conference, European
\nmedical professionals, legal
\nauthorities, experts in
\npalliative care and medical
\nethics, theological scholars
\nand philosophers were all
\ngathered in the Vatican,
\ndebating end-of-life questions
\nfrom different perspectives.
\nThe discussion first began
\nwith providing the setting and
\nperspectives from the WMA
\nas well as the country where
\nthe euthanasia or PAS is
\nallowed. Professor Dr.
\nMontgomery, the president of
\nthe German Medical
\nAssociation, spoke about the
\nperspectives from the WMA.
\nDespite the fact that the
\npractice of active euthanasia
\nwith physician assistance has
\nbeen legalised in some
\ncountries, the WMA strongly
\nencourages all National
\nMedical Associations and
\nphysicians to refrain from
\nparticipating in euthanasia,
\neven if the national law allows
\nor decriminalizes it. On the
\nother hand, Dr. Ren\u00e9 H\u00e9man
\ntook part in showing the
\nviewpoint from the
\nNetherlands, where euthanasia
\nis authorized under certain
\nconditions. The six due care
\nrequirements for euthanasia
\nare as follows; 1) There is a
\nvoluntary and well-considered
\nrequest; 2) There is an
\nunbearable suffering and no
\nprospect of improvement; 3)
\nThe patient is informed about
\nthe situation and future
\nprospects; 4) There is
\nconviction that no other
\nreasonable solution for the
\npatient\u2019s situation is available;
\n5) One other independent
\nphysician is consulted; and 6)
\nTermination of life or assisted
\nsuicide is performed with due
\ncare. In addition to these
\nrequirements, there is no
\nobligation for physicians to
\nperform euthanasia, and it
\nrelies on the physician\u2019s
\ncompassion. However, it is
\nstill not a simple pathway, and
\nphysicians who perform
\neuthanasia also experience
\nintense psychological
\nsuffering. Dr. Yvonne Gilli,
\nfrom the Swiss Medical
\nAssociation, presented the
\ncurrent situation of assisted
\nsuicide in Switzerland. She
\nindicated that the number of
\nassisted suicides in
\nSwitzerland has increased
\nfrom 2% to10% over the past
\n15 years (2000-2014). She also
\nstated that the use of
\ncontinuous deep sedation as a
\ntreatment method in end-of-
\nlife-care has also increased
\nsubstantially in recent years.
\nAdditionally, she mentioned
\nthe importance of organizing
\nthe end-of-life-care guidelines
\nespecially for the palliative
\nsedations, as well as
\nreconsidering the importance
\nof physicians conversing with
\npatients about this delicate
\ndecision.
\nThe second part of the
\nconference was based on
\ntheological views. Ethical
\nspecialists interpreted the
\nCatholic, Jewish, and Islamic
\nperspectives by providing
\ndifferent interpretation of
\ndeath. Dr. Daniela Mosoiu, an
\nexperienced palliative care
\nphysician from Romania who
\nhas dedicated her work in
\nhospice, presented real clinical
\ncases from her practice. Most
\nof the patients were suffering
\nfrom the anxiety of not
\nknowing what to do. In
\naddition, patients, families,
\nand health professionals
\ncollectively suffer. However,
\nthe important element is to
\nprovide \u201ccuring\u201d and
\n\u201chealing\u201d for patients, where
\n\u201ccuring\u201d refers to the
\nphysiological reconstruction of
\nthe physical body, and
\n\u201chealing\u201d refers to mainly
\nmental meanings, such as
\ninner peace, forgiveness,
\nremoval of stigma, and
\nelimination of social barriers.
\nTransformation of suffering,
\nacquaintance with one\u2019s death,
\nand gratitude and worship are
\nessential keys to achieve
\n\u201chealing\u201d.
\nThe third part of the
\nconference was related to laws
\nor delineating euthanasia and
\nPAS, which was presented by
\nProfessor John Keown,
\nProfessor Dr. Volker Lipp, and
\nDr. Laurence Lwoff.
\nEuthanasia, defined as
\nintentionally killing another
\nperson in order to relieve this
\nperson\u2019s suffering, is divided
\ninto three sub-groups: 1)
\nvoluntary, or a person who
\nfollows the person\u2019s will; 2)
\nnon-voluntary, or a person
\nincapable of making decisions
\n(such as coma, mentally
\nretarded or dementia); 3)
\ninvoluntary, or a person who
\n5
\n\u201cI will stand in front of him, behind him and next to him,
\nwhen he needed my care.\u201d
\nwants to live but was killed.
\nWhile PAS is defined as
\nsuicide with assistance of a
\nphysician, there is also another
\ncontext that has become
\nwidely accepted in principle,
\nsuch as \u201cletting die\u201d, defined
\nas limiting, terminating, or
\nwithholding life-sustaining
\ntreatment because it is futile or
\naccording to the patient\u2019s will.
\nIn terms of criminal law, most
\nEuropean countries, except the
\nNetherlands, Belgium, and
\nLuxembourg, ban all forms of
\neuthanasia. The Netherlands
\nallows non-voluntary
\neuthanasia of terminally ill
\nnewborn babies. In countries
\nsuch as Switzerland or
\nGermany, PAS is legal under
\ncertain conditions, while
\neuthanasia is banned in those
\ncountries. However, these
\ndefinitions of each term
\noverlap in many ways, and we
\nhave a variety of conditions in
\nlaws, religions, histories,
\ncultural backgrounds or
\npatients\u2019 conditions, which
\nmake the discussion over
\neuthanasia and PAS more
\nchallenging. Some highlighted
\nthat the discussions regarding
\nthe decision-making processes
\nare as follows: How can we
\ndefine the patient as incapable
\nto decide or who is to decide
\nfor them? How can we deal
\nwith the will of patients with
\ndementia or senility? How can
\nwe decide whether or not to
\nwithdraw fundamental life
\nsupport (such as hydration or
\nnutrition) compared to medical
\nlife-prolonging treatments?
\nIn the latter half of the
\nconference, the discussions
\nmoved to the theme regarding
\ncompassionate use and
\nconscientious objections, the
\nright to determine one\u2019s own
\ndeath, and choice of treatment
\nlimitations as an alternative to
\neuthanasia. Many specialists
\nfrom all backgrounds were
\ngathered to openly discuss
\nthese topics. Roughly
\nestimated, the number of
\npeople euthanized each year in
\nthe Netherlands is set to
\nexceed 7,000, and it rose 67%
\nfrom five years ago. The
\nnumber of persons receiving
\neuthanasia in Belgium is
\nestimated to be as high as
\n4,000 each year. However, it
\nmeans that approximately half
\nof all requests were granted,
\nand the other half of all
\nrequests were denied. This fact
\nimplies that more alternatives
\nare available before selecting
\nthe ultimate choice such as
\neuthanasia or PAS. Professor
\nDr. Leonid Eidelman, from the
\nIsraeli Medical Association,
\npresented the clinical case of a
\npatient who was suffering
\nfrom intensive back pain and
\nshouted for someone to kill
\nhim. However, after he was
\ntreated with continuous
\ninfusion of anesthesia to his
\nspine, his pain was relatively
\ncured, which produced a smile
\nand allowed him to travel
\naround the world before he
\ndied. This case suggests the
\nimportance of reconsidering
\nthis possible treatment as an
\nend-of-life-care measure. Dr.
\nAnne de la Tour, a palliative
\ncare physician from France,
\nexplained the possibility of
\ndeep and continuous sedations.
\nPatients who live in countries
\nthat do not allow euthanasia or
\nPAS, can also be free from
\nunbearable pain through deep
\nand prolonged sedation
\ncontinued until death.
\nHowever, this measure must
\nbe conducted within the legal
\nauthorization, when a patient
\nis in the terminal phase and
\nsuffers from a serious and
\nincurable life-threatening
\ncondition.
\nThe discussion over euthanasia
\nand PAS will never end. As
\nmore people, especially from
\nwestern Europe, are in favor of
\nPAS, it is important to provide
\npatients with many different
\nchoices and let them choose
\nwhat they are willing to
\nreceive. At the same time, it is
\nmore important to discuss end-
\nof-life care, build up the
\nsystem, and provide correct
\ninformation about all treatment
\noptions to the public. As
\nphysicians, we must think
\nabout how we can dedicate
\nourselves to people who are
\nsuffering from terminal
\nillnesses. As such, the
\nconference was concluded
\nwith this symbolic phrase: \u201cI
\nwill stand in front of him,
\nbehind him and next to him,
\nwhen he needed my care\u201d.
\n6
\nAs part of the efforts of the
\nWorld Medical Association
\n(WMA) to generate open
\nregional discussions on the
\ndilemmas related to End-of-Life
\nissues, particularly with respect
\nto palliative care, euthanasia, and
\nphysician-assisted suicide, the
\nWMA Council meeting held in
\nLivingstone, Zambia, in April
\n2017, encouraged the African
\nregion of the WMA to organize
\nan African Regional meeting on
\nEnd-of-Life issues.
\nAs such, the Coalition of African
\nMedical Associations authorized
\nthe Nigerian Medical Association
\nto host the WMA African Region
\nMeeting on End-of-Life issues.
\nThis WMA African Region
\nmeeting on End-of-Life issues
\n(palliative care, euthanasia, and
\nphysician-assisted suicide) was
\nhosted by the Nigerian Medical
\nAssociation in Abuja, Nigeria,
\nfrom February 1-2, 2018.
\nThis meeting was born out of the
\nneed for the WMA to generate
\ndiscussions and assess the scope
\nof the dilemma facing doctors in
\ndifferent cultural domains. The
\nWMA aimed to better understand
\nthe problem in order to
\nadequately address related
\npolicies in the future. This was
\none of the four WMA End-of-
\nLife meetings organized in the
\nAsia-Pacific, Europe, Latin
\nAmerica, and Africa regions.
\nThe End-of-Life meeting, which
\nheld at the Transcorp Hilton
\nHotel and Towers, Abuja,
\npromoted the theme, \u201dAn
\nExcursion into the End-of-Life
\nSpectrum: Defining the
\nboundaries between Palliative
\ncare, Euthanasia, and Physician
\nassisted suicide\u201d. The Secretary
\nGeneral of the WMA, Dr. Otmar
\nKloiber, attended and presented
\nthe WMA policy on End-of-Life
\nissues. Other dignitaries in
\nattendance were the presidents
\nand delegates of the National
\nMedical Associations from
\nNigeria, Zambia, Kenya, South
\nAfrica, Cote D\u2019Ivoire, and
\nBotswana.
\nActivities conducted during the
\nmeeting included the welcome
\ncocktail, formal opening
\nceremony, scientific sessions
\nwith presentations by various
\nguest speakers on End-of-Life
\nissues, breakout technical
\nsessions, local tourism activities,
\nand closing dinner.
\nThe formal opening ceremony
\nwas chaired by the Senate
\nPresident of the Federal Republic
\nof Nigeria, Senator Dr. Bukola
\nSaraki, who was represented by
\nSenator Dr. Lanre Tejuosho,
\nwhile the Honourable Minister of
\nHealth, Professor I.F. Adewole,
\nrepresented the President of the
\nFederal Republic of Nigeria,
\nMuhammadu Buhari GCFR.
\nDuring the meeting, numerous
\ndiscussions focused on palliative
\ncare, euthanasia, and physician-
\nassisted suicide with several
\nobservations:
\n1) There is no specific policy or
\nlegislation on euthanasia and
\n7
\nA report of the WMAAfrican region meeting on End-of-Life Questions
\nhosted by the Nigerian Medical Association in Abuja, Nigeria from
\nFebruary 1-2, 2018
\nNdiokwelu Chibuzo, MD, MWACP*
\n* Nigerian Medical Association \/
\nWest African College of Physicians \/
\nCommunications Director, Junior
\nDoctors Network, World Medical
\nAssociation \/ Member, West African
\nCollege of Physicians
\nthaemm2@gmail.com
\nPicture 1. Dr. Enabulele Osahon, past president Nigerian Medical
\nAssociation; Dr. Othmer Kloiber, WMA Secretary General; and Prof.
\nOgirima Mike, Nigeria Medical Association.
\nphysician-assisted suicide in
\nAfrica.
\n2) Few countries, like Nigeria,
\nZambia, Kenya, Uganda,
\nSouth Africa, and Botswana,
\nhave policies, guidelines, and
\npractices on palliative care.
\n3) In the African culture,
\ntradition and religion, life is
\nheld sacred, and families
\nnever abandon their loved
\nones at the End-of-Life period.
\n4) Palliative care as a concept
\nis generally accepted in the
\nAfrican culture, tradition, and
\nreligion.
\n5) Involvement of physicians
\nin euthanasia and physician-
\nassisted suicide is frowned on
\nas it is viewed as contradictory
\nto medical ethics and the
\nphysicians\u2019 pledge.
\n6) There is a low level of
\nawareness on End-of-Life
\nissues among African
\npopulations and health
\nprofessionals.
\n7) There is a dearth of
\nstandard health care systems
\nand medical personnel
\nequipped to deliver palliative
\ncare.
\n8) There is a high poverty rate,
\npoor access to affordable,
\nequitable and quality health
\ncare, and poor access to
\npalliative care in most African
\ncountries.
\nFinally, the meeting ended
\nwith some resolutions to guide
\nthe WMA in further
\ndiscussions as they relate to
\nthe African region.
\n1) African National Medical
\nAssociations (NMAs) are
\nunanimously opposed to
\neuthanasia and physician-
\nassisted suicide in any form.
\n2) African NMAs support
\npolicies and legislations
\npermitting and strengthening
\npalliative care.
\n3) African NMAs, non-
\ngovernmental organizations
\n(NGOs), and other agencies or
\ninstitutions need to embark on
\nenlightenment and advocacy
\ncampaigns to government,
\npolicy makers, and the general
\npublic on the importance and
\navailability of palliative care.
\n4) There is great need to
\nstrengthen African health
\nsystems, promote universal
\nhealth coverage, improve
\nbudgetary allocation to health
\nservices, and integrate
\npalliative care and other
\nchronic medical conditions
\ninto the health financing and
\ninsurance schemes of African
\ncountries.
\nAcknowledgements
\nNigeria Medical Association, Report
\nof the WMA African region meeting
\non End-of-Life Questions in Nigeria,
\nJanuary 2018
\n8
\nPicture 2. A cross section of
\ndelegates at the meeting.
\nPicture 3. WMA Secretary General on a sight-seeing trip to see the
\nZuma Rock.
\nThe Junior Doctors Network
\n(JDN) organized its annual pre-
\nWorld Health Association
\n(WHA) meeting on May 19-20,
\n2018, at the World Medical
\nAssociation (WMA) offices in
\nFerney-Voltaire, France.
\nAt WHA71, delegates engaged
\nin deep conversations with Dr.
\nMaria Neira, WHO Director of
\nthe Department of Public
\nHealth, Environmental and
\nSocial Determinants of Health,
\non issues related to
\nenvironmental health and
\nclimate change. Many
\nhighlighted the potential
\nleadership role that the WHO
\ncould take in front of other
\nUnited Nations\u2019 (UN) agencies
\nand organizations on issues of
\nclimate change and air pollution.
\nThe conversation even boldly
\nsuggested that the WHO should
\nuse its treaty-making powers to
\ncreate a Framework Convention
\non (un)Clean Air in the near
\nfuture.
\nThereafter, delegates worked on
\nissues related to nutrition and
\nnoncommunicable diseases
\n(NCDs) and had the chance to
\ninteract with an expert panel,
\nincluding Ms. Jess Beagley,
\nPolicy Research Manager at the
\nNCD Alliance, Mr. Jack Fisher,
\npast Executive Director of NCD
\nFree, and Dr. Francesco Branca,
\nWHO Director of the
\nDepartment Nutrition for Health
\nand Development. Delegates
\ndiscussed the third High-level
\nMeeting of the General
\nAssembly on the Prevention and
\nControl of NCDs, how food
\npolicy is different than policy on
\nother NCD risk factors, and how
\nto examine conflicts of interest
\nwhen engaging with the private
\nsector in health interventions.
\nLastly, Ms. Diah Satyani
\nSaminarsih, WHO Advisor on
\nGender and Youth, presented
\nthe new WHO vision to be
\nadopted through the 13th
\nGeneral Programme of Work
\n(GPW13), under the leadership
\nof Dr. Tedros Adhanom, WHO
\nDirector-General.
\nAdditionally, the WHO
\norganized the first-time event,
\n\u201cWalk the Talk\u201d, as a walk\/run
\nactivity around Geneva to
\npromote healthy lifestyles and
\nphysical activity. PreWHA
\ndelegates participated in the
\nevent, by walking or running the
\n8.6km distance, while some
\nfinished the race hand in hand
\nwith Haile Gebrselassie,
\nmultiple Olympic and World
\nChampion long distance runner
\nand world record holder.
\nLastly, all delegates attended the
\nbriefing for delegates to the
\nWHA organized by the Geneva
\nGraduate Institute. After
\n* Socio-Medical Affairs Officer,
\nJunior Doctors Network, World
\nMedical Association
\nyassentch@gmail.com
\n9
\nPicture 6. Dr. Othmer Kloiber,
\nSecretary General WMA; and
\nDr. Tanko Sununu, Secretary
\nGeneral, Nigerian Medical
\nAssociation wearing local
\ntraditional attire.
\nPicture 4. Arrival at the airport. Picture 5. Smiles at the
\nclosing dinner.
\nReport from the WMA JDN preWHA 2018
\nYassen Tcholakov, MD, MSc*
\nPicture 1. Briefing session for
\ndelegates at the Geneva
\nGraduate Institute.
\nlearning about the GPW13
\nand WHA procedural rules,
\nthey gained insight on four
\nimportant WHO topics, such
\nas the polio transition, health
\nemergencies, pandemic
\ninfluenza preparedness plan,
\nand nutrition.
\nWhile the preWHA agenda
\nhas varied from those of
\nprevious years, the JDN\u2019s
\nparticipation in external
\nevents organized by the WHO
\nhas helped foster engagement
\nand communication with other
\ngroups with similar interests.
\n10
\nPicture 4. JDN session on Environmental Health with Dr. Maria
\nNeira at WMA Offices.
\nPicture 3. Alice McGushin, JDN
\ndelegate to WHA, crossed the 8.6km
\nrun finish line with Haile
\nGebrselassie, multiple Olympic and
\nWorld Champion long distance
\nrunner and world record holder.
\nPicture 2. JDN delegation ready to participate in the \u201cWalk the Talk:
\nThe Health for All Challenge\u201d.
\nThe Junior Doctors Network
\n(JDN) was invited to the 2018
\nSpring meeting of the European
\nJunior Doctors Permanent
\nWorking Group (EJD), which
\nwas held at the \u201cAndrija
\n\u0160tampar\u201d School of Public
\nHealth at the University of
\nZagreb in Zagreb, Croatia, from
\nMay 4-5, 2018. I attended this
\nmeeting on behalf of the JDN
\nmembership.
\nAll meeting hosts, including Dr.
\nKitty Mohan, the EJD President,
\nand the Management team,
\ndeveloped a high-quality
\nprogram agenda and positive
\nnetworking environment for
\nconference participants.
\nParticipants included members
\nof the European Junior Doctors
\nAssociations and other invited
\nguests. The opening ceremony
\naddressed \u201cEmployment and
\nFree Mobility\u201d, and was
\nattended by top Croatian
\ngovernment officials and the
\nCroatian Medical Association
\nleadership. Interactive panel
\ndiscussions and meeting
\nsessions provided opportunities
\nfor participants to elaborate on
\nthis topic. Coordinated social
\nevents incorporated formal and
\ninformal networking dinners as
\nwell as a collective walk around
\nthe ancient City of Zagreb that
\nwe experienced with a rain
\nshower.
\nIn addition to my participation
\nand contribution to different
\npanels and sessions, I had the
\nopportunity to introduce the
\nobjectives and mission of the
\nJDN, describe our structure
\nwithin the World Medical
\nAssociation (WMA), and
\nmention our past and current
\nprofessional activities. In
\nfostering our existing
\ncollaborations, I stressed the
\ncommitment of the JDN in
\npartnering with the EJD in areas
\nof mutual interest. For example,
\nas one mutual interest is the
\nWorking Group on Junior
\nDoctors\u2019 working conditions,
\nDr. Kitty Mohan joined the JDN
\nWorking Group on Working
\nConditions.
\nAs JDN members, we believe
\nthat the collaboration with the
\nEJD is one that should be
\nnurtured and encourage future
\nrelationships with other regional
\nJunior Doctors Organizations.
\n* Deputy Chair, Junior Doctors
\nNetwork, World Medical
\nAssociation \/ Member, West
\nAfrican College of Physicians
\nccoreah@gmail.com
\n11
\nJDN at the 2018 Spring Meeting of the European Junior Doctors
\nPermanent Working Group
\nChukwuma Oraegbunam, MBBS, MWACP*
\nPicture 1. Cross section of delegates to the 2018 EJD Spring Meeting.
\nPicture 2. (Left to Right) Dr.
\nKitty Mohan, EJD President;
\nDr. Chukwuma Oraegbunam,
\nJDN Deputy Chair; Dr. Ellen
\nMcCourt, former UK Junior
\nDoctors Committee Chair.
\n\u201cGlobal Surgery\u201d, what\u2019s
\nin a name
\nGlobal Surgery was described by
\nThe Lancet Commission on
\nGlobal Surgery (LCoGS) in 2015
\nas \u201ca field that aims to improve
\nhealth and health equity for all
\nwho are affected by surgical
\nconditions or have a need for
\nsurgical care.\u201d(1) In 1980, Dr.
\nHalfdan Mahler, then the acting
\ndirector-general of the World
\nHealth Organization (WHO),
\ndescribed adequate surgical care
\nas a key factor in achieving
\nhealth care for all.(2) However,
\noutbreaks of communicable
\ndiseases like the human
\nimmunodeficiency virus (HIV)
\nand tuberculosis (TB)
\novershadowed the need for
\naffordable surgical care, and
\nconsequently, global surgery had
\nbeen neglected until the start of
\nthe 21st
\ncentury.(3)
\nCurrently, an estimated 5 billion
\npeople have no access to timely
\nand adequate surgical care, and
\nthis is responsible for the deaths
\nof 17 million people annually
\npredominantly in low- and
\nmiddle-income countries
\n(LMICs) and the poorer wealth
\nquintiles in all countries.(1) Each
\nyear, 401 million Disease
\nAdjusted Life Years (DALYs)
\nare lost due to inadequate
\nsurgical care, compared to 214
\nmillion DALYs lost in the same
\ntime period for HIV, TB, and
\nmalaria combined.(4) DALY is a
\nmeasure of population health,
\nand it calculates the relative
\nimpact of a certain disease
\ncategory on the overall burden of
\ndisease for a population. It
\ncombines the Years of Life Lost
\n(fatal burden of disease) with the
\nYears Lost to Disability (non-
\nfatal burden of disease), and is
\nthe preferred metric to analyse
\nand compare the burden of
\ndiseases.(4) The global health
\ncommunity is starting to realise
\nthat we need to address this
\nalarming situation.(1,4)
\nTraditionally, week-long surgical
\nmissions and provision of money
\nused to be the answer, but now
\nthere is an appreciation that a
\nbroader focus and a need for a
\ndifferent approach are necessary.
\n(3) Currently, five key players
\nare shaping this changed
\napproach: the LCoGS, the World
\nBank, the WHO, Harvard
\nMedical School (HMS) and the
\nG4 Alliance, which is the Global
\nAlliance for Surgical, Obstetric,
\nTrauma, and Anaesthesia Care.
\n(1,5\u20138)
\nThe World Bank challenged the
\nLCoGS in 2014 to produce
\nconsensus-based indicators to
\nevaluate progress in surgical care
\ndelivery in LMIC.(9) The
\nLCoGS responded in 2015 by
\nproducing a report, Global
\nSurgery 2030, in which they
\noutlined an approach through
\ninvestigation, innovation, and
\nimplementation.(1) To monitor
\nthe universal access to safe,
\naffordable surgical, anaesthesia,
\nand obstetric care (SAO) care,
\nthe LCoGS used six core-
\nindicators: access to timely
\nessential surgery; specialist
\nsurgical workforce density;
\nsurgical volume; perioperative
\nmortality rate; protection against
\nimpoverishing expenditure; and
\nprotection against catastrophic
\nexpenditure.(1)
\nHowever, to implement this new
\napproach, the LCoGS was in dire
\nneed of other partners. The
\nWorld Bank started collaborating
\nwith the global surgery systems
\nand included the six indicators in
\ntheir new World Development
\nIndicators dataset in 2016.(6,9)
\nAdditionally, they included
\nglobal surgery in their latest
\nDisease Control Priorities
\npublication in 2015, attributing a
\nwhole volume to the topic.(4)
\nAround the same time, HMS
\nstarted an initiative, the Program
\nin Global Surgery and Social
\nChange, to strengthen global
\nsurgical systems through
\nadvocacy, research, and
\nimplementation science based on
\nthe LCoGS\u2019 six indicators.(5)
\nThe WHO has been involved in
\nthe field of global surgery since
\n12
\n*1 University Children\u2019s Hospital
\nQueen Fabiola, Department of
\nPediatric Surgery, Brussels,
\nBelgium
\n*2 University of Khartoum, Faculty
\nof Medicine, Khartoum, Sudan
\n*3 Universidad Nacional
\nExperimental Francisco de Miranda,
\nDr. Augusto Diez General Surgery
\nResidency program, Coro, Falc\u00f3n,
\nVenezuela
\n*4 Muhimbili University of Health
\nand Allied Sciences, Department of
\nEpidemiology and Biostatistics, Dar
\nEs Salaam, Tanzania
\n*5 Humanitas University, Faculty
\nof Medicine and Surgery, Rozzano,
\nMilan, Italy
\n*6 KU Leuven, Faculty of
\nMedicine, Leuven, Belgium
\nCorrespondence: Manon Pigeolet
\nmanon.pigeolet@outlook.com
\nGlobal surgery: a new and emerging field in global health?
\nManon Pigeolet, MD, MA(candidate)*1
\n, Sara A.M. Alam Eldeen, MD*2
\n, Antonio R. Reyes Monasterio,
\nMD*3
\n, Godfrey Sama Philipo, MD, MPH*4
\n, Irene Schirripa, MD(candidate)*5
\n, Jef Van den Eynde, MD
\n(candidate)*6
\n2005, through their Global
\nInitiative for Emergency and
\nEssential Surgical Care
\n(GIEESC).(7) One of their
\nmain achievements is the
\ndevelopment of the Surgical
\nSafety Checklist, which aims
\nto decrease errors and adverse
\nevents, and increase teamwork
\nand communication in surgery.
\n(4,7) In light of the
\nnegotiations of the new set of
\nSustainable Development
\nGoals, in May 2015, the WHO
\nunderscored the idea that
\nuniversal health coverage must
\ninclude SAO care, and
\nreemphasized this view in
\ntheir 13th
\ngeneral program of
\nwork 2019-2023, adopted at
\nthe 71st
\nWorld Health
\nAssembly in May 2018.(7,10)
\nAnd last but not least, to
\nadvocate for the neglected
\nsurgical patient, a fifth party,
\nthe G4 Alliance was formed in
\n2014: a coalition of more than
\n85 of the world\u2019s leading SAO
\ncare organisations. They aim
\nto provide a united call for
\naccess to safe, essential, and
\ntimely SAO care.(8)
\nHowever, even if the problem
\nhas been clearly outlined by
\nthe LCoGS, important
\nstrategic challenges have
\nemerged in setting global
\nsurgery as a political priority
\nboth at the local and
\ninternational levels. The global
\nsurgery community is a very
\nfragmented one, with its first
\nchallenge being governance.
\n(11) There is still no consensus
\nabout how guiding institutions
\ncan facilitate collective
\nactions, and more importantly
\nwhich institutions should take
\non this leading role.(11) This
\nlack of guidance has led to a
\nlack of process on defining
\nshared solutions on agreed
\nproblems; that is, agreement
\non the fact that surgical care is
\nneglected but there is
\ndisagreement on what level of
\nessential surgical care should
\nbe provided.(11) Lastly, one of
\nthe biggest challenges is that
\npublic opinion tends to
\nmisinterpret the cost-
\neffectiveness of surgery, with
\nmany thinking it is a luxury
\nwhen, instead, it is a very cost-
\neffective tool to fight non-
\ncommunicable diseases,
\nmaternal and child health
\nissues, and injuries among
\nothers.(11\u201313)
\nWe need to overcome these
\nchallenges to ensure collective
\naction for equal access to
\nsurgical care around the world.
\nAs indicated above, global
\nsurgery is an evolving
\ndiscipline acting on the
\nfrontier between clinical
\nsurgery, public health, and
\nglobal politics. Many of the
\nchallenges ahead can only be
\ntackled if representatives from
\nthese different fields unite and
\nwork together in an
\ninterdisciplinary manner on
\nthe local, national, regional,
\nand international levels.
\nInciSioN: uniting the
\nfuture global surgeons,
\nanaesthesiologists and
\nobstetricians of the
\nworld
\nWith growing attention for
\nglobal surgical and anaesthesia
\ncare, and with many medical
\ncurricula lacking attention for
\nglobal surgery and anaesthesia
\ncare, the need for an
\nassociation where global
\nsurgery enthusiasts could
\ndiscuss and take action
\ntogether became a pressing
\nissue. Out of this need, and
\nunder the wings of the
\nInternational Federation of
\nMedical Students\u2019
\nAssociations, the International
\nStudent Surgical Network
\n(InciSioN) was born as an
\ninformal group in 2014 and
\nbecame a fully established
\nindependent organization in
\n2016. InciSioN is an
\ninternational non-profit
\norganisation, comprised of
\nmedical students, residents,
\nand young doctors from
\naround the world, who work
\ntogether to educate on,
\nadvocate for, and perform
\nresearch in global surgery.
\nInciSioN consists of an
\ninternational core team
\ncharged with overseeing the
\nprojects and activities done
\nunder the InciSioN flag
\nglobally, and an international
\nBoard of Trustees, guiding the
\n13
\nPicture 1. Surgical Interns at AIC Kijabe Hospital in Kenya.
\nwork of the core team. The
\nactual work on the ground is
\ndone by 2,800 members
\nglobally, working in over 20
\nnational working groups
\nspread all over the world. For
\ntheir advocacy efforts, they
\nhave often collaborated with
\nthe G4 Alliance, and for their
\nresearch efforts, previous
\ncollaborations included the
\nGlobalSurg 1 and 2 (14\u201321)
\nresearch initiatives, and
\nreporting about basic surgical
\nindicators worldwide.(22) A
\nmultitude of events have been
\norganised by InciSioN,
\nincluding trainings and
\nconferences, with their latest
\nevent being the International
\nGlobal Surgery Symposium
\n(IGSS2018) this May in
\nLeuven, Belgium.(23)
\nIGSS2018 at a glance
\nIGSS2018 brought together
\nover 200 global surgery
\nenthusiasts from over 45
\ndifferent countries
\nrepresenting all different
\ncontinents.(24) Another
\nimpressive achievement, and
\nunfortunately still a rarity at
\nglobal surgery conferences,
\nwas the creation of travel
\nscholarships by IGSS through
\nwhich they were able to
\nwelcome 11 international
\nscholars coming from various
\nLMICs. Each and every one
\nof those 11 scholars are true
\nleaders in the field of global
\nsurgery and made IGSS2018
\ntruly global, creating
\nopportunities to discuss,
\nexchange, and interact
\nbetween the attendees. The
\nconference programme had a
\nwide range of speakers,
\nincluding Dr. Walt Johnson
\n(Director of GIEESC at the
\nWHO), Dr. Kathleen Casey
\n(from the G4 Alliance), and a
\nnumber of practicing SOA
\nspecialists from around the
\nworld. The conference was
\nenergetic and motivated the
\nattendees to work towards
\nimproving surgical and
\nanaesthesia care globally.
\nBelow is a short overview of
\nthe topics discussed.
\n\u2022 Trauma is making its way
\nup in the burden of
\ndisease statistics, with a
\nprojection of 7 million
\ndeaths worldwide due to
\ninjuries by 2030.(25) This
\nwill be a clear challenge
\nto come for LMICs and its
\nSAO providers. The lack
\nof human resources for
\nhealth to address this issue
\nwas emphasized by Dr.
\nBasem Higazy from the
\nWHO, who stressed the
\ndire need of trained health
\npersonnel, in particular
\nSAO providers in LMICs.
\n\u2022 Various speakers touched
\nupon the need for
\nadequate surgical training
\nin LMICs. The newly
\nestablished surgical
\ntraining programme by the
\nCollege of Surgeons of
\nEast, Central and Southern
\nAfrica in 15 African
\ncountries remains one of
\nthe most important
\nachievements in this field.
\n\u2022 Technology is also finding
\nits way into surgery in
\nLMICs. For example,
\nLifebox has developed a
\nsuper-resistant pulse-
\noximeter that is usable for
\nboth adult and pediatric
\npatients in low-resource
\nsettings. It has been
\ndeveloped in collaboration
\nwith WHO and adapted to
\nlocal needs in LMIC. It is
\nresistant to power outages
\nup to 14 hours and
\nunstable electric current,
\nwater-resistant and thanks
\nto its protective case also
\nresistant to falls from
\nheights.(26) Peer-support
\nprogrammes where
\ninterventions can be
\nfollowed and discussed
\nlive via social media are
\nfinding their way into the
\noperating room.
\nInexpensive virtual reality
\nheadsets, like Google
\nCardboard or open source
\nprograms such as Touch
\nSurgery, create local
\npossibilities to improve
\nthe surgical skills of
\nresidents in LMICs.
\n\u2022 However, there is no safe
\nsurgery without safe
\nanaesthesia. The World
\nFederation of Societies of
\nAnesthesiologists and
\nLifebox talked about the
\ncritical need for
\nanaesthesia providers
\nworldwide. LMICs have a
\nlow anaesthesia provider
\nrate (this includes general
\nphysicians providing
\nanaesthesia) ranging
\nbetween 0.19 and 6.89 per
\n100,000 population,
\ncompared to an average of
\n17.96 for the high-income
\ncountries.(27) Or when
\nput in a more general
\ncontext of SAO-provider
\nrate, low-income countries
\nachieve an average of 0.7
\nand lower-middle-income
\ncountries an average of
\n5.5 both per 100.000
\npopulation.(28) These
\nnumbers remain far below
\nthe LCoGS Global
\nSurgery 2030 objective of
\n20 SAO-prividers per
\n100.000, which aims to
\nstrengthen the specialist
\nsurgical workforce
\ndensity. The essential role
\nof anaesthesia in the
\nprovision of surgical care
\nis not always well
\nunderstood by decision
\nmakers, and as a
\nconsequence,
\ndevelopment of
\nanaesthesia care has often
\nbeen given a lower
\npriority than the
\ndevelopment of surgery
\nper se.(29) Lack of
\n14
\ninfrastructure and
\nequipment for anaesthesia
\nprovision in LMICs
\nworsens this situation.
\n\u2022 The conference concluded
\nby briefly touching upon
\nthe topic of women in
\nglobal surgery. Gender is
\nincreasingly being
\ndiscussed during
\nconversations about human
\nresources for health.
\nFemale health workers tend
\nto compensate for the
\nshortcomings of many
\nhealthcare systems around
\nthe world, at times at the
\nexpense of their own health
\nand well-being.(30) Many
\nof these female health care
\nproviders do this in an
\ninformal setting, where
\nthey are poorly supported
\nand poorly paid or not paid
\nat all.(31) When looking
\nspecifically at women in
\nsurgery, the LCoGS,
\nestimates there are only
\naround three females
\nsurgeons for every one
\nmillion people in low
\nincome countries. (32)
\nIGSS2018 a formula for
\nsuccess?
\nCongresses such as IGSS2018
\nhave great potential to be a
\ndriving force for global
\nsurgery. As with any
\nmovement, having some
\norganisations and activities at
\nthe basis is essential to foster
\naction and to provide a means
\nfor the diffusion of ideas.
\nIGSS2018 emphasised the
\ninclusion of participants
\nregardless of gender, ethnicity,
\nprofessional titles, or country
\nof work. A diverse range of
\nspeakers represented the
\ndiverse range of countries and
\nrealities that the topic covers.
\nThe atmosphere in which
\nIGSS2018 took place was one
\nof equity regardless of gender,
\nrace, or professional titles. A
\nfunding program was even
\narranged to cover the traveling
\ncosts of the 11 international
\nscholars. Speakers came from
\nall over the world, so that the
\ncountries and realities that we
\nwere talking about were
\nactually represented in the
\nsymposium itself. IGSS2018
\nwas a home for alike thinking
\npeople to share their
\nexperiences, learn from each
\nother\u2019s stories, and to motivate
\neach other to take on new
\nendeavours. Specialists,
\nresidents, and students all had
\nthe opportunity to build new
\ncontacts, drawing the
\nblueprints for future
\ncollaborations. With
\nconfidence, we can say that
\nIGSS has given rise to new
\nprojects: some participants
\nhave created new InciSioN
\nNational Working Groups after
\nreturning back to their home
\ncountry, others have been
\ninspired to do research in the
\nfield of global surgery, and
\npeople already involved in the
\nfield saw the influence of their
\nwork confirmed.
\nWe believe that IGSS2018
\nprovided an excellent example
\nfor many more symposia to
\ncome: the combination of an
\ninternational audience, diverse
\nand enthusiastic speakers, and
\na shared passion. The general
\nthought permeating the whole
\ncongress was that global
\nsurgery is an important,
\nrecently revived, rapidly-
\nevolving, and exciting field
\nthat more than deserves greater
\nattention, a thought to which
\nwe certainly subscribe to.
\nConclusion
\nGlobal surgical debt and
\naccess to safe surgery is an
\naspect that not only concerns
\nthe doctors of LMICs, but also
\nsurgeons and doctors in high-
\nincome countries and doctors
\nadvising health policies around
\nthe world. We are hopeful for a
\ntime when the geographical,
\npolitical, or socio-economic
\ncircumstance of a person will
\nnot affect access to safe,
\nessential, and timely surgical
\ncare. We are a generation that
\nhas the responsibility to do
\nwhat others could not do in
\npast decades. We live in a time
\nwhere the platform for global
\nsurgery has been established in
\nthe global health arena, and we
\nhave an abundance of
\nopportunities at hand to create
\na world where surgical care
\nwill be truly accessible for all.
\nWe would like to acknowledge the
\nfollowing people for their
\ncontributions towards the writing of
\nthis article. Hanne Gworek
\n(Belgium), Megan E.H. Still (Texas,
\nUSA), Sebastiaan van Meyel (The
\nNetherlands), Florence Van
\nBelleghem (Belgium), and Falke Van
\nWinckel (Belgium).
\nReferences
\n1. Meara JG, M Leather AJ,
\nHagander L, Alkire BC, Alonso
\nN, Ameh EA, et al. Global
\nSurgery 2030: evidence and
\nsolutions for achieving health,
\nwelfare, and economic
\ndevelopment. Lancet [Internet].
\n2015 [cited 2018 Aug 25];386
\n(9993):569\u2013624. Available
\nfrom: https:\/\/doi.org\/10.1016\/
\nS0140-6736(15)60160-X
\n2. World Health Organization.
\nAddress by Dr. H. Mahler
\nDirector-General of the World
\nHealth Organization to the XXII
\nBiennial World Congress of the
\nInternational College of
\nSurgeons. In: Surgery and
\nHealth for All [Internet]. Mexico
\nCity; 1980 [cited 2018 Aug 25].
\np. 4. Available from: http:\/\/
\nwww.who.int\/surgery\/strategies\/
\nMahler1980speech.pdf?ua=1
\n3. Farmer PE, Kim JY. Surgery and
\nglobal health: a view from
\nbeyond the OR. World J Surg
\n[Internet]. Springer; 2008 Apr
\n[cited 2018 Aug 25];32(4):533\u2013
\n6. Available from: http:\/\/
\nwww.ncbi.nlm.nih.gov\/
\npubmed\/18311574
\n4. Debas HT, Donkor P, Gawande
\nA, Jamison DT, Kruk ME, Mock
\nCN. Disease Control Priorities,
\n3rd Edition: Volume 1: Essential
\n15
\nSurgery [Internet]. World Bank.
\n2015. Available from: https:\/\/
\nopenknowledge.worldbank.org\/
\nhandle\/10986\/21568
\n5. Harvard Medical School. Program in
\nGlobal Surgery and Social Change
\n[Internet]. Our Objective. 2018 [cited
\n2018 Aug 26]. p. 1. Available from:
\nhttps:\/\/www.pgssc.org\/the-pgssc
\n6. The World Bank. World
\nDevelopment Indicators [Internet].
\nWorld Development Indicators. 2018
\n[cited 2018 Aug 26]. p. 1. Available
\nfrom: https:\/\/data.worldbank.org\/
\nproducts\/wdi
\n7. World Health Organization. Global
\nInitiative for Emergency and
\nEssential Surgical Care [Internet].
\nWHO. World Health Organization;
\n2017 [cited 2018 Aug 26]. p. 1.
\nAvailable from: http:\/\/www.who.int\/
\nsurgery\/globalinitiative\/en\/
\n8. The G4 Alliance. The G4 Alliance
\n[Internet]. About the G4 Alliance.
\n2016 [cited 2018 Aug 26]. p. 1.
\nAvailable from: http:\/\/
\nwww.theg4alliance.org\/about-the-g4-
\nalliance\/
\n9. Raykar NP, Ng-Kamstra JS, Bickler
\nS, Davies J, Greenberg SLM,
\nHagander L, et al. New global
\nsurgical and anaesthesia indicators in
\nthe World Development Indicators
\ndataset. BMJ Glob Heal [Internet].
\nBMJ Specialist Journals; 2017 Jun 1
\n[cited 2018 Aug 25];2(2):e000265.
\nAvailable from: http:\/\/
\nwww.ncbi.nlm.nih.gov\/
\npubmed\/29225929
\n10. World Health Organization. Draft
\nthirteenth general programme of
\nwork, 2019\u20132023 [Internet]. Geneva;
\n2018 [cited 2018 Aug 26]. Available
\nfrom: http:\/\/apps.who.int\/gb\/ebwha\/
\npdf_files\/WHA71\/A71_4-en.pdf?
\nua=1
\n11. Shawar YR, Shiffman J, Spiegel DA.
\nGeneration of political priority for
\nglobal surgery: a qualitative policy
\nanalysis. Lancet Glob Heal [Internet].
\nElsevier; 2015 Aug 1 [cited 2018
\nAug 26];3(8):e487\u201395. Available
\nfrom: https:\/\/www.sciencedirect.com\/
\nscience\/article\/pii\/
\nS2214109X15000984
\n12. Chao TE, Sharma K, Mandigo M,
\nHagander L, Resch SC, Weiser TG, et
\nal. Cost-effectiveness of surgery and
\nits policy implications for global
\nhealth: a systematic review and
\nanalysis. Lancet Glob Heal [Internet].
\n2014 Jun [cited 2018 Aug 26];2
\n(6):e334\u201345. Available from: http:\/\/
\nwww.ncbi.nlm.nih.gov\/
\npubmed\/25103302
\n13. Grimes CE, Henry JA, Maraka J,
\nMkandawire NC, Cotton M. Cost-
\neffectiveness of Surgery in Low- and
\nMiddle-income Countries: A
\nSystematic Review. World J Surg
\n[Internet]. 2014 Jan 8 [cited 2018 Aug
\n26];38(1):252\u201363. Available from:
\nhttp:\/\/www.ncbi.nlm.nih.gov\/
\npubmed\/24101020
\n14. GlobalSurg Collaborative.
\nManagement and Outcomes
\nFollowing Surgery for Gastrointestinal
\nTyphoid: An International,
\nProspective, Multicentre Cohort
\nStudy. World J Surg [Internet]. 2018
\nMay 3 [cited 2018 Aug 26]; Available
\nfrom: http:\/\/www.ncbi.nlm.nih.gov\/
\npubmed\/29725797
\n15. GlobalSurg Collaborative. The
\nGlobal Surgical Outcomes
\nCollaboration [Internet]. GlobalSurg.
\n2018 [cited 2018 Aug 26]. p. 1.
\nAvailable from: http:\/\/globalsurg.org\/
\n16. GlobalSurg Collaborative. Mortality
\nof emergency abdominal surgery in
\nhigh-, middle- and low-income
\ncountries. Br J Surg [Internet]. 2016
\nJul [cited 2018 Aug 26];103(8):971\u2013
\n88. Available from: http:\/\/
\nwww.ncbi.nlm.nih.gov\/
\npubmed\/27145169
\n17. GlobalSurg Collaborative. An
\ninternational collaborative research
\nnetwork to dexribe variation in global
\ncancer burden. S Afr J Surg [Internet].
\n2017 Sep [cited 2018 Aug 26];55
\n(3):71. Available from: http:\/\/
\nwww.ncbi.nlm.nih.gov\/
\npubmed\/28876581
\n18. GlobalSurg Collaborative.
\nInternational variation in outcomes
\nfollowing cancer surgery. S Afr J Surg
\n[Internet]. 2017 Sep [cited 2018 Aug
\n26];55(3):72\u20133. Available from:
\nhttp:\/\/www.ncbi.nlm.nih.gov\/
\npubmed\/28876585
\n19. GlobalSurg Collaborative. Surgical
\nsite infection after gastrointestinal
\nsurgery in high-income, middle-
\nincome, and low-income countries: a
\nprospective, international, multicentre
\ncohort study. Lancet Infect Dis
\n[Internet]. 2018 May [cited 2018 Aug
\n26];18(5):516\u201325. Available from:
\nhttp:\/\/www.ncbi.nlm.nih.gov\/
\npubmed\/29452941
\n20. GlobalSurg Collaborative.
\nLaparoscopy in management of
\nappendicitis in high-, middle-, and low
\n-income countries: a multicenter,
\nprospective, cohort study. Surg
\nEndosc [Internet]. 2018 Aug 5 [cited
\n2018 Aug 26];32(8):3450\u201366.
\nAvailable from: http:\/\/
\nwww.ncbi.nlm.nih.gov\/
\npubmed\/29623470
\n21. GlobalSurg Collaborative.
\nDeterminants of morbidity and
\nmortality following emergency
\nabdominal surgery in children in low-
\nincome and middle-income countries.
\nBMJ Glob Heal [Internet]. 2016 Dec
\n[cited 2018 Aug 26];1(4):e000091.
\nAvailable from: http:\/\/
\nwww.ncbi.nlm.nih.gov\/
\npubmed\/28588977
\n22. Lancet Commission on Global
\nSurgery. Global Indicator Initiative
\n[Internet]. Lancet Commission on
\nGlobal Surgery. 2015 [cited 2018 Aug
\n26]. p. 1. Available from: http:\/\/
\nwww.lancetglobalsurgery.org\/
\nindicators
\n23. InciSioN. InciSioN [Internet].
\nInciSioN. 2018 [cited 2018 Aug 26].
\np. 1. Available from: http:\/\/
\nincisionetwork.org\/
\n24. InciSioN. IGSS2018 Conference
\nBooklet [Internet]. InciSioN. 2018
\n[cited 2018 Aug 26]. p. 1\u201331.
\nAvailable from: https:\/\/issuu.com\/
\nincision\/docs\/
\nigss2018_booklet_print_final_2
\n25. World Health Organization.
\nProjections of mortality and burden of
\ndisease, 2004-2030 [Internet]. Health
\nstatistics and information systems.
\nWorld Health Organization; 2014
\n[cited 2018 Aug 26]. p. 1. Available
\nfrom: http:\/\/www.who.int\/healthinfo\/
\nglobal_burden_disease\/
\nprojections2004\/en\/
\n26. Acare Technology. Lifebox Pulse
\nOximeter [Internet]. Taipei; 2018
\n[cited 2018 Aug 26]. Available from:
\nhttp:\/\/www.lifebox.org\/wp-content\/
\nuploads\/2018\/06\/Lifebox-
\nPulseOximeter-AH-M1-DM-2-
\n20180409.pdf
\n27. Kempthorne P, Morriss WW, Mellin-
\nOlsen J, Gore-Booth J. The WFSA
\nGlobal Anesthesia Workforce Survey.
\nAnesth Analg [Internet]. 2017 Sep
\n[cited 2018 Aug 26];125(3):981\u201390.
\nAvailable from: http:\/\/
\ninsights.ovid.com\/crossref?
\nan=00000539-201709000-00039
\n28. Holmer H, Lantz A, Kunjumen T,
\nFinlayson S, Hoyler M, Siyam A, et
\nal. Global distribution of surgeons,
\nanaesthesiologists, and obstetricians.
\nLancet Glob Heal [Internet]. Elsevier;
\n2015 Apr 27 [cited 2018 Aug 26];3
\n(Special Issue):S9-11. Available from:
\nhttp:\/\/www.ncbi.nlm.nih.gov\/
\npubmed\/25926323
\n29. Walker I, Wilson I, Bogod D.
\nAnaesthesia in Developing Countries.
\nAnaesthesia [Internet]. Wiley\/
\nBlackwell (10.1111); 2007 Dec [cited
\n2018 Aug 26];62(s1):2\u20133. Available
\nfrom: http:\/\/doi.wiley.com\/10.1111\/
\nj.1365-2044.2007.05288.x
\n30. George A. Nurses, community health
\nworkers, and home carers: gendered
\nhuman resources compensating for
\nskewed health systems. Glob Public
\nHealth [Internet]. 2008 Apr [cited
\n2018 Aug 26];3(sup1):75\u201389.
\nAvailable from: http:\/\/
\nwww.ncbi.nlm.nih.gov\/
\npubmed\/19288344
\n31. Dal Poz MR. Understanding women\u2019s
\ncontribution to the health workforce
\n[Internet]. Lancet. 2008 [cited 2018
\nAug 26]. Available from: https:\/\/
\nwww.thelancet.com\/pdfs\/journals\/
\nlancet\/PIIS0140-6736(08)60289-
\n5.pdf?code=lancet-site
\n16
\nMore than half way through this term, it is time
\nfor us to reflect once more on the achievements
\nour Network has accomplished, and to set sight
\non the future.
\nWe have continued to grow, and now the JDN
\ncomprises members from over 70 countries and
\ncounting. Standardization of our processes, re-
\nporting and terms of reference has been com-
\npleted. We have a newly revamped newsletter,
\nwhose quality reflects the enthusiasm, profes-
\nsionalism and hard work of a dedicated publica-
\ntions and management teams. Our Strategic
\nPlan, through a lengthy and comprehensive con-
\nsultative process, is now complete and ready for
\napproval. We have worked to strengthen our
\ncollaboration with Regional Platforms. We are
\nproud of our engagement with the European
\nJunior Doctors Permanent Working Group, and
\nare looking forward towards building bridges
\nwith other regions around the world.
\nOn the external front, we have continued our
\nengagement on Climate Change, and Antimi-
\ncrobial Resistance, among others, and we have
\nstrengthened our position as a Global Actor ad-
\nvocating for Human Resources for Health, as
\nwell as the role of physicians and Junior Doc-
\ntors in the provision of Primary Care services.
\nWe are now a full member of the World Federa-
\ntion for Medical Education\u2019s Council, and we
\nlook forward to further contributions to various
\nGlobal advocacy issues.
\nThe Junior Doctors Network this year celebrat-
\ned its 7th
\nanniversary. This adventure started in
\n2010 in Vancouver, and has continued to grow
\nexponentially. Every day, more young doctors
\nare joining the JDN to connect with colleagues
\nand work towards matters of interest to them
\nlocally and nationally, but also current issues in
\nthe global health realm.
\nOnce more, I would like us to remember the
\nmission we set for our network to: \u201cEmpower
\nyoung physicians to work together towards a
\nhealthier world through advocacy, education
\nand international collaboration\u201d.
\nI would like to thank the management team, and
\neach and every one of you who has spent time
\nand effort for the advancement on our network
\nthis year. This tremendous work would not have
\nbeen possible without your dedication.
\nPlease remember that the JDN team is always
\nopen to your suggestions and feedback,
\nLooking forward to meeting many of you in
\nIceland,
\n17
\nA Word from the Chair
\nCaline S. Mattar, MD
\nChair, Junior Doctors Network,
\nWorld Medical Association
\nDear colleagues from around the world,
\n18
\nOpportunities to talk to doctors around the world
\nacross generations
\nKazuhiro Abe, MD
\nPublications Director, Junior Doctors Network,
\nWorld Medical Association
\nI am pleased to present the 14th issue of the
\nJunior Doctors Network (JDN) Newsletter to
\njunior doctors around the world.
\nThe 13th
\nissue of the JDN Newsletter was pub-
\nlished by the JDN in April 2018. For the first
\ntime in two years, it was also released on the
\nWorld Medical Association (WMA) website
\nand mailing list. We were very pleased that our
\ndedicated efforts to promote this high-quality
\nscientific product were acknowledged. I believe
\nthat the JDN newsletter should empower criti-
\ncal analysis and reflection on essential global
\nhealth topics among junior doctors around the
\nworld. In addition, I expect that the JDN
\nNewsletter will be a catalyst to encourage com-
\nmunication between WMA and JDN members
\nas well as between national medical associa-
\ntions and junior doctors in each country across
\ngenerations.
\nThis 14th
\nissue includes thought-provoking arti-
\ncles prepared by junior doctors about their com-
\nmunity health initiatives and experiences. I
\nhope that these articles will add value and in-
\nsight for all readers.
\nIn publishing this issue, I sincerely express my
\nappreciation for the outstanding efforts of all
\neditors of the JDN publications team, officials
\nof the JDN management team, and leaders of
\nthe WMA. Please enjoy the articles published
\nin this 14th
\nissue.
\nDear JDN colleagues,
\nCaline S. Mattar, MD
\nChibuzo Ndiokwelu, MD
\nHelena Chapman, MD, PhD, MPH
\nKonstantinos Roditis, MD, MSc
\nMariam Parwaiz, MB ChB, MPH (Hons)
\nMineyoshi Sato, MD
\nRicardo Correa, MD, EsD
\nWunna Tun, MBBS, MD
\n(alphabetical order)
\nEditors in the Publications Team 2017-2018
\n* The JDN Publications Team requests volunteers to assist with editing article submissions and
\nchecking English grammar. If you are interested in this opportunity, please feel free to email our
\nteam at jdn-publications@googlegroups.com.
\nThe Junior Doctors
\nNetwork (JDN) is made up
\nof junior doctors who
\nindependently join the
\nWorld Medical Association
\n(WMA) as Associate
\nMembers, although many
\nare also representatives of
\ntheir respective National
\nMedical Associations.
\nIts mission is:
\n\u201cEmpowering young
\nphysicians to work together
\ntowards a healthier world
\nthrough advocacy, education
\nand international
\ncollaboration\u201d.
\nJunior Doctors Network
\nNewsletter
\n14th issue
\nISSN (print) 2415-1122
\nISSN (online) 2312-220x
\nPublished by the Junior
\nDoctors Network, World
\nMedical Association on
\nOctober, 2018.
\nOpinions expressed in this
\nnewsletter do not necessarily
\nreflect WMA and JDN
\npolicy or positions.
\nContact:
\njdn@wma.net
\nJunior Doctors Leadership 2017-2018
\nJapan
\nKazuhiro Abe
\nPublications Director
\nCaline S. Mattar
\nChair
\nLebanon
\nChukwuma Oraegbunam
\nDeputy Chair
\nNigeria
\nKonstantinos Roditis
\nSecretary
\nGreece
\nYassen Tcholakov
\nSocio-Medical Affairs Officer
\nCanada
\nAudrey Chloe Fontaine
\nEducation Director
\nFrance
\nSydney Chileshe
\nMedical Ethics Officer
\nZambia
\nChiaki Mishima
\nMembership Director
\nJapan
\nChibuzo Obiora Ndiokwelu
\nCommunications Director
\nNigeria
\n19
\nAhmet Murt
\nImmediate Past Chair
\nTurkey
\nPaxton Bach
\nImmediate Past Deputy Chair
\nCanada<\/p>\n"},"caption":{"rendered":"

Junior Doctors Network Newsletter Index Working conditions and leadership education: the topics of JDN Meeting in Riga …………………………. 1 Report from WMA European Region Meeting on End-of-Life Questions 4 A report of the WMA African region meeting on End-of-Life Questions hosted by the Nigerian Medical Association in Abuja, Nigeria from February 1-2, 2018…….. 7 Report […]<\/p>\n"},"alt_text":"","media_type":"file","mime_type":"application\/pdf","media_details":{"sizes":{"thumbnail":{"file":"14th-issue-of-JDN-NL_P2-pdf-106x150.jpg","width":106,"height":150,"mime_type":"image\/jpeg","source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2018\/09\/14th-issue-of-JDN-NL_P2-pdf-106x150.jpg"},"medium":{"file":"14th-issue-of-JDN-NL_P2-pdf-212x300.jpg","width":212,"height":300,"mime_type":"image\/jpeg","source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2018\/09\/14th-issue-of-JDN-NL_P2-pdf-212x300.jpg"},"large":{"file":"14th-issue-of-JDN-NL_P2-pdf-724x1024.jpg","width":724,"height":1024,"mime_type":"image\/jpeg","source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2018\/09\/14th-issue-of-JDN-NL_P2-pdf-724x1024.jpg"},"full":{"file":"14th-issue-of-JDN-NL_P2-pdf.jpg","width":1058,"height":1497,"mime_type":"application\/pdf","source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2018\/09\/14th-issue-of-JDN-NL_P2-pdf.jpg"}}},"post":null,"source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2018\/09\/14th-issue-of-JDN-NL_P2.pdf","_links":{"self":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/media\/11444"}],"collection":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/media"}],"about":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/types\/attachment"}],"author":[{"embeddable":true,"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/comments?post=11444"}]}}