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wmj201403<\/a><\/p>\n

COUNTRY
\n\u2022 World Health Assembly Week
\n\u2022 WMA members
\nvol. 60
\nMedicalWorld
\nJournal
\nOfficial Journal of the World Medical Association, INC
\nG20438
\nNr. 3, September 2014
\nCover picture from LATVIA
\nEditor in Chief
\nDr. P\u0113teris Apinis
\nLatvian Medical Association
\nSkolas iela 3, Riga, Latvia
\nPhone +371 67 220 661
\npeteris@arstubiedriba.lv
\neditorin-chief@wma.net
\nCo-Editor
\nProf. Dr. med. Elmar Doppelfeld
\nDeutscher \u00c4rzte-Verlag
\nDieselstr. 2, D-50859 K\u00f6ln, Germany
\nAssistant Editor
\nVelta Poz\u0146aka
\nwmj-editor@wma.net
\nJournal design and
\ncover design by
\nP\u0113teris Gricenko
\nLayout and Artwork
\nThe Latvian Medical Publisher
\n\u201cMedic\u012bnas apg\u0101ds\u201d,
\nPresident Dr. Maija \u0160etlere,
\nKatr\u012bnas iela 2, Riga, Latvia
\nCover painting: \u201cMedicus curat, natura sanat\u201d,
\n1997, by Latvian graphic artist Guntars\u00a0Sieti\u0146\u0161
\nPublisher
\nThe World Medical Association, Inc. BP 63
\n01212 Ferney-Voltaire Cedex, France
\nPublishing House
\nPublishing House
\nDeutscher-\u00c4rzte Verlag GmbH,
\nDieselstr. 2, P.O.Box 40 02 65
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\nThe magazine is published bi-mounthly.
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\nSubscription fee \u20ac 22,80 per annum (incl. 7%
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\nAssociation and for Associate members the
\nsubscription fee is settled by the membership
\nor associate payment. Details of Associate
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\nMedical Association website
\nwww.wma.net
\nPrinted by
\nDeutscher \u00c4rzte-Verlag
\nCologne, Germany
\nISSN: 0049-8122
\nDr. Margaret MUNGHERERA
\nWMA President
\nUganda Medical Association
\nPlot 8, 41-43 circular rd., P.O. Box
\n29874
\nKampala
\nUganda
\nDr. Leonid EIDELMAN
\nWMA Chairperson of the Finance
\nand Planning Committee
\nIsrael Medical Asociation
\n2 Twin Towers, 35 Jabotinsky St.
\nP.O.Box 3566, Ramat-Gan 52136
\nIsrael
\nDr. Masami ISHII
\nWMA Vice-Chairman of Council
\nJapan Medical Assn
\n2-28-16 Honkomagome
\nBunkyo-ku
\nTokyo 113-8621
\nJapan
\nDr. Cecil B. WILSON
\nWMA Immediate Past-President
\nAmerican Medical Association
\n515 North State Street
\n60654 Chicago, Illinois
\nUnited States
\nSir Michael MARMOT
\nWMA Chairperson of the Socio-
\nMedical-Affairs Committee
\nBritish Medical Association
\nBMA House,Tavistock Square
\nLondon WC1H 9JP
\nUnited Kingdom
\nDr. Guy DUMONT
\nWMA Chairperson of the Associate
\nMembers
\n14 rue des Tiennes
\n1380 Lasne
\nBelgium
\nDr. Xavier DEAU
\nWMA President-Elect
\nConseil National de l\u2019Ordre des
\nM\u00e9decins (CNOM)
\n180, Blvd. Haussmann
\n75389 Paris Cedex 08
\nFrance
\nDr. Heikki P\u00c4LVE
\nWMA Chairperson of the Medical
\nEthics Committee
\nFinnish Medical Association
\nP.O. Box 49
\n00501 Helsinki
\nFinland
\nProf. Dr. Frank Ulrich
\nMONTGOMERY
\nWMA Treasurer
\nHerbert-Lewin-Platz 1
\n(Wegelystrasse)
\n10623 Berlin
\nGermany
\nDr. Mukesh HAIKERWAL
\nWMA Chairperson of Council
\n2\/174 Millers Road\/PO Box 577
\nAltona North, VIC 3025
\nAustralia
\nDr. Otmar KLOIBER
\nWMA Secretary General
\n13 chemin du Levant
\n01212 Ferney-Voltaire
\nFrance
\nWorld Medical Association Officers, Chairpersons and Officials
\nOfficial Journal of the World Medical Association
\nOpinions expressed in this journal\u00a0\u2013 especially those in authored contributions\u00a0\u2013 do not necessarily reflect WMA policy or positions
\nwww.wma.net
\n81
\nAfter 50 years of the World Medical Jour-
\nnal, we have come to a point where a major
\nchange must be made: We are going virtual.
\nFor those who love a tangible paper prod-
\nuct to hold in your hand, scribble notes in
\nthe margins, and file on your bookshelves,
\nthis is a sad departure from an old tradi-
\ntion. At the same time, we must acknowl-
\nedge that an attractive on-line journal can
\nreach more people than our printed journal
\never could. New media consumers expect
\ninteractive formats with graphics and vid-
\neos, and better searchability will facilitate
\nmore targeted and versatile communica-
\ntions with our members, as well as with
\nother interested persons and institutions.
\nWe will take this departure as a step for-
\nward, as an opportunity to reach out and
\ncreate a greater impact.
\nThe recent Ebola outbreak in West-Africa is
\nlikewise a signal to change: The health and
\nhealth care situation in many if not most
\nof the poor countries in Africa is no longer
\nan acceptable situation for this world. The
\ncrisis response\u00a0 \u2013 our own and that of the
\nglobal community\u00a0 \u2013 has been poor if not
\nnegligent. The countries affected have not
\ninvested enough in their health care systems
\nand the international community has done
\nwhat does best: actively looking away until
\nthe problem far away became a threat to the
\nwhole world. Meanwhile, the rich countries
\ncontinue their devastating trend of brain
\ndrain from the poor countries of this world.
\nWe must develop adequate response mech-
\nanisms to counteract such outbreaks, to
\ncontain the spread of these diseases, to care
\nfor the infected, to maintain acceptable liv-
\ning conditions in the affected regions dur-
\ning such crisis.But we also have to put more
\npressure on world leaders and national poli-
\nticians to address our contribution to the
\nunderlying social causes of these disasters:
\nour unequal sharing of resources, our exclu-
\nsive trade policies, and our arms deals that
\nfuel conflicts in the poor parts of this world.
\nThe leaders within these countries will have
\nto address the corruption and the abuse
\nof foreign aid funding, and foster internal
\ncommitment to investment in health and
\nhealth care. Ebola is only one time bomb
\nthat is ticking. Simply hoping that all this
\nresolves itself alone is not a solution.
\nIn Ukraine, we experience a conflict be-
\ntween two nations, which, until very recent-
\nly in history, we barely discerned as separate
\nnations. In a time of a common European
\nMarket, the conflict in Ukraine\u00a0\u2013 without
\njudging who may be right or wrong\u00a0\u2013 strikes
\nus as a wholly unacceptable way of coexist-
\ning on this planet. And in other parts of
\nthis world, more and more radical groups
\nshow blatant disrespect the most basic rules
\nof human behaviour, not to mention re-
\nspect for those who care for the ill and the
\nwounded.
\nTwenty-five years ago, we believed the gaps
\nwere beginning to close and our global
\nproblems seemed to be lessening. But that
\nwas a mistake. There is no doubt that our
\nintensive international cooperation as pro-
\nfessionals, dedicated to caring, to healing
\nand to relieving suffering, is more necessary
\nthan ever.This, in itself, is reason enough to
\nintensify our efforts for cross-boarder col-
\nlaboration and common standard setting.
\nOur World Medical Journal is just one tool
\nwe can use in this most important under-
\ntaking.
\nOtmar Kloiber
\nEditorial
\n50 Years and Beyond
\n82
\nWMA News
\nThe sixty-seventh session of the World
\nHealth Assembly (WHA) took place in
\nGeneva from 19\u201324 May. It was attended
\nby many representatives from the World
\nMedical Association and National Medi-
\ncal Associations who spoke at scores of side
\nevents and other conferences during the
\nweek. Dr. Margaret Mungherera, President
\nof the WMA, and Dr. Mukesh Haikerwal,
\nChair, addressed a number of meetings. As
\nusual, it was often the informal discussions
\nbetween events that proved to be the most
\nuseful. A r\u00e9sum\u00e9 of some of the formal
\nevents follows.
\nWorld Health Professions
\nRegulation Conference
\nOn May 17 and 18, the weekend before
\nthe WHA opened, the World Health Pro-
\nfessions Alliance held another successful
\nconference on regulation at the Crown
\nPlaza Hotel, Geneva.This followed similar
\nevents held in 2008 and 2010. The main
\nobjectives of the conference were to evalu-
\nate the challenges facing health profes-
\nsional regulation and to identify and pro-
\nmote best practices.
\nA succession of keynote speakers and pan-
\nellists from around the world addressed
\nthe conference of senior physicians, nurses,
\ndentists, physical therapists and pharma-
\ncists from more than 45 countries. Among
\nthem were Dr. Mungherera and Annabel
\nSeebohm, legal advisor to the WMA.
\nDr. Mungherera spoke about the key chal-
\nlenges and experiences of health practi-
\ntioner regulation in Africa, and evolving
\nscopes of practice and inter-professional
\ncollaboration. She said that the challenges
\nin Africa included the perception of gov-
\nernments about professional autonomy,
\nclinical independence and self-regulation
\nof the health professions. Strategies to ad-
\ndress these challenges included establishing
\nan enabling legal framework, creating struc-
\ntures that ensured efficient decentralised
\nfunctions supported by sufficient resources,
\nand continued efforts to ensure all health
\nprofessionals had an in-depth understand-
\ning of their ethical obligations and their
\nrights to professional autonomy and clinical
\nindependence.
\nDr. Mungherera said that evolving scopes
\nof practice of health professionals and in-
\nter-professional collaboration in African
\ncountries also created regulatory challeng-
\nes. Strengthening health systems was one
\nmeans of achieving universal health care.
\nEfforts to improve health human resourc-
\nes in African countries were increasingly
\ntargeted at the primary health care level.
\nShe spoke about the provision of effective
\nhealth care across primary health care, in-
\ncluding in situations of armed conflict. She
\nalso referred to migration within the Afri-
\ncan continent and especially across borders
\nwhich created a huge challenge for regula-
\ntion. However this could be addressed, at
\nleast in part, by regional collaboration. She
\nadded that many other regulatory related
\nchallenges needed to be addressed to ensure
\na sustainable and effective health system
\nin Africa, such as the selection of students
\ninto health training schools, curriculum is-
\nsues especially around the teaching of clini-
\ncal ethics and ensuring health profession-
\nals remained competent through access to
\nCPD\u00a0\u2013 especially for health professionals in
\nremote and rural areas.
\nAnnabel Seebohm spoke about the impact
\nof standardisation initiatives in Europe
\nand the global lessons for health profes-
\nsional regulation and the challenges facing
\nhealth professional regulation. She said
\nthat current initiatives by the European
\nUnion affected health professional regula-
\ntion in several ways and flowed from the
\nEuropean Union mandates in health care
\nand the internal market. European Union
\ncompetencies were based on the Treaty of
\nLisbon. After then, the European Union
\naction respected the responsibilities of
\nMember States for the definition of their
\nhealth policy and for the organization
\nand delivery of health services and health
\ncare. The exercise of the health profes-
\nsions, along with all the rules and regula-
\ntions which applied to their activities af-
\nfected the organization of health services
\nand health care and was therefore Member
\nStates\u2019 responsibility. Nevertheless, specific
\nexamples showed that health professional
\nregulation was and would be highly influ-
\nenced by European Union initiatives.
\nFollowing the conference, leaders of the
\nmain health professions issued a press re-
\nlease urging their members to pay more at-
\ntention to regulation issues and implement
\nthe right systems in order to act in the pub-
\nlic interest.
\nThey concluded that in the face of the
\nmany challenges facing health professions
\nand their patients globally\u00a0\u2013 changing de-
\nGeneva Report for WMJ
\nWorld Health Assembly Week
\nNigel Duncan
\n83
\nWMA News
\nmography, increased expectations of health
\nservices, more mobile professionals\u00a0\u2013 there
\nis a greater need than ever for regulation
\nsystems that ensure quality of service and
\nprotect the public.
\nThey said that participants at the conference
\nagreed that different systems of regulation
\nsuited different national environments, but
\nwhatever the model, regulation was a re-
\nsponsibility and a public duty,not an option.
\nRegulation systems should be underpinned
\nby accountability and responsiveness and
\nshould observe principles such as checks
\nand balances between stakeholders, and
\npatients and professionals being aware of
\nrights and duties.
\nThere was agreement between WHPA
\nmembers (the International Council of
\nNurses, the International Pharmaceutical
\nFederation, the World Confederation for
\nPhysical Therapy, the World Dental Feder-
\nation and the World Medical Association)
\nthat the goals of health professional regu-
\nlation should be person-centred, involving
\npatient care, patient rights and patient safe-
\nty. They should also take into account so-
\ncial and economic welfare and professional
\npractice.
\n\u2018Regulation has started to feature more
\nprominently in many policy debates,\u2019 said
\nJudith Shamian, President of the Interna-
\ntional Council of Nurses. \u201cThe problem is
\nthat in most countries far too few people
\nunderstand the advantages and disadvan-
\ntages of different regulatory systems.\u2019
\nMichel Buchmann, President of the Inter-
\nnational Pharmaceutical Federation, said:
\n\u2018A regulation model that takes into account
\ninter-professional collaborative practice
\nis most likely to be effective. There now
\nneeds to be a sustained political commit-
\nment to effective regulation by both deci-
\nsion makers and professionals. Profession-
\nals themselves, who can be guarantors of
\ncompliance, have a leadership role to play
\nin regulation.\u2019
\nMarilyn Moffat, President of the World
\nConfederation for Physical Therapy said:
\n\u201cIt is clear that there is no single model for
\na good regulatory system, but all should
\nensure that physical therapists and other
\nhealth professionals provide safe and com-
\npetent care\/services. Regulatory bodies also
\nneed to understand the day-to-day realities
\nof the health professions they are seeking to
\nregulate.\u201d
\nMargaret Mungherera, President of the
\nWorld Medical Association said: \u2018There are
\nsignificant challenges and obstacles in many
\nparts of the world, such as Africa, where
\nthere is a negative perception of govern-
\nments about professional autonomy, clini-
\ncal independence and self-regulation. This
\nneeds to change\u2019.
\nTin Chun Wong, President of the World
\nDental Federation said: \u2018We expect the
\nhealth professions as well as the pub-
\nlic to play a major role whenever profes-
\nsional regulation is under discussion. The
\nWHPA will continue to promote learning
\nand information-sharing on this important
\nsubject.\u2019
\nMeanwhile the WMA\u2019s Junior Doctors
\nNetwork was holding its own meeting to
\ndiscuss their response to the various issues
\nbeing raised during the World Health As-
\nsembly week. The issue of medical educa-
\ntion was high on their agenda of topics that
\nwere discussed.
\nWorld Health Assembly
\nThe World Health Assembly opened on the
\nMonday and WHO Director General Dr.
\nMargaret Chan addressed the gathering of
\nrepresentatives from all over the world.
\nShe spoke about the international spread
\nof polio virus and the fact that at the end
\nof 2013, 60 per cent of polio cases resulted
\nfrom international spread, with strong evi-
\ndence that adult travellers were playing a
\nrole. She said the causes of this could be
\nfound in armed conflicts, civil unrest, mi-
\ngrant populations, weak border controls,
\npoor routine immunization coverage, bans
\non vaccination by militant groups and the
\ntargeted killing of polio workers. These fac-
\ntors were largely beyond the control of the
\nhealth sector.
\nShe referred to the disruptive effects of
\nrising inequality and economic exclusion
\non social cohesion and stability, about the
\nwarnings on climate change and the health
\neffects of air pollution.
\nShe said there was no good evidence that
\nthe prevalence of obesity and diet-related
\nnon-communicable diseases was receding
\nanywhere. Highly processed foods and bev-
\nerages loaded with sugar were ubiquitous,
\nconvenient, and cheap. She expressed her
\ndeep concern at the increasing prevalence
\nof childhood obesity in every region of the
\nworld, with the increase fastest in low and
\nmiddle-income countries. And she said
\nshe had established a high-level Commis-
\nsion on Ending Childhood Obesity. What
\nshe expected from the Commission was a
\nstate-of-the-art consensus report on which
\nspecific interventions, and which combina-
\ntions, were likely to be most effective in dif-
\nferent contexts around the world. She had
\nasked the Commission to deliver its report
\nto her in early 2015 so that she could convey
\nits recommendations to next year\u2019s Health
\nAssembly.
\nWorld Health Professions
\nAlliance Reception
\nOn Monday, the WHPA held its annual
\nluncheon reception at the InterContinen-
\ntal Hotel on the theme of \u2018Health Care in
\nDanger\u2019.
\nDr.Mungherera welcomed the guests with a
\nbrief introduction. She made the point that
\nin areas of conflict where health care was at-
\ntacked, it was largely local health personnel
\n84
\nWMA News
\nand facilities that were worst affected. She
\nsaid that health ministers around the world
\nshould be informed about this situation so
\nthat they could become involved. In addi-
\ntion, ministers needed the support of all
\nstakeholders. Finally, it was important to
\nput in place indicators to measure and mon-
\nitor all incidents and the measures taken.
\nThe keynote speaker at the event was Ms
\nChristine Beerli, Vice President of the In-
\nternational Committee of the Red Cross.
\nShe said the ICRC had documented 1,809
\nincidents of assaults or threats against pa-
\ntients, health care personnel, ambulances
\nand health care facilities between January
\n2012 and December 2013. Yet this repre-
\nsented only the tip of the iceberg.The statis-
\ntics were that 168 health care personnel had
\nbeen killed, 267 had been injured, 564\u00a0kid-
\nnapped or arrested and 212 threatened. The
\nnumber of patients killed or wounded to-
\ntalled 545 and 410 healthcare facilities had
\nbeen attacked or looted. In addition 351
\nambulances had been attacked, robbed or
\ndelayed.
\nMs. Beerli said this was unacceptable and
\nshowed the urgency of protecting the medi-
\ncal missions. Local health care providers ac-
\ncounted for 91 per cent of the documented
\nincidents. The perpetrators included state
\narmed forces, such as the military and po-
\nlice and armed non-state actors. However
\nthe ICRC \u2018Health Care in Danger\u2019 project,
\nlaunched in 2011, was on track, first to im-
\nprove the safety, quality and timeliness of
\nmedical services in armed conflict and also
\nto engage the various stakeholders in find-
\ning and promoting practical solutions to
\nprotect health care. A broad community of
\nconcern was being built.
\nBut she said more needed to be done, and
\nshe mentioned several specific require-
\nments. Health ministers had to be brought
\non board because they had an essential role
\nto play and they needed the support of all
\nstakeholders, such as national medical as-
\nsociations, nursing associations and oth-
\ners. And finally indicators to measure and
\nmonitor the effects of incidents had to be
\nput in place.
\nWMA\/IFMSA Seminar
\nOn the Tuesday the annual WMA lunch-
\ntime seminar was held at the Chateau de
\nPenthes on the topic of \u2018Doctors Fighting
\nViolence against Women and Girls\u2019. The
\nevent was jointly organised with the Inter-
\nnational Federation of Medical Students\u2019
\nAssociations and with the support of the
\nNorwegian Agency for Development Co-
\noperation and the Ministry of Health and
\nWelfare of Taiwan.
\nThe first guest speaker was Taiwan\u2019s Health
\nMinister Chiu Wen-ta, who told the gath-
\nering about his country\u2019s efforts to prevent
\nviolence against women. He said that Tai-
\nwan had made huge efforts to prevent vio-
\nlence targeting women, including passing
\nseveral acts to regulate and prevent violent
\ncrimes targeting women, such as the Do-
\nmestic Violence Prevention Act of 1998
\nand the Sexual Harassment Prevention
\nAct of 2005. Taiwan was the first country
\nin Asia to implement the Sexual Assault
\nCrime Prevention Act in 1997.
\nHe said that Taiwan was dedicated to the
\ncause of gender mainstreaming and had
\nhad gender mainstreaming policies since
\n2003. These had focused on assessing the
\ndifferent implications for women and men
\nin legislation and government programs.
\nIn addition, Taiwan had signed the Con-
\nvention on Elimination of All Forms of
\nDiscrimination against Women of the
\nUnited Nations in 2007, and an enforce-
\nment act was passed by the Legislature in
\n2011 to implement the international codes
\nfor protecting women\u2019s rights passed the
\nenforcement rules.
\nHe said that Taiwan\u2019s efforts had paid off,
\nciting figures showing 18 percent of women
\nlast year suffered violence at the hands of
\nan intimate partner, lower than the world
\naverage of 30 percent estimated by the
\nWorld Health Organization. The Ministry
\nof Health had launched a program with
\n24-hour hotlines, counselling, emergency
\nassistance, and events to raise community
\nawareness of the issue. And according to
\nministry statistics, in 2013 alone, the pro-
\ngram provided 990,000 consultations for
\ndomestic violence victims and 180,000 con-
\nsultations for sexual assault victim
\nThe second keynote speaker was Professor
\nSir Michael Marmot,Director of University
\nCollege London Institute of Health Equi-
\nty, and chair of the World Medical Asso-
\nciation\u2019s Socio-Medical Affairs Committee.
\nHe outlined the extent of domestic violence
\naround the world. It was a global public
\nhealth concern with one in three women
\nthroughout the world experiencing physical
\nand\/or sexual violence by a partner or sexual
\nviolence by a non partner.In many countries
\nmarried women believed a husband was jus-
\ntified in beating a wife if she refused to have
\nsex. Education, however, was key, he said.
\nThe more educated women were the less
\nlikely they were to think that violence from
\na husband was justified.
\nSir Michael said that although domes-
\ntic violence was evident across all classes,
\neconomic and ethnic groups, the statistics
\nshowed that this pattern of behaviour was
\nmore prevalent among the less well educat-
\ned. A study among nine countries showed
\nthat those women most likely to report
\nhaving experienced violence were married
\nat a young age, had multiple children and
\na family history of domestic violence be-
\ntween their parents. As well as resulting in
\nmurder and injury, domestic violence also
\nled to suicide, induced abortions, depres-
\nsive disorders and alcohol problems. And
\nwomen with mental health disorders were
\nalso more likely to have experienced domes-
\ntic violence.
\nHe said that physicians and health profes-
\nsionals had to be more active in this field.
\n85
\nWMA News
\nStaff training in equality and diversity is-
\nsues should be improved so that physicians
\nand others could detect more easily cases of
\nabuse among their patients and could ask
\nrelevant questions. He suggested that phy-
\nsicians should routinely ask their women
\npatients about domestic abuse where they
\nhad reason to suspect violence, a leading
\ndoctor said today. Physicians should ask
\nabout domestic abuse more often so that it
\nnormalised the question.
\n\u2018For instance, much domestic abuse starts
\nduring a woman\u2019s pregnancy and physicians
\nshould be aware that asking questions dur-
\ning this time is particularly effective. Pre-
\nviously silent women may come forward
\nbecause of fear of harm to their baby\u2019. In
\naddition, he said, women and girls should
\nbe empowered through education and social
\nsupport.
\nDr.Mungherera,who also spoke,said:\u2018Do-
\nmestic \u201cGender Based Violence\u201d was only
\none of the many forms of violence that
\nwomen experienced worldwide. In conflict
\nsituations, sexual violence was common
\nand was often associated with physical
\nviolence and abductions. Unwanted preg-
\nnancies, HIV\/AIDS, mental disorders and
\ntraumatic fistula were common complica-
\ntions.
\n\u2018In addition, low use of family planning
\nservices has also been associated with GBV
\nand hence the need to integrate such servic-
\nes into the reproductive health services. It is
\nalso important that GBV is included in the
\npre-service training and continuing educa-
\ntion curricula of physicians and other health
\nworkers. GBV services should be integrated
\ninto mental health and primary care ser-
\nvices and these should be made available
\nuniversally.\u2019
\nIn a press release about the event, Dr.
\nMungherera added: \u2018The recent kidnapping
\nof young Nigerian girls illustrates in the
\nmost horrific way this devastating scourge.
\nIt is not enough to deplore the magnitude
\nof the phenomenon. Urgent, strong and
\nconcrete policies must be taken now with
\nthe participation of all sections of society,
\nincluding the health sector, to meet this
\nmajor global public health, gender equality
\nand human rights challenge.\u2019
\nWMA Presentations to
\nWorld Health Assembly
\nDuring the week the WMA made several
\npresentations to the Assembly on behalf
\nof the World Health Professions Alliance.
\nAmong them were:
\nMonitoring the Achievement of
\nthe Health-Related Millennium
\nDevelopment Goals
\n\u2018We would like to commend WHO in its
\nefforts to make sure health remains central
\nin the post-2015 development agenda. In
\nthe lead-up to the 69th
\nsession of the Gen-
\neral Assembly, where the post-2015 devel-
\nopment framework will be discussed, we
\nwould like to see the following points sup-
\nported by WHO:
\n\u2018The \u201cHealth across all stages of life\u201d goal
\nshould be clearly stated in the framework
\nand include targets on communicable and
\nnon-communicable diseases, mental health,
\nsexual and reproductive health and family
\nplanning, maternal and child health, and
\nneglected tropical diseases, as well as the
\nsocial determinants of health.
\nUniversal health coverage should be ac-
\nknowledged as a means of achieving
\nhealth for all, not an end in itself. Only by
\nstrengthening holistic health care systems
\nand linking them to the social determinants
\nof health can we improve the health status
\nof all people.
\nThe interdependence of the development
\ngoals should be recognized, emphasiz-
\ning health as critical to their achievement.
\nHealth is particularly important in attain-
\ning the goals in education, gender equality,
\neradication of poverty and environmental
\nsustainability,including minimizing the im-
\npact of climate change on people\u2019s health.
\nTo demonstrate this interdependence, we
\nsuggest that all development goals include
\nthe health-related indicators.\u2019
\nPrevention and Control of
\nNon-communicable Diseases
\n\u2018We would like to commend WHO on
\nthe progress made in the implementa-
\ntion of the 2008-2013 Action Plan for
\nthe Global Strategy for the Prevention
\nand Control of NCDs following the UN
\nHigh-Level Meeting in September 2011.
\nWe, however, have several concerns with
\nregard to the Terms of Reference (TOR)
\nfor the Global Coordination Mechanism
\nand would appreciate your attention to
\nthese matters:
\n\u2018Structure of the coordinating mecha-
\nnism\u00a0 \u2013 The TOR states that participants
\nwill include non-state actors along with
\nthe UN funds, programs and agencies.
\nHowever, the rules and terms of participa-
\ntion for non-state actors are not clear. The
\nterm itself \u201cparticipants\u201d is vague and non-
\ncommittal. We suggest the use of the term
\n\u201cpartners\u201d instead and a clear definition of
\nthe partnership requirements and selection
\ncriteria.
\nDefinition of non-state actors\u00a0\u2013 We believe
\nthat the implementation of the Action Plan
\nwill depend on the tireless work and com-
\nmitment of healthcare workers at the na-
\ntional level.Professional associations are key
\nto facilitating the translation of the global
\npolicy into action on the ground. This is
\nparticularly important within the context of
\nmoving towards universal health coverage
\nand integrating NCDs into the post-2015
\ndevelopment agenda. We propose that the
\nrole and expectations of professional asso-
\nciations in the TOR be more clearly defined
\n86
\nWMA News
\ninstead of merely counting them as \u201cnon-
\nstate\u201d actors.
\nWorking groups\u00a0 \u2013 The eligibility criteria,
\nfunction and expected outputs of the work-
\ning groups are not clear. We suggest a more
\nclear definition of their role and functions
\nin the final TOR, and we also suggest mak-
\ning resources available to support their ac-
\ntivities.\u2019
\nThe Global Challenge of Violence, in
\nParticular Against Women and Girls
\n\u2018We welcome the report addressing the
\nglobal challenge of violence, in particular
\nagainst women and girls, which features
\nthe magnitude of the global scourge of the
\nphenomenon. We deplore the costs of vio-
\nlence, its devastating health consequences
\non society as a whole. Violence against
\nwomen is a manifestation of structural in-
\nequalities between women and men. We
\nunderscore the crucial need for policies ad-
\ndressing specifically violence from a gender
\nperspective.
\n\u2018Furthermore, although we support
\nWHO\u2019s activities to combat violence
\nthrough multi-sectorial approaches, we
\nbelieve that there is more to be done.
\nPhysicians have a unique role to play
\nin combating this, one of the most se-
\nvere human rights violations. They see
\nthe health problems individuals face in
\nthe context of that person, their family,
\ncommunity, workplace and all the other
\ncomplex factors that affect their health
\nand their recovery from illness. The views
\nof physicians must therefore be incorpo-
\nrated systematically into any comprehen-
\nsive strategies to prevent and respond to
\nviolence.
\nPhysicians and their health professionals\u2019
\ncolleagues are at the frontline in the pro-
\nvision of comprehensive services in sup-
\nport of victims, ensuring that violence is
\nidentified, documented and victims reha-
\nbilitated. We believe that specific, quality
\nand affordable training must be further
\ndeveloped in medical schools and in the
\nframework of Continuing Professional
\nDevelopment. Such a requirement should
\nbe reflected by Member States, WHO and
\nother international agencies in their com-
\nmitments to stop violence.
\nFinally, given the alarming rate of sexual
\nviolence in humanitarian emergency sit-
\nuations, we demand of Members States,
\nWHO and other relevant UN agen-
\ncies that they strengthen their response
\nto violence against women and girls in
\nsituations of conflicts, as a matter of ur-
\ngency.\u2019
\nWorld Medical Association
\nWelcomes Major Step
\nForward on Palliative Care
\nAt the end of the week,the Assembly unan-
\nimously approved a resolution on palliative
\ncare and the WMA responded with the fol-
\nlowing press release:
\n\u201cThe World Medical Association has wel-
\ncomed last week\u2019s decision by the World
\nHealth Assembly to provide greater support
\nfor palliative care.
\nFollowing years of pressure from the pal-
\nliative care movement supported by the
\nWMA, the WHA adopted a resolution
\nwhich aims to ensure that palliative care
\nis integrated into all relevant global dis-
\nease control and health system plans. This
\ninvolves including palliative care as an in-
\ntegral part of the education and training of-
\nfered to care providers.
\nDr. Margaret Mungherera, President of the
\nWMA, said: \u2018The WMA has long argued
\nfor better palliative care for those millions
\nof people who are suffering pain without
\naccess to adequate treatment. This must in-
\nclude education of the public and of health-
\ncare professionals, to overcome barriers to
\neffective pain management.
\n\u2018We are delighted that the World Health
\nAssembly has now recognised the need for
\nbetter basic training and continuing edu-
\ncation for all undergraduate medical and
\nnursing courses, and as part of in-service
\ntraining of caregivers at the primary care
\nlevel. Only in this way can we improve the
\ncurrent level of palliative care required by
\nmore than 40 million people around the
\nworld.
\n\u2018It is the ethical duty of physicians to al-
\nleviate pain and suffering. Palliative care is
\nfundamental to improving people\u2019s quality
\nof life and well-being. It is a matter of hu-
\nman dignity and human rights.
\n\u2018In too many countries there are no satisfac-
\ntory palliative care services and I hope that
\nlast week\u2019s decision in Geneva will be a ma-
\njor step forward.\u2019\u201d
\nAfrica Project
\nDuring the week, Dr. Mungherera ad-
\ndressed many meetings about the Africa
\nProject that she had pursued since becom-
\ning President of the WMA. She spoke
\nabout progress in involving African na-
\ntional medical associations more in the
\nactivities of the WMA with the aim of
\nstrengthening the health systems in their
\ncountries. She said African NMAs were
\ngenerally too weak to play their capacity
\nbuilding and advocacy role. Yet with ade-
\nquate capacity, and networking opportuni-
\nties from the WMA, NMAs in Africa had
\nthe potential to positively influence the
\nquality of health care in their countries by
\npromoting standards in medical education,
\nregulation and clinical practice of doc-
\ntors. She had visited many of the African
\nNMAs and planned to visit more in the
\ncoming months.
\nMr. Nigel Duncan,
\nPublic Relations Consultant, WMA
\n87
\nINDIA Child Abuse
\nIntroduction
\nThe UN Convention on the Rights of the
\nChild (UN CRC) (1989) is the most widely
\nendorsed child rights intrument worldwide,
\nwhich defines children as all persons up to
\nthe age of 18 years [1].
\nDefining violence and children protection
\nrights, the Convention declares \u201cStates
\nParties shall take all appropriate legisla-
\ntive, administrative, social and educational
\nmeasures to protect the child from all forms
\nof physical or mental violence, injury or
\nabuse, neglect or negligent treatment, mal-
\ntreatment or exploitation, including sexual
\nabuse, while in the care of parent(s), legal
\nguardian(s) or any other person who has the
\ncare of the child.\u201d [1,2]
\nThe World Health Organisation (WHO)
\nhas defined \u201cChild Abuse\u201d as a violation of
\nbasic human rights of a child, constituting
\nall forms of physical,emotional ill treatment,
\nsexual harm, neglect or negligent treatment,
\ncommercial or other exploitation,resulting in
\nactual harm or potential harm to the child\u2019s
\nhealth, survival, development or dignity in
\nthe context of a relationship of responsibil-
\nity, trust or power. \u201cChild Neglect\u201d is stated
\nto occur when there is failure of a parent\/
\nguardian to provide for the development of
\nthe child, when a parent\/guardian is in a po-
\nsition to do so (where resources available to
\nthe family or care giver; distinguished from
\npoverty). Mostly neglect occurs in one or
\nmore area such as: health, education, emo-
\ntional development, nutrition and shelter.
\n\u201cChild maltreatment\u201dsometimes referred to
\nas child abuse and neglect,includes all forms
\nof physical and emotional ill-treatment, sex-
\nual abuse, neglect, and exploitation that re-
\nsults in actual or potential harm to the child\u2019s
\nhealth, development or dignity. Within this
\nbroad definition, five subtypes can be dis-
\ntinguished\u00a0 \u2013 physical abuse; sexual abuse;
\nneglect and negligent treatment; emotional
\nabuse; and exploitation [3]. Failure to ensure
\nchild right to protection adversely affects all
\nrights.Besides,Child protection is critical to
\nthe achievement of Millennium Develop-
\nment goals (MDG). These MDGs can\u2019t be
\nachieved unless child protection is an inte-
\ngral part of program & strategies to protect
\nchildren from child labour, street children,
\nchild abuse, child marriage, violence in
\nschool and various forms of exploitation.
\nChild Abuse & Neglect (CAN) is a world-
\nwide social and public health problem,
\nwhich exerts a multitude of short and long
\nterm effects on children. The consequence
\nof children\u2019s exposure to child maltreatment
\nincludes elevated levels of post-traumatic
\nstress disorder, aggression, emotional and
\nmental health concerns, such as anxiety and
\ndepression. A well designed epidemiologic,
\nAdverse Childhood Experiences (ACEs)
\nStudy [4] revealed a high risk of heart dis-
\nease in adult survivors of maltreated chil-
\ndren, after correcting for age, race, educa-
\ntion, smoking & diabetes.
\nSeveral developed countries of the world
\nhave well-developed child protection sys-
\ntems, primarily focused on mandatory re-
\nporting, identification and investigations of
\naffected children, and often taking coercive
\naction. The burden of high level of notifi-
\ncations and investigations is not only on
\nthe families, but also on the system, which
\nhas to increase it\u2019s resources [5]. In these
\ncontexts, the problems of child abuse and
\nneglect in India need serious and wider
\nconsideration, particularly among the un-
\nderprivileged rural and urban communities,
\nwhere child protection systems are not de-
\nveloped\u00a0\u2013 or do not reach.
\nMagnitude of Problems, Chal-
\nlenges & Types of Child Abuse
\nIndia has about 440 million children; they
\nconstitute more than 40 per cent of the
\npopulation. Each year, 27 million babies
\nare born. Many face unsafe birth, and many
\ndo not survive them. Many more struggle
\nthrough childhoods of privation and risk,
\nand fail to reach their full potential. As
\nthe poor vastly out-number the non-poor,
\na large majority of these births are among
\nthe underprivileged section of the popu-
\nlation, where the parents cannot provide
\nproper care to their children. The situation
\nof the newborn and the periods of infancy
\nand early childhood are particularly critical
\nand the morbidity and mortality rates con-
\ntinue to remain very high. Maternal under-
\nnutrition,unsafe deliveries,low birth weight
\nbabies and poor newborn care, lack of ad-
\nequate immunizations, poor nutrition and
\nunsafe water, neglect of early development
\nand learning opportunities are major issues
\nthat need to be appropriately addressed [6].
\nOne can argue that many of these defi-
\ncits are of under-development rather than
\nof safety, but this is debatable: childhood
\nrights must include protection against ne-
\nglect and negligent treatment, and the de-
\nnial of services is negligence. Social and
\ncultural defaults in child-rearing practices
\nreflect social norms and very often adverse
\ntraditions are passed from one generation to
\nthe next, especially in illiterate and poorly
\ninformed communities, and are extremely
\nresistant to change. As guardians of health,
\nChild Abuse & Neglect in India:Time to Act
\nNarendra Saini
\n88
\nINDIAChild Abuse
\nthe IMA has to plan and manifest its effort
\nto address child abuse in this reality.
\nAn obvious challenge is
\nthat of magnitude
\nThe numbers in need of care and protection
\nare huge and increasing. Extreme poverty,
\ninsecurity of daily living, illiteracy and lack
\nof education, result in very little care to the
\nchild during the early formative years. Even
\nservices that are operating nation-wide, and
\nare mandated to offer free or virtually free
\nservices are poorly run and often poorly uti-
\nlized.The financial allocation for health care
\nis far too small, despite some increases. The
\nallocation of attention to health surveillance
\nand to the social aspects of public health
\nseems even smaller.
\nThe urban under-privileged, large migrating
\npopulations and neglected rural communities
\nare particularly affected. In large cities, there
\nis more physical infrastructure and availabil-
\nity of basic services, but major inequalities
\nin access and genuine coverage. Pavement
\ncommunities, including street children on
\ntheir own, and child labourers employed
\nin menial and un-protected work are espe-
\ncially at risk and without support. Migrants
\nand their children seem invisible to services
\nthat require the so-called \u201cclient\u201d to produce
\nproof of a location address. Other children
\nin difficult circumstances such as those shut
\naway in institutions, those affected by disas-
\nters, those in conflict zones; refugees, HIV\/
\nAIDS-affected,and children with disabilities
\nneed appropriate care and rehabilitation [6].
\nThe Central budget allocation for child
\nprotection has never even reached 50 paisa
\n(half a rupee) of every 100 rupees pledged
\nfor social development. This grave resource
\nchallenge calls for re-examination. It also
\ncalls for stronger voices from the public and
\nmedical constituencies.
\nAbsence of monetary investment and lack
\nof economic capacity are important con-
\ncerns. But child abuse knows no class or
\nlivelihood barriers, or age buffers. It threat-
\nens and afflicts children up and down the
\neconomic ladder, and up and the 0\u201318 age
\nspectrum.The IMA recognizes the need for
\ndiagnostic detection of children at risk\u00a0 \u2013
\nand the importance of finding ways to act
\nto help children who appear to be at risk.
\nA Government of India, Ministry of Wom-
\nen & Child Development (2007) survey
\nshowed that the prevalence of all forms
\nof child abuse is extremely high (physical
\nabuse (66%), sexual abuse (50%) and emo-
\ntional abuse (50%) [7]. A more recent study
\nby the National Commission for Protec-
\ntion of Child Rights (NCPCR), conducted
\namongst 6,632 children respondents, in
\n7\u00a0states; revealed 99% children face corporal
\npunishment in schools [8].
\nIndian Medical Association
\n(IMA) perspective
\nThe term \u201cprotection\u201d relates to protection
\nfrom all forms of violence, abuse, and ex-
\nploitation. This underlines the importance
\nof anticipating and averting what might
\nhappen to damage and demean a child\u00a0\u2013 not
\njust response to hurt inflicted. Moreover, it
\ncalls for a deeper and wider comprehen-
\nsion of what protection means. Based on
\nour understanding, the Indian Child Abuse,
\nNeglect & Child Labour (ICANCL) group
\nand Indian Medical Association (IMA) has
\nstrongly propagated the view that \u201cprotec-
\ntion\u201d must also include protection from dis-
\nease, poor nutrition, and lack of knowledge,
\nin addition to action against abuse and ex-
\nploitation. This infers that the denial of
\nsuch safeguards does constitute negligence
\nor neglect, both of which are included in
\nthe internationally recognized definition of
\nviolence.
\nThe 9th
\nISPCAN Asia Pacific Conference of
\nChild Abuse & Neglect (APCCAN 2011)
\nconference outcome document \u201cDelhi Dec-
\nlaration\u201d re-affirmed and pledged a resolve
\nto stand against the neglect and abuse of
\nchildren and to strive for achievement of
\nchild rights and the building of a caring
\ncommunity for every child, free of violence
\nand discrimination. It urged and asserted
\nthe urgent need to integrate principles,
\nstandards and measures in national plan-
\nning processes, to prevent and respond to
\nviolence against children [9, 10].
\nThe concept of a \u201ccaring community\u201d as
\nchildren\u2019s right, conceived by eminent In-
\ndian public health expert Dr. Eric Ram a
\ngeneration ago, argues that every sectoral
\nentity, every service or infrastructure touch-
\ning a child\u2019s daily life\u00a0\u2013 and every person in
\nany of these\u00a0\u2013 every arm of the State and
\nits institutions\u00a0\u2013 has the potential to be a
\n\u201ccaring community\u201d for children. It is an
\nissue of attitude, of not just giving care to
\nthe child, but caring about what happens to
\na child, and thus honouring the ethics that
\nshould guide any dealings with any child.
\nIndia\u2019s Approach to Promotion
\n& Protection of Children
\nThe Government has assigned focal respon-
\nsibility for child rights and development to
\nthe Ministry of Women and Child Devel-
\nopment (MWCD). The sectoral manage-
\nment of schemes by this and other central
\nministries has not given children the con-
\nvergent attention they deserve. Health care
\nservices are in one sectoral portfolio, child
\ndevelopment and nutrition in another,youth
\nservices affecting older children in another,
\nand education in yet another, and services
\nfor children with disability parked in yet
\nanother, and projects for children rescued
\nfrom labour in yet another. The focal point
\nministry has not so far managed holistic co-
\nordination of planning, programming and
\nmonitoring very effectively. The National
\nCommission for Protection of Child Rights,
\nset up in 2007, enquires, investigates, and
\nrecommends but lacks autonomy and any
\nauthority to act. The same limitation holds
\nfor State-level commissions [8].
\nNGOs and civil organizations and fo-
\nrums: India has a strong presence of non-
\ngovernmental bodies, networks, commu-
\nnity-based organizations, civic forums and
\npeoples\u2019 campaigns. In recent years, these
\norganizations and platform have sharpened
\ntheir focus on protection issues. The news
\n89
\nINDIA Child Abuse
\nmedia are also increasingly alert in playing a
\nwatch-dog role.
\nHaving accepted the treaty obligation of
\nimplementing the UN Convention on the
\nRights of the Child in 1992,the Government
\nof India has reported thrice to the UN on na-
\ntional effort to realize these rights. Its latest
\n(2011) report lists some welcome forward-
\nlooking legislations and actions, but unfor-
\ntunately lacks information on impact of laws
\nand programmes and actual benefits [11].
\nThe official routing of services and commu-
\nnications to the family as the receiving unit
\nfails to address the need to reach children
\nplaced in any situation or setting other than
\na family or household location. Children
\nmust be sought and reached where they are,
\nnot where they should conventionally be.The
\nIMA can see this is as a working challenge in
\ntrying to access children in need\u00a0\u2013 in insti-
\ntutions, in street groups, in work-places, on
\nthe move, or even in prisons. Linkage with
\nNGOs connected to such kinds of settings
\nmay be considered as an outreach option.
\nGeneral Measurers of Implementation
\nTo address national child right commit-
\nments, several policies, laws and pro-
\ngrammes have been introduced. The core
\ncommitment is still the one that India en-
\nshrined in the Constitution: to safeguard
\nchildren \u201cagainst exploitation and from
\nmoral and material abandonment.\u201d A new
\nNational Policy for Children (2012) has just
\nreplaced the 1974 policy [12].That hallmark
\nexpression of commitment recognised chil-
\ndren to be \u201ca supreme national asset\u201d and
\naccorded \u201cparamount importance\u201d to their
\nbest interests in all situations of dispute.The
\nnew policy also expresses firm commitment
\nto children\u2019s rights, but gives their interests
\n\u201cprimary\u201d rather than \u201cparamount\u201d status.
\nThe past decade has produced some positive
\nofficial assertions of commitment.(See Note
\nto the report).The challenge predictably lies
\nin translating policy into programmes, and
\nthen carrying programmes into practice.
\nThe State\u2019s development enterprise in India
\nalso urgently needs good monitoring and
\nregular reporting. Much of the data given in
\nofficial national reports is old,and some of it
\nis consequently not representative of exist-
\ning realities.This must improve.
\nEffective Systems for
\nChild Protection
\nWhose responsibility is it to ensure the
\nsafe, protective and caring environment that
\nevery child deserves? Ideally, the parents
\nshould be responsible for proper care and
\nprotection of their child. Every birth should
\nbe planned and all births registered. How-
\never, the child must not suffer in case the
\nparents cannot provide care and protection.
\nIt is the duty of the proximate community
\nand the Government at large to address the
\nissues of care and protection.In this respon-
\nsibility, the State and its institutions must
\nfunction pro-actively at all levels of gover-
\nnance and service.
\nThe UN CRC does not absolve either family
\nor community or society at large of care and
\nprotection of children. But it firmly puts the
\nonus on the State. Governments are the ul-
\ntimate duty bearer.In India,the State should
\nensure that all vulnerable children have the
\nassurance of the best anticipatory, preventive
\nand restorative protection of their right to
\nlife, survival, well-being and dignity. India\u2019s
\nnew National Policy for Children [12] reaf-
\nfirms the promise of the original 1974 policy
\nin pledging protective care to children \u201cbe-
\nfore, during and after birth and throughout
\nthe period of growth.\u201d In practical terms,
\nthis must include access to comprehensive
\nhealth care and nutrition, learning and play,
\nsocial welfare and the protecting hand of
\nlaw. Integrated child protection systems can
\ncontribute to breaking the cycle of child-
\nhood insecurity and exploitation.
\nRole of Government
\nIndia should not need to be reminded that
\nthe ultimate responsibility to protect a na-
\ntion\u2019s children lies with the State.The Con-
\nstitution of India recognised and affirmed
\nthis in 1950, by pledging to safeguard
\nchildren against \u201cexploitation, and moral
\nand material abandonment.\u201d By ratifica-
\ntion of international instruments such as
\nUN CRC, by recognising international
\nstandards such as UN General Comment
\n#13, the Government should commit ap-
\npropriate legislative, administrative, social
\nand educational measures to prevent and
\nprotect children from maltreatment [13]. In
\n1992, India accepted the obligations of the
\nUN Convention on the Rights of the Child
\n(CRC).The National Commission for Pro-
\ntection of Child Rights (NCPCR) was es-
\ntablished in 2007 with a mandate of enquiry
\nand investigation. However, there is a wide
\ngap between (i) policy and implementation
\nand between (ii) practice and outcome, and
\nmillions of children fall through the gaps.
\nGovernment should assign adequate child
\nprotection budgets and its officials should
\nalso ensure that Governmental funds are
\nproperly utilised. The \u201cchild\u2019s voice\u201d must
\nbe heard by the policymakers! Both the
\nState and professional bodies must also give
\nmore attention to the need for services and
\nschemes to be more than reactive, and be-
\ncome proactively preventive. There may be
\ndesign faults as well as delivery faults: both
\nrequire detection and correction. Otherwise
\nhealth attentions as well as safety attention
\nare only in \u201cresponse\u201d mode. For many chil-
\ndren, this may be too little, and too late.
\nRole of Non Government
\nOrganisations (NGOs)
\nA large number of NGOs are working in the
\nfield of child welfare and child protection,
\nand many have created valuable models of
\nprevention, intervention and rehabilitation.
\nHowever, because of the huge numbers of
\nchildren requiring protection, their efforts
\ncan make only a marginal impact.The larger
\nand central responsibility falls on the State.
\nIt is for the State, as well, to bring together
\ndifferent professions and disciplines to make
\ncommon cause in defence of children\u2019s safety
\nand security. Professional bodies can high-
\nlight this potential by taking the initiative
\n90
\nINDIAChild Abuse
\nto make connections and to converge efforts.
\nThis the IMA has set out to do.
\nRole of the community
\nWherever the parents are unable to take care
\nand protect the child,the proximate commu-
\nnity and their elected representatives must
\ntake up more caring responsibility, with due
\ndiligence and also due benevolence. Thus,
\nrural panchayats (local self government) and
\nurban local councils can ensure that every
\nchild is safely born, receives basic health care
\nand nutrition, and protection from abuse
\nor neglect\u00a0\u2013 and can feel secure throughout
\nchildhood. India\u2019s policy assures this. But in
\npractice, even the first moment of survival
\ncan fall prey to abusive neglect.This is where
\nthe medical professional must be available,
\naware and attentive [14\u201315].
\nEducation, Empowerment and Enabling
\nMechanisms: Families and the community
\nmust be educated, informed and enabled
\nso that they can provide care and protec-
\ntion to their children. All those entrusted
\nwith the child\u2019s upbringing and develop-
\nment must learn that the best approaches
\nare non-violent.Parental guidance and basic
\nsupport to vulnerable families must be ex-
\npanded. In India, the Government cannot
\nafford to separate children from their vul-
\nnerable families and place them in institu-
\ntions. Such approaches are also being chal-
\nlenged in more developed countries as well.
\nWhat most families need is some extra sup-
\nport to cater for their children, in the form
\nof sponsorship schemes, social protection
\nprogrammes. Awareness of their rights and
\ninformation about governmental assistance
\nwould ensure proper utilization of various
\n\u201cschemes\u201d [16\u201317].
\nRole of Multi-disciplinary professionals,
\nthe private sector, religious institutions:
\nIn India, there is also an urgent need for
\nappropriately trained multi-disciplinary
\nprofessionals and human resources to make
\nservices for children viable and effective.
\nBesides these professionals, all educated
\npersons, the private sector and religious in-
\nstitutions can do more for child protection
\nand child welfare. Children are not some-
\none else\u2019s responsibility.
\nAttitudes, Traditions, Customs, Behav-
\niour & Practices: There is need to under-
\nstand social norms and traditions and their
\neffect on children and their right to safety\u00a0\u2013
\nand to condemn harmful practices and sup-
\nport those that are positively protective. A
\nmajor attitudinal change in civil society is
\ncalled for. Any institution that senses this
\nshould make the first move.
\nMany protective traditions and practices
\nexist, such as strong family values. How-
\never, certain stereotypes, attitudes and social
\nnorms that violate the rights of the child
\nalso persist, such as the use of corporal pun-
\nishment as a way to discipline children or
\nthe social acceptance of child labour. Other
\nharmful practices associated to gender roles,
\nsuch as child marriage or gender-biased sex
\nselection, manifest a patriarchal and hierar-
\nchic attitude towards girls and women, who
\nare still seen by many as a liability or as pa-
\nraya dhan (someone else\u2019s wealth or property
\nof the marital family) [18].
\nThe traditional acceptance of caste and oc-
\ncupational divisions, and the perception that
\nthey represent a justified socio-cultural lad-
\nder has been legally questioned and limited
\nor banned\u00a0\u2013 but it persists, and imposes an
\nidentity-based restriction on many children\u2019s
\nfair access to rights and opportunities. This
\nconstitutes abuse. A better understanding of
\nthose norms and attitudes, are necessary to
\npromote social change in the best interest of
\nthe child.
\nRecommendations & Plan
\nfor a Way Forward
\nProfessional organisations and their infra-
\nstructures must not be found wanting in
\nefforts to make India safe for children. The
\nIndian Medical Association is a nation-
\nwide entity, with a large membership of
\ntrained professionals not only trained to
\nsave and safeguard lives, but pledged to
\ndo so. The Hippocratic Oath is already a
\npromise made by every medical practitio-
\nner, carrying a pro-active commitment to
\nbe healers.
\nSurvival, early child health care, nutrition,
\neducation, development and child protec-
\ntion are most crucial child rights. In India,
\nchild rights, protection and exploitation
\nare intimately linked to socio-cultural and
\neconomic inequalities. The deprived sec-
\ntions of society may not know all their
\nrights, and may not have high expectations.
\nBut the State does know, and so do profes-
\nsional bodies that all children have equal
\nrights and entitlement to priority attention
\nand care. Multi-disciplinary professionals
\nshould step forward and work together to
\nmake such attention and care a reality ac-
\ncessible to every child [19].
\nIt is important for professionals and their
\ninstitutions to monitor the government
\nefforts in protection of child rights. They
\nshould be able to collate available national
\nchild health indicators, address key issues
\nand concerns in their spheres of operation,
\nand promote and support necessary re-
\nsearch. They must also monitor their own
\nperformance of their own chosen duties
\nand responsibilities.We can be proud of our
\nservice to the nation. But there is always
\nmore for us to do. What we now propose
\nis in keeping with our pledge to be the best
\nmedical professionals possible.
\nThe prevention of sickness, the relief of in-
\njury, the service of relieving pain and suf-
\nfering, and of both preventing the loss or
\nbreakdown of health and well-being, and
\nof restoring them, is already our chosen
\nvocation. The protection of human dignity
\nin facing and overcoming hurt is a part of
\nmedical service.
\nAddressing the underprivileged,
\nvulnerable families and
\ncommunities as a priority
\nIn the process of voluntary service in un-
\nderserved regions of our country, some of
\nour IMA member\u2019s learnt some important
\nlessons from the vulnerable families and
\ncommunities. The most important lesson
\nwas that public awareness about child abuse
\n91
\nINDIA Child Abuse
\n& neglect has to be raised & society atti-
\ntudes have to change. Children should have
\nknowledge regarding life skills, child rights
\nand participation.
\nConsistent implementation &
\nstrict enforcement of laws
\nAdequate Legislative framework and their
\nconsistent implementation & enforcement
\nare very important. Beyond rationalization
\nof existing laws, the main challenge in In-
\ndia remains their enforcement and the fact
\nthat there is a certain degree of impunity for
\nthose violating the law. For instance, if one
\ncompares the prevalence of child marriage in
\nIndia (43% of women aged 20-24 were mar-
\nried before they were 18) and the numbers of
\npeople prosecuted for violating the anti-child
\nmarriage law (a few hundred per year,at best),
\nit is evident that the law is not enforced [18].
\nMedical Professionals:Training
\non Child Rights and Protection
\nMedical professionals are specially man-
\ndated to report cases of child sexual abuse,
\nunder the \u201cThe Protection of Children from
\nSexual Offences Act (POCSO), 2012\u201d.
\nHowever, the Indian Medical Association
\n(IMA) is aware that hardly any training is
\nimparted to medical students, doctors and
\nallied child health professionals in India on
\nChild Rights and Protection and how to re-
\nport cases of Child Abuse? [21].
\nTherefore, IMA has decided to recommend
\nto the Medical Council of India (MCI)
\n(statutory body with the responsibility of
\nestablishing and maintaining high stan-
\ndards of medical education and recogni-
\ntion of medical qualifications in India) to
\nadvocate necessary changes in curriculum,
\nteaching, training and practice of medical
\nprofessionals, undergraduates as well.
\nMedical Professionals to take a
\nstand against Child Abuse
\nTo take a stand against child abuse is not
\noutside our existing mandate. Children are
\nalready at our door, silently asking us to rec-
\nognize them as the persons most vulnerable
\nto the loss of well-being, and the least able
\nto avoid it. We have a job to do.
\nWe as an association and as a very large
\nnumber of people who know their job\u00a0 \u2013
\nintend to take up the task we have chosen.
\nOur theme was not an idle or forgetful
\nchoice. Our next report should be able to
\ntell how we worked to live up to it.
\nInformation Note to the Report
\nNew National Policy for Children (2013).
\nIt establishes 18 years as the ceiling age of
\nchildhood,and details many of the 1974 pol-
\nicy commitments, adding an affirmation of
\nIndia\u2019s acceptance of the UN CRC,thus rec-
\nognising the UN Convention at policy level.
\nNational Policy for Persons with Disabili-
\nties (2006).The policy recognises that a ma-
\njority of persons with disabilities can have
\na better quality of life if they have access to
\nequal opportunities and effective rehabilita-
\ntion measures.
\nPolicy Framework for Children and AIDS
\nin India (2007).This policy seeks to address
\nneeds of children affected by HIV\/AIDS,
\nby integrating services for them within the
\nexisting development and poverty reduction
\nprogrammes.
\nNational Rehabilitation and Resettlement
\nPolicy (2007) Under this policy, no project
\ninvolving displacement of families can be
\nundertaken without detailed assessment of
\nsocial impact on lives of children
\nNational Urban Housing and Habitat
\nPolicy (2007). The policy seeks to promote
\nsustainable development of habitat and ser-
\nvices at affordable prices in the country and
\nthereby provide shelter to children from
\ndisadvantaged families.
\nNationalPlanofActionforChildren(2005).
\nThe action plan was adopted in response to
\nthe UN General Assembly Special Session
\non Children (2002).It lacked specific activi-
\nties, and implementation fell short of most
\nstated goals and targets. A\u00a0 new national
\nplan is presently being drafted.
\nNational Legislations
\nThe legislative framework for children\u2019s
\nrights is being strengthened with the for-
\nmulations of new laws and amendments to
\nexisting laws.These include the Food Secu-
\nrity Act (2013), The Protection of Children
\nfrom Sexual Offences(POCSO) Act, 2012,
\nRight to Free and Compulsory Education
\nAct (2009), Prohibition of Child Marriage
\nAct (2006), the Commissions for Protec-
\ntion of Child Rights Act (2005), Juvenile
\nJustice (Care and Protection of Children)
\nAct 2000,amended in 2006,Right to Infor-
\nmation Act(RTI) 2005, the Goa Children\u2019s
\n(amendment) Act 2005, the Child Labour
\n(Prohibition & Regulation) Act, 1986 (two
\nnotifications in 2006 & 2008), expanded
\nthe list of banned and hazardous processes
\nand occupation) and the Information and
\nTechnology (Amendment) Act 2008. In
\naddition, there are new legislations are on
\nanvil,such as HIV\/AIDS bill.The two most
\nimportant legislations meant to exclusively
\nprotect children are the following;
\nThe Juvenile Justice (Care and Protec-
\ntion) Act 2000 (amended in 2006) was a
\nkey national legislation. It established a
\nframework for both children in need of care
\nand protection and for children in conflict
\nwith the law. This law is presently being re-
\nviewed for substantive changes, and may be
\nreplaced by a new law.
\nHarmonisation is needed with other existing
\nlaws, such as the Prohibition of Child Mar-
\nriage Act 2006, the Child Labour Prohibi-
\ntion and Regulation Act 1986 or the Right
\nto Education Act 2009. Important contra-
\ndictions exist among these laws,starting with
\nthe definition and age of the child. Conflict
\nwith personal laws should also be addressed,
\nensuring universal protection of children, re-
\ngardless of the community they belong to.
\nProtection of Children from Sexual
\nOffences (POCSO) Act 2012
\nThe Protection of Children from Sexual
\nOffences Act, 2012, specifically address the
\nissue of sexual offences committed against
\nchildren,which until now had been tried un-
\n92
\nINDIAChild Abuse
\nder laws that did not differentiate between
\nadult and child victims. The punishments
\nprovided in the law are also stringent and
\nare commensurate with the gravity of the of-
\nfence. Under this act, various child friendly
\nprocedures are put in place at various stages
\nof the judicial process. Also, the Special
\nCourt is to complete the trial within a period
\nof one year, as far as possible. Disclosing the
\nname of the child in the media is a punish-
\nable offence, punishable by up to one year.
\nThe law provides for relief and rehabilita-
\ntion of the child, as soon as the complaint
\nis made to the Special Juvenile Police Unit
\n(SJPU) or to the local police. Immedi-
\nate & adequate care and protection (such
\nas admitting the child into a shelter home
\nor to the nearest hospital within twenty-
\nfour hours of the report) are provided. The
\nChild Welfare Committee (CWC) is also
\nrequired to be notified within 24\u00a0hours of
\nrecording the complaint. Moreover, it is a
\nmandate of the National Commission for
\nthe Protection of Child Rights (NCPCR)
\nand State Commissions for the Protection
\nof Child Rights (SCPCR) to monitor the
\nimplementation of the Act [20].
\nTelephonic help lines (CHILDLINE
\n1098) and Child Welfare Committees
\n(CWC) under the Juvenile Justice Act (2000)
\nhave been established, where reports of child
\nabuse or a child likely to be threatened to be
\nharmed can be made and help sought.
\nNational Programmes
\nThe Government of India is implement-
\ning several programmes on social inclusion,
\ngender sensitivity, child rights, participation
\nand protection.The approach is based on UN
\nCRC and Millennium Development Goals
\n(MDGs). These programmes include: Inte-
\ngrated Child Development Services(ICDS),
\nSABLA Scheme for Adolescent Girls, and
\nSaksham project for adolescent boys; Ra-
\njiv Gandhi Cr\u00e8che Scheme for children of
\nworking mothers, scheme of assistance to
\nhome for children (Sishu Greh) to promote
\nin-country adoption, Dhanalakshmi- condi-
\ntional cash transfer schemes for girl child,
\nProgramme for Juvenile Justice, Child
\nLine (24-hour toll-free telephone helpline
\n(No. 1098), Integrated Child Protection
\nScheme(ICPS), Integrated program for
\nstreet children,Ujjawala (scheme for preven-
\ntion of trafficking and rescue, rehabilitation,
\nreintegration and repatriation), Sarva Shik-
\nsha Abhiyan National programme for school
\neducation, National Rural Health Mission
\n(NRHM), Mid Day Meal Scheme, Jawaha-
\nrlal Nehru National Urban Renewal Mission
\n(JNNURM), Universal Immunization Pro-
\ngramme (UIP) and Integrated Management
\nof Neonatal & Childhood illness (IMNCI).
\nIntegrated Child Protection
\nScheme (ICPS)
\nThe Ministry of Women and Child Develop-
\nment, Government of India has launched an
\nIntegrated Child Protection Scheme (ICPS)
\n(2009), which is expected to significantly
\ncontribute to the realization of State respon-
\nsibility for creating a system that will effi-
\nciently and effectively protect children. It\u00a0is
\nmeant to institutionalize essential services
\nand strengthen structures, enhance capacity
\nat all levels, create database and knowledge
\nbase for child protection services, strengthen
\nchild protection at family and community
\nlevel and ensure appropriate inter-sectoral
\nresponse at all levels and raise public aware-
\nness. The guiding principles recognize that child
\nprotection is a primary responsibility of the fam-
\nily, supported by community, government and
\ncivil society.The ICPS is an important initia-
\ntive, but is still in its infancy [22].
\nReferences
\n1. UN Convention on the Rights of the Child
\n(with Optional Protocols), available from www.
\nunicef.org\/crc
\n2. UN Committee on the Rights of the Child, 56th
\nsession General Comment No. 13 (2011) Arti-
\ncle 19: The right of the child to freedom from all
\nforms of violence
\n3. World Health Organisation.Child Maltreatment.
\nhttp:\/\/www.who.int\/topics\/child_abuse\/en\/
\n4. Adverse Childhood Experiences (ACEs) Study.
\nDong et al, Circulation, 2004;110:1761
\n5. O\u2019Donnell M, Scott D, Stanley F (2008) Child
\nAbuse & neglect \u2013 is it time for public health
\napproach? Australian & New Zealand Journal of
\nPublic Health 32(4), 325-330.
\n6. Srivastava RN (2011). Child protection: whose
\nresponsibility? CANCL NEWS 11(1), 4-5.
\n7. Study on Child Abuse: India (2007). Ministry
\nof Women and Child Development, Govern-
\nment of India, available from www.wcd.nic.in\/
\nchildabuse.pdf
\n8. Eliminating Corporal Punishment in Schools.
\nNational Commission for Protection of Child
\nRights(NCPCR), available from http:\/\/www.
\nncpcr.gov.in\/publications_reports.htm
\n9. Delhi Declaration. http;www.indianpediatrics.
\nnet\/delhideclaration2011.pdf.
\n10. Srivastava RN. Child Abuse & Neglect: Asia
\nPacific Conference and the Delhi Declaration.
\nIndian Pediatrics 2011; 49:11-12.
\n11. India: Third & Fourth Combined Periodic Re-
\nport on the Convention on the Rights of the
\nChild 2011, available from www.wcd.nic.in
\n12. National Policy for Children (2012), available from
\nhttp:\/\/pib.nic.in\/newsite\/erelease.aspx?relid=94782
\n13. UN Committee on the Rights of the child, 56th
\nsession General comments No 13(2011) Arti-
\ncle\u00a019: The right of the child to freedom from all
\nforms of violence, available from http:\/\/www2.
\nohchr.org\/english\/bodies\/crc\/comments.htm
\n14. Seth R, Banerjee SR, Srivastava RN. National
\nConsultation on Urban Poor. CANCL News
\n2006, 6(2), 12-15.
\n15. Seth R, Kotwal A, Ganguly KK. An ethno-
\ngraphic exploration of toluene abusers among
\nstreet and working children of Delhi, India.
\nSubstance use and misuse 2005, 40:1659-1679.
\n16. Seth R. Care of the Rural Child. CANCL News
\n2008, 8(1):9-13.
\n17. Mody RC, Seth R. Progress report of village
\nBhango: Education and health of rural children.
\nCANCL News 2008, 8(1):23-24.
\n18. Bergua J. UNICEF India. Child Protection Ba-
\nsics 2011, 1-8.
\n19. Srivastava RN. Child health & welfare, panchay-
\nats & rural development. CANCL News 2008,
\n8(1), p3-4.
\n20. The Protection of Children from Sexual Of-
\nfences Act, 2012, available from wcd.nic.in\/child
\nact\/childprotection31072012.pdf
\n21. Aggarwal K, Dalwai S, Galagali P, Mishra D,
\nPrasad C, Thadhani A, et al. Recommendations
\non recognition and response to child abuse and
\nneglect in the Indian setting. Indian Pediatric
\n2010; 47:493-504.
\n22. Integrated Child Protection Scheme (ICPS)
\n(2009), available from www.wcdhry.gov.in\/icps01.
\nhtm
\nDr. Narendra Saini
\nHon. Secretary General, IMA
\n93
\nWMA NewsGERMANY
\nFirst of all, I would like to thank Ms. Al-
\nbrecht, Mr. Bach and Mr. Diehl for imme-
\ndiately agreeing to grant me a little speaking
\ntime when I offered to say a few words on the
\nsubject of poverty and health.
\nI see the award of the Paracelsus Medal as
\nan expression of solidarity on the part of the
\nGerman doctors\u2019 association with the people
\nwho are particularly close to my heart, and to
\nwhom I have devoted my medical work over
\nthe last decades. People living on the fringe of
\nsociety, here and elsewhere.
\nThe debate about the underclass and the
\nprecariat has clearly shown that poverty is
\nan issue that raises many concerns and fears
\namongst the people in Germany. Established
\nfindings on the relationship between and the
\nmutual influence of poverty and health or dis-
\nease have been available in German-speaking
\ncountries for over 20\u00a0years. And yet this con-
\ntext still attracts too little public and profes-
\nsional interest.
\nThe situation of poor people and their prob-
\nlems is a side issue,it is still given way too little
\nattention, especially since the parties involved
\nhave no influential lobby, their needs are not
\nseen as being or allowed to become a priority.
\nIt is this phenomenon of non-consideration,
\nof turning a blind eye, of ignorance which we
\ncan also find in the discussions on the health
\ncare reform and on the co modification of the
\nhealth system.
\nPoverty and its relationship to and impact on
\nhealth and on the development of disease is
\nstill an underestimated and neglected subject
\nin the context of the debate on poverty. Al-
\nthough\u00a0\u2013 particularly in terms of these close
\ncorrelations\u00a0 \u2013 it is clear that poverty in one
\nof the richest countries in the world does not
\nsimply mean a lack of consumer goods, or
\nconvenience, or social participation, but is of-
\nten accompanied by physical and mental suf-
\nfering, by higher morbidity rates, and even a
\nsignificantly lower life expectancy.
\nEven Goethe once said: \u201cEmpty pocket, sick
\nheart.\u201d The relationship between social condi-
\ntions and disease has been proven by numerous
\nsocio-scientific and natural scientific studies.
\nA concrete connection between social sta-
\ntus and disease, with significantly increased
\ndisease prevalence could be found for almost
\nall groups of somatic and mental illness. De-
\npression and suicide rates, amongst others,
\nincreased significantly, unemployed people
\nshow a 20-fold higher suicide rate than the
\nemployed. Poverty causes stress and associated
\nillnesses.
\nIn addition to the morbidity, the mortality of
\npeople experiencing poverty is also higher in
\nour society. Between the richest and the poor-
\nest quarter of the German population,there is a
\ndifference in life expectancy of 11 years for men
\nand 8 years for women. 31% of men affected by
\npoverty do not reach the age of 65. In our open
\nmedical centre, I more and more frequently ex-
\nperience people with life-threatening diseases
\nbeing denied adequate treatment because they
\nhave no health insurance. In Germany, people
\nare dying because the health care system is no
\nlonger there for them when they need it. Be-
\ning poor means being subjected to great psy-
\nchosocial stress, especially in our achievement-
\noriented society. To make matters worse, there
\nis still a negative culture of defamation and
\nfinger-pointing towards socially disadvantaged
\npeople which often causes them to seriously
\ndoubt their own worth.
\nThe so-called health care reforms\u00a0\u2013 are they
\nreally reforms which benefit the people? The
\nchanges in the law already made and those
\nplanned are at the expense of poor and socially
\ndisadvantaged people. High health insurance
\npremiums, additional fees, higher deductibles,
\nthe axing of medical services all lead to further
\nhealth risks and social exclusion. In this con-
\ntext, Amartya Sen addressed the importance
\nof structurally implemented opportunities to
\naccess resources, including health care. He
\nspeaks of capabilities, of realization oppor-
\ntunities, of being able to use and implement
\nexisting individual resources. But it is precisely
\nthis that is becoming more and more difficult,
\nsometimes even impossible, for many people
\nin our society today, due to administrative
\nhurdles.
\nWe cannot just silently accept the brutal
\nprofit-oriented policies of large sectors of the
\npharmaceutical industry. When the chairman
\nof a leading German pharmaceutical compa-
\nny publicly stated at the end of last year that
\nthe cancer drug Nexavar\u00a0\u2013 and I quote: \u201cwas
\nnot developed for the Indian market, but for
\nWestern patients who can afford it,\u201d then this
\nmust be strongly condemned. Mahatma Gan-
\ndhi said more than half a century ago: \u201cPoverty
\nis the worst form of violence\u201d. Sadly, this kind of
\ncorporate behaviour shows that his statement
\nis clearly as accurate today as it was then.
\nEqually important and necessary is our soli-
\ndarity with and practical support for people in
\ncountries which still have a completely inade-
\nquate health care infrastructure, whether these
\nare in Europe\u00a0\u2013 such as Greece\u00a0\u2013 or on other
\nAcceptance Speech for the Paracelsus Medal on the Occasion 117th
\nGerman Medical Assembly on 26th
\n\/27th
\nMay, 2014 in D\u00fcsseldorf
\nGerhard Trabert
\n94
\nWMA News GERMANY
\ncontinents. Countries in which sickness, death
\nand suffering are tragically part of everyday
\nlife. And the causes of which, considering, for
\nexample, the many AIDS sufferers in Africa
\nand their inadequate health and specifically
\nmedicinal care, are to be found also and par-
\nticularly in the greed for profit of European
\nand German corporations.
\nIn our medical centre without restrictions for
\npeople without medical insurance, we are cur-
\nrently constantly confronted with the situa-
\ntion that people who are looking for asylum in
\nGermany are deported. To this respect I must
\nsharply criticize the European Dublin III
\nAgreement under which asylum seekers can
\nat any time be deported to the first European
\ncountry in which they set foot. It is and must
\nbe clear to everyone that deportation to Bul-
\ngaria, Greece or Italy results in these destitute
\npeople seeking help being \u201creleased\u201d into ac-
\ncommodation unfit for human habitation,into
\nhomelessness, or often even being imprisoned.
\nThus, their human rights are not respected,
\nsometimes they are even deported back to the
\ncrisis regions and war zones from which they
\nhave fled. Numerous scientific studies have
\nshown that a large proportion of the people af-
\nfected experience severe post-traumatic men-
\ntal stress disorders. These are often not recog-
\nnized and acknowledged and then exacerbated
\ndue to the repressive and hostile treatment
\nthey are subjected to in the countries of refuge.
\nAs a doctor I have gathered experience with
\nthe suffering of the local people in numerous
\nwar zones. Recently, I attended a medical aid
\nmission in the Lebanon for Syrian war refu-
\ngees.The Lebanon,with a population of only 4
\nmillion people, has taken in over 1 million war
\nrefugees. Germany boasts of taking in 10,000
\nSyrian war refugees. A scandalously low ad-
\nmission quota. At the same time it prevents
\nadmission of these people who are in mortal
\ndanger by imposing repressive regulations
\nculminating in an unacceptable \u201cdeclaration
\nof obligation\u201d for family members of Syrian
\nrefugees. The planned drastic tightening of
\nthe asylum law by the Federal Ministry of the
\nInterior will dramatically worsen the situa-
\ntion, especially the health situation, for many
\npeople. Conclusion: European regulations and
\nthe associated deportation practices are un-
\njust, unsocial and endanger the lives of many
\npeople in need. Germany should also not be
\nthinking about stepping up its military in-
\nvolvement in the world, but its humanitarian
\nefforts. This makes me sad and angry at the
\nsame time. We must not remain silent.
\nOnce again we hide behind laws, rules and
\nregulations and don\u2019t see the individual suffer-
\ning that we create through the implementa-
\ntion of these unjust regulations. Abb\u00e9 Pierre,
\nthe French priest who, amongst other things
\nfounded the Emmaus movement, once said:
\n\u201cRespect laws if their application shows respect
\nfor the people themselves.\u201d These legal regula-
\ntions clearly do not do so. In this regard, we
\ndoctors have to make a stand and fight for these
\npeople even more actively and vehemently.
\nThe Danish therapist Jesper Juul has \u201cintro-
\nduced\u201d an interesting term into the German
\nlanguage, the term of \u201cGleichw\u00fcrdigkeit\u201d or
\nequal dignity. This term does not exist in the
\nGerman language, but in other languages. For
\nme, this term expresses a fundamental quality
\nof human relationships and communication.
\nTo encounter people with dignity,thus return-
\ning to them a little of the dignity they have
\nbeen robbed of. This dignity is especially re-
\nflected in comprehensive health care which is
\naccessible for everyone,regardless of social sta-
\ntus. Giving people affected by poverty dignity,
\nrespect and appreciation back means finding
\nnew approaches in health care. Approaches
\nthat take us to the ostracized people in our so-
\nciety.This reminds me of two statements made
\nby famous people from our neighbouring
\ncountries. The Swiss philosopher Kurt Matti
\nsaid: \u201cWhere would it take us if everyone said,
\nwhere would that take us and nobody went to
\nsee where it would take us if we went.\u201d Franz
\nKafka, the Austrian of Czech origin, said, very
\npragmatically: \u201cPaths are formed by walking.\u201d
\nWe must do something now.
\nAnd it is precisely this need to act now, tan-
\ngibly and practically, that St\u00e9phan Hessel, who
\ndied last year, demanded. Hessel, the Berlin-
\nborn French citizen and R\u00e9sistance fighter who
\nsurvived the Buchenwald concentration camp,
\nco-author of the United Nations Declaration of
\nHuman Rights, published a remarkable pam-
\nphlet in 2010, entitled: \u201cTime for Outrage\u201d. In
\nthis pamphlet, Hessel criticizes the treatment
\nof poor people in the heart of Europe. He does
\nthis by denouncing the deliberate suppression
\nand the loss of human rights and criticizes the
\npower of financial capitalism. He ends with the
\nwords: \u201cCreating something new means put-
\nting up resistance. Putting up resistance means
\ncreating something new.\u201c
\nWe should all be outraged at how socially dis-
\nadvantaged people are treated in our society, at
\nhow their circumstances are reported on, in-
\nadequately, sometimes ignoring facts, denying
\ncausal links. Let\u2019s start putting up resistance
\nto anti-social, unjust policies, constructive and
\nconsistent resistance, in solidarity and togeth-
\ner with the people concerned.
\nI wish all of us, especially us doctors, that we
\ncan summon up the commitment, the courage
\nand intransigence when it comes to the reali-
\nsation of humane, human rights-based health
\ncare for socially disadvantaged people.
\nOur work as doctors has always been based on
\nthe fundamental philosophy that medical care
\nmust be offered regardless of religion, race,
\nethnicity or social status. It seems that this
\nhas to be increasingly complemented by the
\nphrase that we will also treat human beings in
\nneed of help, regardless of their health insur-
\nance status, whether they are health insured or
\nnot, and irrespective of their residence status
\nin our country, in accordance with our medi-
\ncal skills and knowledge. Just talking about
\nit won\u2019t remove discrimination and injustice.
\nContrasting approaches must again be dem-
\nonstrated more clearly in order to achieve
\nconcrete and practical improvements of the
\nsituation for the patients concerned.
\nFinally, let me say this: This acceptance speech
\nis a little out of the ordinary, in terms of time
\nand of content. On the one hand, I see my-
\nself as having an obligation and a responsibil-
\nity to address the situation of poor marginal-
\nized people here and now. On the other I am
\nguided by the man who, 62 years ago, first won
\nthis award, by Albert Schweitzer. He said: \u201cIt
\nis my right to be uncommon\u00a0\u2013 if I can. I seek
\nopportunity\u00a0\u2013 not security\u201d.
\nProf. Dr. Med. Dipl. Soz.-p\u00e4d. Gerhard Trabert
\n95
\nUkrainian CrisisLATVIA
\nOn August 25, I together with Mr. Ren\u0101rs
\nPutni\u0146\u0161, Parliamentary Secretary of the
\nMinistry of Health (as at the moment there
\nis no Minister of Health in Latvia accord-
\ning to legislation he is the highest ranking
\nofficial in the sector) arrived in Ukraine to
\nsee the situation in the area of health care,
\nespecially paying attention to the wounded
\nsoldiers and refugees.
\nAs at that time active warfare was taking
\nplace, we were allowed to attend Dnipro-
\npetrovsk Region situated next to Donetsk.
\nThere are approximately 3.5 million in-
\nhabitants in Dnipropetrovsk Region. The
\ncity itself, which lies 240 kilometres from
\nDonetsk, can be considered an important
\nindustrial, educational and scientific centre.
\nDniprodzerzhynsk (a suburb of Dnipro-
\npetrovsk) is the birthplace of the former
\nSoviet leader Leonid Brezhnev. During his
\ncareer Brezhnev was supporting the devel-
\nopment of the region by promoting rock-
\netry industry, electrical technologies, metal
\nindustry and establishing a series of univer-
\nsities, including the Medical Academy.
\nBefore our visit to Dnipropetrovsk I had
\nwatched Russian TV channels that pre-
\nsented the city as a ruined, economically
\nexhausted and abandoned place. The truth
\nwas quite different\u00a0\u2013 the city was well illu-
\nminated, the lawns mowed, new apartment
\nblocks being built. Dnipropetrovsk receives
\ndaily from a hundred to a thousand refugees
\nfrom Donetsk Region, mostly women and
\nchildren.
\nObviously, in Donetsk Region, which is
\nunder the control of separatists, a human
\ncrisis has begun because Dnipropetrovsk
\nis flooded by chronically ill people from
\nthere. For instance, now a ward, perform-
\ning haemodialysis to 120 patients daily, has
\nto manage additional haemodialysis for 78
\nrefugees. All the refugees have arrived after
\ninterrupted medical care and can be consid-
\nered as severe cases.
\nPatients with diabetes mellitus who need
\ninsulin and other antidiabetic remedies have
\narrived hoping to be rescued. I witnessed
\nmyself that to a psychoneurological institu-
\ntion with 60 beds for children from Dnipro-
\npetrovsk Region there were hospitalized 50
\nchildren with different inborn and heredi-
\ntary pathologies, mental disorders etc. from
\nDonetsk.
\nThe nurse had injected sopoforic medicine
\nduring the transportation and there was
\nno documentation that could contain evi-
\ndence about their parents or relatives, even
\nthe names of most of the children were not
\nknown.
\nThe children were taken to Dnipropetrovsk
\nto save them from being killed as separat-
\nists tend to believe that they only cause
\nexpenses. Practically all pregnant women
\nwith pathologies or extrauterine pregnancy
\nhave fled Donetsk for Dnipropetrovsk as
\nseparatist leaders have announced that all
\ndeliveries should take place in equal condi-
\ntions and the specialized Mother and Child
\nCentre had been turned into a hospital for
\nsoldiers.
\nThe flow of refugees is handled by volun-
\nteers, mostly students, and the people of
\nDnipropetrovsk support reception cen-
\ntres by donating food, warm clothing and
\nsanitary items. So far it has been possible to
\nplace refugees in different premises, hostels
\nand empty apartments.
\nThe wounded have been brought to Dni-
\npropetrovsk (also Kharkiv) as well.On aver-
\nage, there are about 30 patients with poly-
\ntraumas. The severe cases are transferred to
\nMechnikov Hospital of Dnepropetrovsk
\nRegion while the milder ones are taken to
\nthe military hospital. I must admit that the
\nmilitary hospital is badly equipped, practi-
\ncally plundered and should be closed. Only
\na nineteenth century military doctor could
\nconsider it a hospital.The reanimation ward
\nis as in the fifties of the last century.
\nMechnikov Hospital is quite a surprise.
\nThe former chief of Health Board had
\nbuilt a spacious emergency ward with
\ndiagnostic equipment, operation halls,
\nintensive care units. The hospital already
\ncares for some thirty severe cases simul-
\ntaneously and the staff has learned to cope
\nwith the situation.
\nWhen a patient with burn wounds was
\nbrought in, cartridges and hand grenades
\nfell out of his pockets. In an intensive
\nunit you can find about a dozen wounded
\nmostly with bullet injured legs and exten-
\nsive burn wounds.There is an officer whose
\nneck has been hit with a bullet which had
\npassed between esophagus and trachea not
\ntouching the major blood-vessels while
\nbreaking the lower jaw on exit. Some sol-
\nWhatWe Can Learn From the Ukrainian Crisis
\nKiev-Dnipropetrovsk, August 25\u201327 (eyewitnessed)
\nP\u0113teris Apinis
\n96
\nUkrainian Crisis LATVIA
\ndiers with milder wounds who have already
\nbeen treated properly have been placed
\nnear the main entrance\u00a0\u2013 to keep safe from
\nprovocations.
\nA week ago a wounded pregnant woman
\nwas taken to the hospital and doctors man-
\naged to save the child.About one third from
\nthe wounded is civilians.
\nSoon the Ukrainian doctors will become
\nmega-stars concerning caring for wounds
\nand polytraumas\u00a0\u2013 there is no such train-
\ning practice in other countries. So it seems
\nwe have to go to Mechnikov Hospital and
\na similar institution in Kharkiv and vol-
\nunteer for experience. The war of today is
\nvery different from WWII\u00a0\u2013 every wound is
\ncombined with a lacerated wound, crushed
\nbones and internal burns. Unbelievably
\nmany traumatic amputations. An anaesthe-
\ntist we had a cup of coffee together in the
\nemergency ward told me about a patient
\nwhose leg just fell of the transportation
\ntrolley while being driven from the ambu-
\nlance van. An experienced nurse fainted at
\nthe sight.
\nIt seems to me that the first lesson we get
\nfrom the Ukrainians relates to the first aid
\nexperience, actually the mistakes they are
\nmaking. Unfortunately, there is no chance
\nfor me to reach the front line as separatists
\nhave resumed their offensives.
\nI had a conversation with a young surgeon
\non his ten-day leave who asked not to reveal
\nhis name. He is in his late twenties, used to
\nwork as a surgeon in a prominent Dnipro-
\npetrovsk hospital, then got mobilized and
\nsent to the battlefront.
\nEvery other day he worked at the battle-
\nfront and spent the days in the sanitary ve-
\nhicle. He had been observing, draining, im-
\nmobilizing up to 32 wounded patients per
\nday. The biggest problem is that there is no
\nobvious battlefront, most of the soldiers get
\nshot, wounded or killed while they rest in
\nbarracks or tents.
\nObviously, my companion had been in-
\nstructed regarding conversations with
\nstrangers. There had been no instruction
\nabout medical matters, however, and we
\ncould discuss medical issues more freely.
\nThose fighting on the Ukrainian side are
\nyoung men doing obligatory military ser-
\nvice\u00a0 \u2013 eighteen-year-olds, sooner, cannon
\nfodder. There are also battalions of volun-
\nteers\u00a0 \u2013 experienced men who have done
\nmilitary service before, but they are unbe-
\nlievably poorly equipped.
\nVolunteers are much easier to manage,
\nmany of them have graduated from univer-
\nsities and as many there are students. They
\nall receive booklets containing first aid algo-
\nrithms (neat and easy-to-understand) and
\nthey are eager to practise. As a result they
\nare taught how to inject analgetics immedi-
\nately. First aid kits, however, resemble driv-
\ners\u2019 first aid kits\u00a0\u2013 a red rubber constrictor
\nthat has been kept in a storehouse for years
\nand as a result has become fragile, gauze
\nbandage, iodine or green antiseptic liquid
\n(for a friend to pour on a friend\u2019s burns), eye
\ndrops that I don\u2019t recognize.
\nThe biggest problem is evacuation of the
\nwounded person from the fire zone\u00a0 \u2013 at
\nfirst it is just reaching him, then evacua-
\ntion by an available vehicle\u00a0 \u2013 usually an
\narmoured personnel carrier or a lorry that
\njolts so heavily that the wounded feels like
\ngoing through hell. After the transporta-
\ntion the injured person is taken to the san-
\nitary vehicle described above where he is
\nexamined by a professional doctor or gets
\ntransported to a nearest regional hospital
\n(there is one in every bigger town next to
\nthe battlefront), where there is only a lo-
\ncal internist or no one at all to treat the
\nwounded.
\nThe most professional institution near the
\nbattlefront is a surgical hospital where real
\nhelp is provided to the wounded. From
\nthere they get transported to Kharkiv or
\nDnipropetrovsk, more often by helicopter
\nthan by ambulance car. More severe cases
\ngo to civil hospitals while milder ones\u00a0\u2013 to
\nmilitary hospitals. Sorting takes place in
\nDnipropetrovsk Airport, and the decision is
\nmade by an experienced military doctor, a
\ncolonel, Head of the Lung Surgery Depart-
\nment from Odessa. All by himself. He only
\ntells me his name and patronymic, omitting
\nhis surname, as it is not important.
\nThe person who is not afraid of telling his
\nname and who supervises the process from
\nmorning till night and the whole healthcare
\nin the region is Professor Igor Makedon-
\nsky, Head of the Regional Health Depart-
\nment. He is a paediatrics surgeon, a well-
\nknown professional in the whole country
\nand he has been Head of Dnipropetrovsk
\nChildren\u2019s Hospital; at the moment he
\nis assigned responsibility for the regional
\nhealthcare. Reserved, introvert, polite, but
\nunbelievably confident in his statements
\nand actions. He manages to procure funds
\nboth from the region and Kiev.
\nIt is only fair to mention that support from
\nlocal people is incredibly great. People
\nbring to hospitals food, medicine; local in-
\ndustries have started producing stretchers,
\nhospital equipment, up to vacuum pumps,
\ndermatomes, pulse oximetres that are at
\nleast 10 times less expensive than the ana-
\nlogues supplied to Latvia by international
\ncompanies.
\nLudmila Ivanovna Padalko, Head Physi-
\ncian of Dnipropetrovsk Perinatal Centre,
\ntells us that there is enough donated food to
\nfeel safe for a week or even two.The Centre
\nis large, there are nearly 400 beds, includ-
\ning gynaecological beds, and the maternity
\nward. In Ukraine, the number of beds is
\ndecisive in healthcare as it determines the
\nmoney allotment to the hospital. The ma-
\nternity ward has 12 separate entrances each
\nof which leads to a small separate mater-
\nnity ward installed with a bed, a maternity
\ntable and even a triangle bath. The patient\u2019s
\nhusband is also welcome. There is a bath-
\nroom, resting facilities and even a TV set.
\nThe ward is for patients with pregnancy
\n97
\nUkrainian CrisisLATVIA
\npathology from the whole Dnipropetrovsk
\nRegion.
\nHowever, those who want to give birth in
\ncivilized conditions come to this hospital
\nas well. According to Ukrainian legislation
\nmaternity assistance should not be charged.
\nAs a result those who are not eligible but
\nstill want to give birth to their children in
\nthis wonderward have to pay a donation to
\nthe hospital (only by credit card).
\nIt feels strange to hear about the way the
\ndonations are spent.Five men from the hos-
\npital have been called up\u00a0\u2013 an anaesthetist,
\ntwo medical assistants and two workers.The
\nhospital has purchased for all chest armour
\nfor 4,000 grivnas, helmets for 3,000 grivnas,
\nand special footwear for 2,000 grivnas. It
\nturns out that those who are not provided
\nwith such assistance get to the battlefront
\nwithout any protective means.
\nThere used to be similar exclusive prenatal
\ncentres in Donetsk and Luhansk as well,
\nbut the separatist government considered
\nthat the centres mainly dealt with artificial
\ninsemination. At the moment the centres
\ncare for at least about one third of patients
\nmore than usual.
\nIn Kiev I had a possibility to visit the
\nUkrainian Ministry of Health and meet
\nthe Minister of Health Oleg Musij. It was
\na holiday\u00a0 \u2013 the National Independence
\nDay. Oleg Musij was not wearing a jacket
\nand poured tea himself. He is energetic,
\ntalkative and smiles a lot. He is an anaes-
\nthetist, long-term President of the Ukrai-
\nnian Medical Association. He managed
\nmedical service on Maidan, spent days and
\nnights on duty, provided first aid, orga-
\nnized evacuation, performed about ten in-
\ntubations and resuscitations directly on the
\nsquare or in the Ukrainian House next to
\nit. Once he got shot by a water-cannon at
\n20 degrees below zero Celsius and nearly
\nturned into a block of ice while perform-
\ning resuscitation. He is the only minister in
\nthe new government who does not belong
\nto any party and is free of any political in-
\nfluence. However, his deputies have been
\nassigned by several parties. Oleg Musij is
\ngetting ready for winter when there will
\nbe no heating; they have almost run out of
\nsupplies of medicines and dressings. The
\nphysicians\u2019 salaries are three times lower
\nthan in Latvia and ten times lower than
\nin Europe on average. \u201c\u0411\u044b\u043b\u0438 \u0431 \u043c\u043d\u0435 \u0422\u0432\u043e\u0438
\n\u043f\u0440\u043e\u0431\u043b\u0435\u043c\u044b (If only I had your problems)\u201d,
\nhe said with a smile. The health budget in
\nUkraine is 3.5 billion euro for 45 million
\ninhabitants, and that is in a country at war
\nor\u00a0\u2013 the Ukrainian Ministry of Health has
\n77 euro per capita per year.
\nTo tell the truth, the Ministry of Health
\nmanages only 65% of the health funds.
\nMilitary medicine is managed by the Min-
\nistry of Defence. Those working on rail-
\nways go to Railway Hospitals and sailors
\ngo to Marine Medical Centres, miners
\nhave their own specialized hospitals. There
\nare fourteen different departments com-
\npeting among themselves while all of them
\nsuffer from the economic crisis. Altogether
\nit makes 118 euro per capita from the state
\nbudget. As a result patients almost fully
\npay for medical care, including their stay
\nin hospitals.
\nIt seems that the biggest problem created by
\nthe war in the east of Ukraine is running out
\nof resources\u00a0\u2013 no one knows how Ukraine
\nwill survive the winter without energy and
\nthe very restricted reserves of fuel.
\nThere is something that is not said aloud,
\nbut can be sensed\u00a0 \u2013 humanitarian assis-
\ntance causes only problems. Nothing is
\nsaid, but you become aware that Europe-
\nan countries send what they do not need
\nthemselves\u00a0 \u2013 old dressings, unidentified
\npills etc.The logic is simple\u00a0\u2013 when you are
\nat war, you need a month\u2019s supply of nar-
\ncotic painkillers, infusion liquids, antibac-
\nterial remedies, respiratory equipment and
\nouter fixation materials including dress-
\nings. In fact, the same is true today for any
\nplace in Europe. Such reserve is necessary
\nand it should be a modern one. Of course,
\nthis is not the same amount that Ukraine,
\nwhich is at war, now needs.
\nWhat can Latvian medicine do for Ukraine?
\nAs a country holding the EU Presidency in
\n2015, we can convene a conference about a
\nunited healthcare system,attracting medical
\nthought from Ukraine, Moldova, Georgia
\nand Belarus. We can help Ukraine to reach
\nthe European level not through simpli-
\nfied humanitarian aid, but by all European
\ncountries jointly dealing with the conse-
\nquences of the Ukrainian tragedy.
\nAnd there is a tragedy. There are young
\nmen with amputated legs. There are officers
\nwhose gunshot wounds have turned into
\nosteomyelitis. There is a guy with a bullet
\nstuck in the frontal cavity. It is a strange
\nfeeling when you enter a ward with 5-6
\nwar-wounded patients, and each has his
\nown story and now they are bedridden.
\nThere are polytraumas that suppurate.
\nI am the first doctor from Europe who had
\nbeen so close to the battlefront to see what
\nis going on in healthcare. I was not allowed
\ncloser than 100 kilometres from the front
\nline, so I could not see first aid provided to
\nsoldiers and I did not see the hospital tents
\nmyself. I am ready to return to understand
\nwhat is going on in reality at the battlefront
\nin the middle of Europe.I took a lot of pho-
\ntos for professional purposes including doc-
\ntors and patients; however, I cannot publish
\nthe photos for ethical and professional rea-
\nsons.
\nP\u0113teris Apinis, President of the
\nLatvian Medical Association
\n98
\nNMA news
\nJunior Doctors\u2019 Work Hours:
\nfrom regulations to reality
\nPhysicians worldwide are sick. We experience increasing levels of
\nstress, burnout, and mental health disorders compared to our not-
\nin-medicine neighbours [1]. Dissatisfaction is high, and many of
\nour colleagues would not choose medicine all over again, let alone
\nrecommend it to the next generation of our healthcare system [2].
\nInjured wellbeing, the \u201cphantom limb\u201d of our profession, limits our
\nability to provide quality of care, reduce health care costs, and im-
\nprove the health of populations [3\u20135]. How can we care for the
\nworld, if we cannot care for ourselves?
\nPerhaps caring can begin with our trainees.
\nIn medical school and residency, trainees are more susceptible to
\ndehumanizing traits, mental health disorders, and stigmatizing at-
\ntitudes that we carry throughout our careers [6,7]. Those we en-
\ncourage to heal, including women and minorities, are particularly
\nvulnerable [7]. Loss of wellbeing may be due to fear of health work-
\nforce crises and safety concerns. Medical errors are often attributed
\nto trainee fatigue and long hours worked. Century-old education
\nmodels have been called into question.The wellbeing of junior doc-
\ntors and their patients worldwide is at risk. Members of the Junior
\nDoctors Network have expressed their concerns and offered solu-
\ntions for consideration.
\nWorkforce
\nTrainee security is uncertain and threatens the sustainability of
\nour health workforce. In North America and the UK, after hun-
\ndreds of thousands of dollars of medical education debt, trainees
\nare struggling to find employment [8]. This is amidst predictions
\nfor worldwide shortages of health professionals by over 10 million
\nby 2035\u00a0[9]. In developing nations, junior doctors are first-line for
\noutbreaks irrespective of training [10] and when under scrutiny are
\na face for criticism and dismissal. In developed nations, bullying is
\na concern [7]. To ensure a sustainable health workforce, we need to
\nhelp nurture the right trainees for the right job for the right place
\nthrough safe, quality, and accessible medical education. The WMA
\nJDN is working with the World Health Organization and other
\nstakeholders to determine the drivers behind health workforce sup-
\nply-demand mismatches worldwide and provide our members with
\nthe best information possible to support their healthcare systems
\nand ease their minds.
\nDuty Hours
\nLonger hours are associated with higher burnout, fatigue, depres-
\nsion, and injuries [11,12], and national regularly bodies have re-
\nsponded. In 2003, the Accreditation Council for Graduate Medical
\nEducation) in the United States limited work hours to 80\u00a0hours
\nper week and the longest consecutive working time to 30\u00a0hours for
\nsenior residents, and 16 hours for first year trainees. The ACGME
\nmandated teaching hospitals to ensure adequate sleeping facili-
\nties for residents. The European Working-Time Directive applied
\nin 2009 limited work hours of employed doctors to 48 hours per
\nweek and 24 hours of consecutive work.There is even national varia-
\ntion with Qu\u00e9bec (Canada) limiting hours to 72 hours per week
\nand a maximum of 16 consecutive hours per day while Manitoba
\n(Canada) has an 89-hour limit [12]. In Turkey, hours are limited to
\n40\u00a0hours per week.
\nIn regions without enforced restrictions,there is concern that longer
\nhours may be related to poor physician health. In Australia, younger
\ndoctors worked more and reported being more psychologically dis-
\ntressed, suicidal, and burnt-out more and are more burnt-out than
\ntheir older colleagues [7]. According to a Cross Sectional Survey of
\nHong Kong doctors, physicians working more than 52 work hours
\nper week were at a higher risk of burnout [13]. In Europe, despite
\nthe European Working Time Directive there is variability with UK
\nphysicians reporting working more than 56 hours due to occupa-
\ntional pressures [14]. In Turkey, doctors are considered a strategic
\nworkforce and are not covered by the same 40-hour limits of other
\nworkers with average working hours of junior doctors varying be-
\ntween 48\u2013110\u00a0hours per week by specialty and reports of having to
\nwork under stress to meet service needs [15]. However, in regions
\nwith enforced restrictions, there is concern that patient care, medi-
\ncal education, and even junior doctor quality of life are suffering,
\nespecially with surgical trainees [16,17].
\nInstead of focusing on quantity, perhaps we need to focus on the
\nquality of the hours junior doctors spend serving patients and sup-
\nporting their own wellbeing.This will likely require attention to the
\ncomprehensive working and learning environment including how
\nwell we communicate with the entire healthcare team, how well we
\nare taught, and how well we take the time to take care of ourselves.
\nEducation
\nMedicine is becoming increasingly complex. The number of avail-
\nable diagnostic tests,diagnoses,and treatment options has expanded
\nexponentially and contributed to the clinical and educational work-
\nload of all physicians [18].To compensate, the time a patient spends
\nin the hospital has been declining and junior doctors have increas-
\ningly needed to meet this service need without the same educational
\nbenefit, and without the legal, financial, or social supports as their
\nolder colleagues [19]. The healthcare team is also changing, with
\ngreater focus on interprofessional care to meet increasing health
\nsystem needs. However, the insular training of junior doctors may
\npredispose us to burnout and unprofessional behaviours [20]. The
\naverage age of a new Junior Doctor from North America is 28 with
\nat least two degrees and a six-figure debt. Our costs have inflated.
\nOur lives have stagnated.Our futures are uncertain.The century-old
\n99
\nNMA news
\nmedical education system may no longer be able to keep pace. Re-
\nform may be needed, including access to quality medical education
\nresources, consideration of new models such as competency-based
\nmedical education, and collective education with other professions,
\nsectors, and patients with the wellbeing of healthcare professionals
\nand the safety of patients in mind.
\nConclusion
\nWhen a physician is sick we should provide care, but we also need
\nsustainable solutions including a global workforce that meets sup-
\nply and demands, working conditions that balance education and
\nservice, and a current medical education system. We need a health-
\ncare system that prevents the suffering of our own by improving the
\nwellbeing of our trainees. Together, with further institutional com-
\nmitment and collaboration with our stakeholders, we can foster a
\nculture that is safe for both junior doctors and the patients for which
\nthey care. It is a culture of wellbeing. It is medicine\u2019s culture to care.
\nReferences
\n1. Myers et. al. CMA Guide to Physician Health and Wellbeing. Canadian
\nMedical Association. Canada. 2003.
\n2. Kane, Leslie. Physician Compensation Report. Medscape. US. 2013.
\n3. Spinelli,W.M.The Phantom Limb of the Triple Aim. Mayo Clinic Proceed-
\nings 2013 8(12):1356\u20131357
\n4. Physician Wellness: a missing quality indicator. Lancet 2009.
\n5. To err is human: Building a Safer Health System. Institute Of Medicine.
\n2000.
\n6. Burnout During Residency Training: A Literature Review. J Grad Med
\nEduc. Dec 2009 http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2931238\/
\n7. National Mental Health Survey of Doctors and Medical Students. October
\n2013. BeyondBlue. Australia. http:\/\/www.beyondblue.org.au\/docs\/default-
\nsource\/default-document-library\/bl1132-report—nmhdmss-full-report_web
\n8. What\u2019s Really Behind Canada\u2019s Unemployed Specialists? Royal College Em-
\nployment Study. Royal College of Physicians and Surgeons of Canada. 2013.
\n9. A Universal Truth: No Health Without a Workforce.World Health Organi-
\nzation. November 2013.
\n10. Junior Doctors Condemn Working Conditions in Dealing with Ebola Fever.
\nWMA. 2014. https:\/\/www.wma.net\/en\/40news\/20archives\/2014\/2014_16\/
\n11. Dembe AE. Estimates of injury risks for healthcare personnel working night
\nshifts and long hours. Qual Saf Health Care\u00a02009;18:336\u2013340\u00a0doi:10.1136\/
\nqshc.2008.029512
\n12. Resident Duty Hours: Enhancing Sleep, Supervision, and Safety. IOM 2009
\n13. Yuen SK, Cheung A: Burnout among public doctors in Hong Kong: cross-
\nsectional survey. Hong Kong Med J 2012, 18(3):186\u2013192
\n14. Temple, Sir John. Doctors\u2019training and the European Working Time Direc-
\ntive.The Lancet. 375. 9732. June 2010.
\n15. Terzi, Cem. \u201cGENEL CERRAH\u0130 UZMANLIK E\u011e\u0130T\u0130M\u0130 RAPORU.\u201d 1
\nJan. 2010. Web. 25 Aug. 2014. http:\/\/www.turkcer.org.tr\/files\/files\/uzman-
\nlik_egitimi_raporu_2010.pdf
\n16. Antiel\u00a0 RM et al.\u00a0 Effects of duty hour restrictions on core competencies,
\neducation, quality of life, and burnout among general surgery interns.\u00a0JAMA
\nSurg\u00a02013;148:448\u201355.
\n17. Hamadani\u00a0FT et al.Abolishment of 24-hour continuous medical call duty in
\nQuebec: a quality of life survey of general surgical residents following imple-
\nmentation of the new work-hour restrictions.\u00a0J Surg Educ\u00a02013;70:296\u2013303.\u00a0
\n18. Anderson, G., and J. Horvath. 2004. The growing burden of chronic disease
\nin America. Public Health Reports 119(3):263\u2013270
\n19. Kozak, L. J., C. J. DeFrances, and M. J. Hall. 2006. National hospital dis-
\ncharge survey: 2004 annual summary with detailed diagnosis and procedure
\ndata. Hyattsville, MD: National Center for Health Statistics.
\n20. Montgomery A. The inevitability of physician burnout: Implications for in-
\nterventions. Burnout Research. 1.1. June 2014
\nMattar C., Washington University in St Louis, USA
\nDeputy Chair, Junior Doctors Network,
\nRunyan A.,Wayne State University, Detroit, USA
\nTun W.,
\nUniversity of Medicine, Yangoun, Myanmar
\nCommunications Officer, Junior Doctors Network,
\nEhsen F., University of Marmara, Turkey
\nWiley E, University of Maryland, USA
\nSocio-medical Affairs Officer, Junior Doctors Network
\nPereira Ian, Queen\u2019s University, Canada
\nEducation Officer, Junior Doctors Network
\nCorresponding Author Mattar Caline
\nE-mail: cmattar@dom.wustl.edu
\nOrder of Physicians of Albania
\nOffice bearers
\nDr. Din ABAZAJ\u00a0\u2013 President
\nProf. Ruzhdie QAFMOLLA\u00a0\u2013 Vice-President
\nDr. Shaqir KRASTA\u00a0\u2013 General Secretary
\nMs. Kontilia RAPO\u00a0\u2013 Vice General Secretary
\nMembership: By the law No. 8615 date 1.06.2000 \u201cFor the Order of
\nPhysicians in the Republic of Albania\u201d,all the doctors and the dentists
\nto practice the profession must be registered (mandatory) to the Order
\nand have a individual license which is issued for a term of 5 years.
\nThe mission of the Order of Physicians of Albania is the preserva-
\ntion of high standards on the formation and exercise of medical pro-
\nfessions and protection of patients and public from the malpractice
\nof health services.
\nFor the accomplishment of this mission the Order of Physicians of
\nAlbania, it:
\n\u2022 accomplishes the registration and maintains the doctor\u2019s register
\nfor the exercise of their profession;
\n\u2022 supervises the implementation of the professional obligations in
\naccordance with the requests of medical sciences, rules of ethics
\nand Medical Deontological Code;
\n\u2022 assures the ethic,moral and deontological guidance of the doctors
\nand dentists communities, the independence of exercising of the
\nmedical profession according to the standards and protects the
\nmoral interests of this profession;
\n100
\n\u2022 protects the interests of the patients and public from the misuse of
\nhealth services and violations of the Deontological Medical Code;
\n\u2022 collaborates for assuring the progressive development of the pro-
\nfessional standards on the health services, for the planning and
\ndrafting of the medical programs, post university specialization,
\neducation and continuous qualification of doctors;
\n\u2022 gives or forbids the individual\u2019s permission for the exercise of this
\nprofession.
\nThe main structures of the Order of Physicians of Albania are:
\n\u2022 Assemblies; (General and Regional)
\n\u2022 Councils; (National and Regional)
\n\u2022 Disciplinary Commissions;
\n\u2022 Department for the Registration and Licensing.
\n\u2022 Other permanent and ad-hoc commissions
\n(Urdhri i Mjekeve te Shqiperise)
\nRr. \u201cBelul Hatibi\u201d, Poliklinika No.10, Tirana, Albania
\nAmerican Medical Association
\nRobert M. Wah, MD, President
\nSteven J. Stack, MD, President Elect
\nArdis D. Hoven, MD, Immediate Past President
\nAndrew W. Gurman, MD, Speaker
\nSusan R. Bailey, MD, Vice Speaker
\nBarbara L. McAneny, MD, Chair
\nJames L. Madara, MD, CEO and Executive Vice President
\nMission: To promote the art and science of medicine and the bet-
\nterment of public health.
\nOur guiding principles set the aspirations that we endeavor to
\nachieve:
\n\u2022 AMA is one enterprise, highly capable, well coordinated and fo-
\ncused on high impact results.
\n\u2022 AMA believes that there is a national imperative to chart a suc-
\ncessful course for health care delivery that will improve the health
\nof the nation.
\n\u2022 AMA embraces the need for change and believes physician lead-
\nership is critical to the successful evolution of health care in a
\npatient focused delivery system.
\n\u2022 AMA will build on its legacy of leading physician ethics, setting
\nstandards for medical education, and advancing medical science
\nto serve as the premier voice for the core values of the medical
\nprofession.
\n\u2022 AMA has the unique combination of talent with practical skills
\nand intellectual capabilities, the financial resources, and influen-
\ntial multi-sector relationships to be a leading voice in the trans-
\nformation of health care.
\nThe AMA has a robust House of Delegates consisting of represen-
\ntation from every State and medical society,a solid base of physician
\nmembers, a thriving advocacy influence, the most revered journals
\nand resources in medicine, and respected practice tools.
\nTogether, we can shape a better, healthier future\u00a0\u2013 not just for pa-
\ntients and physicians, but for the country as a whole.
\n330 N. Wabash, Suite 39300, Chicago, Illinois USA 60611
\nhttp:\/\/www.ama-assn.org
\nThe Australian Medical
\nAssociation (AMA)
\nOffice Bearers:
\nAMA President; Associate Professor Brian Owler, a Neurosurgeon
\nbased in Sydney, Australia
\nAMA Vice President; Dr Stephen Parnis, an Emergency Physician
\nbased in Melbourne, Australia
\nThe AMA is the peak representative and advocacy body for all reg-
\nistered medical practitioners and medical students in Australia.
\nMedical students can join the AMA for free and are supported with
\nadvocacy, lobbying and mentoring.
\nAMA membership provides political representation, political and
\nprofessional lobbying, media commentary, public health advocacy,
\nworkplace representation and advice, career advice and support, in-
\ndustrial relations expertise and craft group representation.
\nMembers shape and debate current issues facing the medical work-
\nforce and patients. Policies are developed at the association\u2019s annual
\nNational Conference
\nThe prestigious Medical Journal of Australia keeps members informed
\nof the Association\u2019s work and provides a major commitment to medi-
\ncal research and education.The Medical Journal of Australia celebrat-
\ned its 100th anniversary in 2014.The monthly publication Australian
\nMedicine also keeps members up to date with the latest in health news.
\nThe AMA keeps in regular contact with a large number of politi-
\ncians, political parties and government ministers. It frequently pres-
\nents submissions to, and appears before, committees inquiring into
\nhealth issues.
\nIt is also represented on a number of government committees, en-
\nsuring that the voice of the profession is heard well before decisions
\nare made. It also keeps politicians informed about the views of the
\nprofession in order to help achieve better health outcomes for all
\nAustralians.
\nNMA news
\n101
\nThe AMA frequently runs campaigns to influence government de-
\ncisions, which it believes may not be in the country\u2019s best interests.
\nAll policies and advocacy by the AMA is in the interests of the
\nmedical profession and patients.
\nAMA House, 42 Macquarie street, Barton ACT Australia 2600
\nAnne Trimmer Secretary General
\nPh: 61 2 6270 5460; Fx: 61 2 6270 5499
\nE-mail: atrimmer@ama.com.au
\nama.com.au
\nAustrian Medical Chamber
\n(\u00d6\u00c4K\u00a0\u2013 \u00d6sterreichische \u00c4rztekammer)
\nOffice Bearers
\nPresident: Dr. Artur Wechselberger
\nVice Presidents: Dr. Karl Forstner, Dr. Harald Mayer, Dr. Johannes
\nSteinhart
\nInternational Affairs: Dr. Reiner Brettenthaler, Presidential Officer
\nDirectors: Dr. Lukas St\u00e4rker, Dr. Johannes Zahrl
\nMembership:According to the Austrian Medical Act, the Austrian
\nMedical Chamber represents the professional, social and economic
\ninterests of all doctors engaged in medical activities in Austria. Fur-
\nthermore, it acts as umbrella association under public law for its
\nnine members, the medical chambers in the Austrian provinces.
\nMembership is obligatory for every doctor wishing to pursue medi-
\ncal activities in Austria.
\nActivities: Legal responsibilities of the Austrian Medical Cham-
\nber include, besides others, admission to and administration of the
\nmedical register, as well as recognizing foreign medical qualifica-
\ntions. Furthermore, the Austrian Medical Chamber is the com-
\npetent authority for issuing medical diplomas and for conducting
\nspecialist and GP qualifying exams. The elaboration of concepts,
\nexpert opinions and proposals regarding the Austrian health care
\nsystem, including the right to comment on draft bills or enacting
\nguidelines on medical fees, on the medical code of conduct etc., as
\nwell as concluding contracts with social insurance institutions and
\ncollective agreements, and executing disciplinary legislation and ar-
\nbitration also belong to the responsibilities of the Austrian Medical
\nChamber. Moreover, the Chamber is involved in the elaboration of
\nspecialist and GP training programs, and it also has its own institu-
\ntion offering CME\/CPD for Austrian medical doctors.
\nCurrent topics of interest include the reform of primary health care
\nin Austria, the Electronic Health Record (ELGA), and the current
\nshortage of country doctors.Besides various media activities on cur-
\nrent political issues, the Austrian Medical Chamber lately hosted
\ntwo events widely covered by the media: A conference in celebra-
\ntion of the 40th
\nanniversary of the \u201cMutter-Kind-Pass\u201d (\u201cMother
\nand Child-Health Record Book\u201d), a then revolutionary prevention
\nprogram for both mother and child, and an international congress
\ndealing with the situation of doctors in rural areas.
\nWeihburggasse 10\u201312, 1010 Wien, Austria
\nBangladesh Medical Association
\n(BMA)
\nOffice Bearers (2012-2014):
\nPresident: Dr. Mahmud Hasan
\nSecretary General: Dr. M. Iqbal Arslan
\nInternational Affairs Secretary: Dr. Md. Abul Hashem Khan
\nMembership: BMA offers five category of membership i.e.General
\nMembership, Honorary Membership, Life Membership, Associate
\nMembership & Concerned Membership. Bangladeshi residence
\nany medical doctor whose MBBS or equivalent degree accredited
\nby Bangladesh Medical & Dental Council (BM&DC) can join the
\nBangladesh Medical Association as a General or Life member.
\nServices provided: Members are entitled to attend meetings of
\nthe association where matters of professional interest are discussed.
\nThey can also take part in continuing professional development ac-
\ntivities and social services provided by the association.They also get
\ncopies of journal and other publications of association.
\nActivities (some examples):
\n\u2022 With Members: as above.
\n\u2022 With the Public: Interactions with the press regarding profes-
\nsional activities and doctor patient relationship are regularly held.
\nFree clinics are run by the association and its members.
\n\u2022 With the Governments: Regular interactions are held with the
\nofficials of Ministry of Health,regarding health policy,health ser-
\nvice delivery and professional interest of doctors.
\n\u2022 With the Media: Press releases related to health issues of public
\ninterest,promotion of debates related to health policies,education
\non health related issues.
\nBMA Bhaban, 15\/2 Topkhana Road, Dhaka-1000
\nPhone: +88-02-9568714, 9562527
\nFax : +88-02-9566060
\nE-mail: bma.org.bd@gmail.com
\nwww.bma.org.bd
\nNMA news
\n102
\nAssociation Belge des Syndicats
\nM\u00e9dicaux
\nPresident: Dr. R. LEMYE
\nVice-President: Drs. M. Moens\u00a0\u2013 L. De Clercq\u00a0\u2013 J. de Toeuf\u00a0\u2013
\nM.\u00a0Vermeylen
\nSecretaries-General: Drs. M. Masson\u00a0\u2013 Y. Louis
\nTreasurer: Dr. L. Deflandre\u00a0\u2013 Head of International Affairs:
\nDr.\u00a0B.\u00a0Maillet
\nActivities: The ABSyM\/BVAS (Belgian Association of Medical
\nUnions) was created in 1963 as a reaction to the decision of the
\ngovernment to oblige the medical profession to be regulated by the
\nBelgian State. Belgian physicians thought that this system could
\nnot match their medical ethics which is based on a doctor-patient
\nrelationship of trust implying free choice of a doctor by a patient,
\ndoctor\u2019s therapeutic freedom as well as secrecy.The rules and legisla-
\ntion established by the State affected those principles.
\nQuite rapidly, physicians from all over the country get organized
\nand created doctor\u2019s associations on the ground. Those associations
\nfederated and developed necessary means to deal with conflicting
\nsituations. This association that is presently called ABSyM\/BVAS
\nwas the successor of the former Belgian Medical Federation (F\u00e9-
\nd\u00e9ration M\u00e9dicale Belge\u00a0\u2013 FMB) which was unable to organize a
\nresistance movement.The conflict raised the year after,in 1964,with
\na medical strike that lasted nearly one month and had been very
\nwell planned.The medical corps, organized as an emergency doctor
\nservice, then proposed nothing more than depersonalized care, ac-
\ncording to the modalities and procedures the government wanted to
\nestablish. As the conflict got worse and since the government had
\ndecided to requisition the physicians, the ABSyM\/BVAS launched
\na \u201cluggage\u201doperation. Most of the physicians went abroad to escape
\nthe potential requisitions.This operation brought the government to
\ngive in on this issue. The conflict led to some agreements that fore-
\nsaw an annual collaboration system which allowed the coexistence
\nof a medical private practice and a social financing. This annual or
\nbiennial agreements\u2019 system is still ongoing although it has been
\ndealing with many problems and had to tackle the evolution of the
\nmedical profession in which it is often difficult to fully preserve the
\nHippocratic principles. Let\u2019s think about the control over expendi-
\nture, the necessity of teamwork but also the exchange of data which
\nis the inevitable consequence to reach the necessary balance.
\nThe ABSyM\/BVAS did not only focus on union defense. It has
\nbeen firmly committed in the defense of patients\u2019 interests and dia-
\nlogue with them, who have also formed associations. The ABSyM\/
\nBVAS has been committed in the quality of care thanks to an incen-
\ntive system rather than restraints and sanctions. Furthermore, the
\nABSyM\/BVAS gives priority to security and patients\u2019 rights and
\nalso organizes direct dialogue with other health care professionals
\n(pharmacists, dentists, nurses, physiotherapists\u2026). It also takes care
\nof the working conditions of physicians and their health. Its sphere
\nof activity is as extended as the one of associations but in the mean-
\ntime, it also preserves means of action when the negotiation shows
\nno signs of good results.The Belgian \u201cdefederalization\u201dwhich is cur-
\nrently ongoing gives the ABSyM\/BVAS new concerns, especially
\nsince it remains one of the few unitary organizations in the country.
\nNevertheless, the strongly professionalized ABSyM\/BVAS is look-
\ning to the future with confidence.
\nChauss\u00e9e de la Hulpe 150, B\u00a0\u2013 1170 Bruxelles
\nPhone: +32 2\/644 12 88
\nE-mail: info@absym-bvas.be
\nwww.absym-bvas.be
\nBrazilian Medical Association
\n(AMB)
\nOffice Bearers (2011\u20132014):
\nPresident: Florentino de Araujo Cardoso
\n1st
\nVice-President: Jorge Carlos Machado Curi
\n2nd
\nVice-President: Newton Monteiro de Barros
\nGeneral Secretary: Aldemir Humberto Soares
\n1st
\nSecretary: Antonio Jorge Salom\u00e3o
\n1st
\nTresurer: Jos\u00e9 Luiz Bonamigo Filho
\n2nd
\nTreasurer: Murilo Rezende de Melo
\nDirector of International Affairs: Miguel Roberto Jorge
\nJunior Doctors Representative: N\u00edvio Lemos Moreira Junior
\nMembership: Any medical doctor from all States of Brazil can join
\nthe Brazilian Medical Association as a regular member if he\/she is
\na regular member of the respective State Medical Association affili-
\nated to the AMB.
\nServices provided: The main services provided by the AMB to their
\nmembership are a Board Certification jointly with the respective
\nSpecialty Society as well as its periodical renew, the Brazilian Hi-
\nerarchical Classification of Medical Procedures and related mini-
\nmum medical fees, news and scientific publications, representation
\nof their interests in national and international forums.
\nActivities:
\n\u2022 With Members: a Continuing Medical Education Program, the
\nEvidence Based Medical Guidelines Project.
\n\u2022 With the Public: Salve Sa\u00fade (Cheers Health) Campaign to pro-
\nmote healthy habits and the prevention of Non Communicable
\nChronic
\nNMA news
\n103
\nDiseases
\n\u2022 With the Governments: a Law Proposal to increase yearly fund-
\ning for health to a minimum of 10% of the GDP, lobby at the
\nMinistry of Education for quality control when approving new
\nand inspecting existent medical schools, lobby at the Ministry of
\nHealth for adoption of a medical career in the public services.
\n\u2022 With the Media: press releases related to health issues of public
\ninterest,promotion of debates related to health policies,education
\non health related issues.
\n\u2022 With Strategic Partners: special programs with pharmaceutical
\nand health insurance companies, and financial institutions aiming
\nto promote health information to the public as well as to provide
\nfree access to scientific publications to Brazilian physicians.
\nRua S\u00e3o Carlos do Pinhal 324, CEP 01333-903, S\u00e3o Paulo-SP, Brazil
\n+55 11 3178 6800
\nE-mail: rinternacional@amb.org.br; www.amb.org.br
\nBritish Medical Association
\nChair of Council, Dr. Mark Porter
\nChair of Representative Body, Dr. Ian Wilson
\nTreasurer, Dr Andrew Dearden
\nChief Executive, Mr. Keith Ward
\nMembership is open to anyone registered to undertake a medical
\nundergraduate course leading to a licence with the GMC to practice
\nmedicine and to anyone eligible for registration with the General
\nMedical Council, and for those with qualifications allowing reg-
\nistration in the area or region where they work. Applications are
\nnormally made online at www.bma.org.uk
\nThe BMA is a trade union, not part of the Trades Union Congress
\nand with no party political affiliation. We are also a voluntary pro-
\nfessional association, a medical publisher (the BMJ and its various
\njournals and e learning resources) and a company limited by guaran-
\ntee. The core membership offering includes free access to the BMJ,
\nto a wide variety of e learning resources, to trade union support if in
\nemployment difficulties (and equivalent support for those members
\nwho are employers) and to guidance on professional matters includ-
\ning ethics and to an extensive library increasingly available electron-
\nically. Many members are actively engaged with the BMA through
\nlocal,regional and national structures,helping to make policy and to
\npromote that policy to the public and to governments.
\nThe Association is an influential and active advocate, for the health
\nof the public in the UK and elsewhere. This includes advocacy on
\nmatters such as tobacco use and alcohol abuse, as well as on the
\navailability of comprehensive health care through the National
\nHealth Service. We engage with members on all matters of health
\nand health care policy, as well as working with and for members on
\nmatters such as their employment conditions, and training organ-
\nisation and opportunities.
\nWe are formally recognised to negotiate contracts of employment,
\nincluding pay, for doctors with the Government and health service
\nbodies, and are interlocutors with government on legislation, reg-
\nulation and other actions that will affect the public, patients and
\ntheir care.We use a social determinants of health approach to public
\nhealth advocacy, pointing out to the four governments within the
\nUnited Kingdom the impact of their decisions on health and well
\nbeing expectations.The Media ask the BMA to express the views of
\ndoctors on all and every health issue,including health service organ-
\nisation and to explain major health issues of the day to the public.
\nWe engage in strategic partnerships with many others on matters of
\ninterest \u2013 including for example social determinants of health, to-
\nbacco control, protection and promotion of an integrated and com-
\nprehensive health care system and promoting a healthy childhood
\nfor all children.
\nBMA House, Tavistock Square,
\nLondon\u00a0WC1H\u00a09JP,\u00a0UK
\nPresident, Professor the Baroness Ilora Finlay
\nCanadian Medical Association
\nThe Canadian Medical Association is a national, voluntary associa-
\ntion of physicians that advocates on behalf of its members and the
\npublic for access to high-quality health care. The CMA also pro-
\nvides leadership and guidance to physicians.
\nThe CMA was formed in Quebec City in 1867, just three months
\nafter the birth of Canada. It was created by 164 physicians who
\nrecognized the need for a national medical body. They selected Sir
\nCharles Tupper, who would later serve as Canada\u2019s prime minister,
\nas the first president. Plans are currently underway to celebrate the
\n150th
\nanniversary of the association in Quebec City in August 2017
\nat the CMA\u2019s annual General Council meeting, which is held every
\nyear in August. This meeting is traditionally attended by interna-
\ntional guests from the WMA and other national medical associa-
\ntions.
\nToday the CMA has more than 80,000 members,and lobbies vigor-
\nously on behalf of both members and their patients \u2013 on Ottawa\u2019s
\nParliament Hill, during federal election campaigns and in the me-
\ndia.
\nThe CMA also takes the lead on public health issues. The CMA\u2019s
\ngoal is to ensure the survival and robust health of Canada\u2019s medicare
\nsystem in the face of numerous challenges.
\nThe CMA has been an active participant in the World Medical As-
\nsociation since the founding of the WMA in 1947.There have been
\ntwo Canadian Presidents of the WMA, most recently Dr.\u00a0 Dana
\nNMA news
\n104
\nHanson in 2009 \u2013 2010. The current CMA representative to the
\nWMA Council is Dr. Andre Bernard. The CMA continues to be
\nactively engaged with the work of the WMA on many fronts, in-
\ncluding serving as Chair of the advocacy advisory group and the
\nworking group on person centered medicine.
\nThrough its Office of Ethics, Professionalism and International Af-
\nfairs, the CMA contributes to several international initiatives, par-
\nticularly in the area of medical ethics. It achieves this through its
\nwork with the WMA as well as other organizations such as the
\nWorld Health Organization and the International Committee of
\nthe Red Cross. The CMA\u2019s previous ethics director, Dr. John Wil-
\nliams, also served in this role at the WMA, while the current Ex-
\necutive Director of the Office, Dr. Jeff Blackmer, now serves as the
\nprimary ethics advisor to the WMA.
\nThe CMA\u2019s Mission, Vision and Values are as follows:
\nMission. Helping physicians care for patients.
\nVision. The CMA will be the leader in engaging and serving physi-
\ncians, and the national voice for the highest standards for health
\nand health care.
\nValues: We are known for…
\n\u2022 Professionalism. Uniting physicians on fundamental tenets impor-
\ntant to the medical profession.
\n\u2022 Integrity. Honesty in representing our members and conducting
\nour business.
\n\u2022 Compassion. Caring for physicians, patients and each other.
\n\u2022 Community building. Bringing diverse communities together to
\npursue common goals.
\nDr. Jeff Blackmer MD MHSc FRCPC Executive Director
\nOffice of Ethics, Professionalism and International Affairs
\nChinese Medical Association
\nOffice Bearers
\nPresident: Dr. CHEN Zhu (2010\u20132015)
\nSecretary General: Dr. LIU Yanfei
\nMission:
\nUniting Medical Professionals, Upholding Medical Ethics and
\nPromoting Social Justice Chinese Medical Association (CMA) is
\na non-profit national professional organization in China. It is an
\nimportant social force in the development of medical science and
\ntechnology and a linkage between the government and the medi-
\ncal professionals. Established in 1915, CMA now has 87 specialty
\nsocieties. CMA has joined 40 International Organizations and in
\nthe year 1947, CMA became a member of the World Medical As-
\nsociation. CMA publishes 162 medical journals including online
\nelectronic journals and makes several hundred kinds of audio-visual
\nproducts. It organizes more than 200 domestic and\/or international
\nconferences each year.
\n42 Dongsi Xidajie, 100710, Beijing, China
\nE-mail: intl@cma.org.cn
\nConseil National De L\u2019ordre Des
\nMedecins (CNOM)
\nOffice Bearers (2008\u20132014)
\nPresident: Mbutuku Mbambi Antoine
\nVice-President: Kaswa Kasiama Jean
\n1st
\nSecretary: Sese Ndele Henri
\n2st
\nSecretary: Ebondo Ngoie Symphorien
\nTreasurer: Beya Luiza Marie
\nMembership: Any medical doctor from all States & can join the
\nDRC Medical Council as a regular member if he\/she has an in-
\nscription to the CNOM.
\nServices provided: The main services provided by the CNOM to
\ntheir membership are a Board Certification jointly with the respec-
\ntive Specialty Society as well as its periodical renew, the Congolese
\nHierarchical Classification of Medical Procedures and related mini-
\nmum medical fees, news and scientific publications, representation
\nof their interests in national and international forums.
\nActivities
\n\u2022 With Members: a Continuing Medical Education Program, the
\nEvidence Based Medical Guidelines Project.
\n\u2022 With the Public: Salve Sa\u00fade (Cheers Health) Campaign to pro-
\nmote healthy habits and the prevention of Non Communicable
\nChronic Diseases.
\n\u2022 With the Governments: with the Ministry of Education for qual-
\nity control when approving new and inspecting existent medical
\nschools,lobby at the Ministry of Health for adoption of a medical
\ncareer in the public services.
\n\u2022 With the Media: press releases related to health issues of public
\ninterest,promotion of debates related to health policies,education
\non health related issues.
\n\u2022 With Strategic Partners: special programs with pharmaceutical
\nand health insurance companies, and financial institutions aiming
\nto promote health information to the public as well as to provide
\nfree access to scientific publications to Congolese physicians.
\nN\u00b0 17 Avenue Enseignement, Kasavubu\/Kinshasa\/RD Congo
\nPhone: +243 818128510
\nE-mail: cnomrdcongo@gmail.com; www.cnom-rdcongo.org
\nNMA news
\n105
\nNational Medical Union
\nof Costa Rica
\nOffice Bearers (2012\u20132014)
\nPresident: Dr. Edwin Solano Alfaro
\nVice-President: Dr. Alexis Castillo Guti\u00e9rrez
\nSecretary of Minutes & Correspondence: Karim Rojas Herrera
\nSecretary of Labor Affairs: Carlos Delgado Jim\u00e9nez
\nTreasurer: Dr. Johnny Rojas Quiros
\nSecretary of information: Dra.\u00a0Patricia Nunez Fallas
\nSecretary of International Affairs Dr.\u00a0Xinia Mar\u00eda \u00c1vila Matamoros
\nSecretary of education Dr. Manuel Rosales Caama\u00f1o
\nSecretary of organization DRA.\u00a0Liliana Vargas P\u00e9rez
\nBoard Member I Dra.\u00a0Rita Maria Vargas Arias
\nBoard Member II Dr.\u00a0Catalina Morales Alp\u00edzar
\nBoard Member III Dr.\u00a0Mar\u00eda de los Angeles Rodriguez Masis
\nMonitoring Member Dr. Jos\u00e9 Alberto M\u00e9ndez Elizondo
\nMembership: Any physician who is enrolled in the Colegio de
\nMedicos Y Cirujanos de Costa Rica can be affiliated as a member
\non a voluntary basis to Union Medica Nacional, currently 70% of
\ndoctors nationwide are affiliated.
\nServices provided: Legal Counsel in the field of labor law, admin-
\nistrative law, criminal law and mal practice. It boasts a service shop
\nfacilities for the affiliate, retirement fund and union related repre-
\nsentation in case of conflicts regarding conditions of the medical
\nemployment.
\nActivities (some examples)
\nAssemblies with affiliates twice a year, two annual national councils
\nof Directors of local councils, lectures nationwide that envelope dif-
\nferent labor union issues and information related to the Board of
\nDirectors, we have different commissions with Costa Rican gov-
\nernment members for the study of problems regarding the medi-
\ncal labor, also specific and follow-up of the Costa Rican legislation
\nregarding issues that will or can affect the affiliates.
\n\u2022 With Members: a Continuing Medical Education Program, the
\nEvidence Based Medical Guidelines Project, also discussion of
\nrelated affairs, concerning their labor conditions.
\n\u2022 With the Public: weekly program on television with interviews to
\ndifferent affiliates, regarding their experiences of physicians na-
\ntionwide,as an example doctors working on rural areas and bring-
\ning their knowledge and medicines to this areas.
\n\u2022 With the Government: Caja Costarricense de Seguro Social,
\nInstituto Nacional de Seguros, Ministerio de Salud, Ministe-
\nrio de Trabajo y Seguridad Social, Direcci\u00f3n de Servicio Civ-
\nil, Asamblea Legislativa, Ministerio de Hacienda, y el Poder
\nEjecutivo.
\n\u2022 With the Media: Publications in different newspapers and maga-
\nzines, conferences press, interviews and discussions about trade
\nunionism, live interviews on radio and television.
\n\u2022 With Strategic Partners:: Colegio de M\u00e9dicos y Cirujanos de
\nCosta Rica, Sindicato de M\u00e9dicos Especialistas, Sindicato de
\nProfesionales en Ciencias M\u00e9dicas, Uni\u00f3n Nacional de Emplea-
\ndos de la CCSS, Asociaci\u00f3n Nacional de Profesionales en Efer-
\nmer\u00eda, Bancos Estatales, companies.
\nSan Jos\u00e9 Costa Rica.
\nSabanaSur,100meterstotheEastoftheMinisteriodeAgriculturayGanaderia.
\nPhone: (+ 2290\u20135490)
\nE-mail: unmedica@racsa.co.cr; www.unionmedica.com
\nNational Order of Physicians of
\nCote d\u2019Ivoire
\nThe National Order of Physicians of Cote d\u2019Ivoire regulator Medi-
\ncal Corporation has a status Institution of the Republic by the law
\n60\u2013284 of 10 September 1960.
\nThe law has defined it three (03) main tasks:
\n1. Administrative, for the registration of doctors all over the coun-
\ntry through the Departmental Councils with regional vocation
\n2. Disciplinary by the jurisdiction to try and punish doctors across
\nthe disciplinary courts at both Departmental Councils and the
\nNational Council.
\n3. Aid works and retirement for doctors to preserve the reputation of
\nthe Corporation by medical social actions (residential acquisitions,
\nvehicles, various equipments, membership social mutual funds).
\nBeyond these national activities, ONMCI is mainly engaged in
\nextra-national activities:
\n\u2022 Writing a Harmonized Code of Ethics and Conduct for medical
\nspace West African States (ECOWAS), comprising nearly three
\nhundred (300) million people\u00a0\u2013 five (15) countries\u00a0\u2013 three (03)
\nlanguages (Portuguese\u00a0\u2013 English -French)
\n\u2022 Participation and elaboration in the West African Organization
\n(WAHO) the harmonization of training curricula of general
\nmedicine and medical specialties,the presence of ONMCI within
\nthe Regional Council for the Training of Health Professionals
\n(RCTHP), Board responsible for developing and issuing accredi-
\ntation to training structures healthy.
\nThe wish of ONMCI would like that these advances regionally
\nWest Africa can inspire the other physicians States in the region of
\nCentral Africa, grouped within the Economic Community of Cen-
\ntral African States (ECCAS).
\nAKA Dr. Kroo Florent
\nPresident of the National Council of ONMCI
\nNMA news
\n106
\nCzech Medical Association
\n(CzMA)
\nThe CzMA is a voluntary and independent organization of medical
\ndoctors, pharmacists and other workers in the healthcare services
\nand related fields in the Czech Republic.
\nThe number of our members has been gradually rising since 1989
\nwhen the CzMA became a democratic institution with democrat-
\nically elected president and council. The members of the CzMA
\nare affiliated on basis of their specialities in particular scientific
\nsocieties. In larger cities the doctors organize local medical clubs.
\nOne hundered twenty scientific societes and 40 local medical
\nclubs currently work within CzMA. Both Czech citizens and for-
\neigners may become members of the CzMA. As the CzMA has
\nslowly gained popularity number of its members reached more
\nthan 34\u00a0000. It represents almost 90 per cent of all doctors in the
\nrepublic.
\nThe history of the CzMA dates back to 1860 and is closely linked
\nwith the founder Jan Evangelista Purkyne (1787\u20131869), a world
\nrenowned scientist in physiology. His name gives prestige to the
\nname of our Association and helps us to hand down the traditions
\nof the humane and scientific legacy.The aim of J.\u00a0E.\u00a0Purkyne and his
\ncolleagues was,above all,the development and promotion of knowl-
\nedge in medical sciences and related fields and their application in
\nhealth care for people. These fundamental aims remain unchanged
\nto the present time.
\nThe CZMA is involved in postgraduate and continuing medical
\neducation in almost all fields of medicine, in organizing national
\nand international congresses, symposia, courses as well as in promo-
\ntion of effective health care.
\nThe CzMA has also close relations with European and medical as-
\nsociations worldwide. Of these the most important cooperation has
\nbeen with the World Medical Association (WMA). The president
\nof the CzMA has participated in most of its Council meetings and
\nGeneral assemblies.The Helsinki Declaration has been translated in
\nCzech by the CzMA and published in the Czech Medical Journal
\n(both the Seoul and Fortaleza versions).
\nThanks to its reputation the CzMA also grants awards and prizes
\nwhich are received with the respect they deserve.
\nProfessor Jaroslav Blaho\u0161, M.D., D.Sc.
\nPresident Czech Medical Association J. E. Purkyne
\nFormer WMA president
\nDanish Medical Association (DMA)
\nOffice Bearers
\nDr. Mads Koch Hansen, President
\nDr. Jette Dam-Hansen,Vice-President
\nDr. Andreas Rudkj\u00f8bing, Chair of International Committee
\nBente Hyldahl Fogh, CEO
\nMembership: Nearly all Danish doctors are members of the DMA.
\nThe total number of members as on January 1 2014: 27.090. This
\nmeans that 97 percent of the doctors authorized to practice in Den-
\nmark are members of the DMA.
\nObjectives:The specific objectives of the DMA are to unite Danish
\ndoctors in order to protect the interests of the medical profession.
\nDMA serves as the body through which the influence of the medi-
\ncal profession may be exercised in the society on issues related to
\nsickness and health and in general support the medical profession.
\nActivities: Subjects as better treatment for psychiatric patients,
\nquality in treatment, patient data security, emergency patients
\nand antibiotic resistance among others are right now high on the
\nagenda in the DMA. Related to the doctors we work with CPD,
\npatient complaint systems and autonomy. DMA exerts its influence
\nthrough various channels, including formal governmental hear-
\nings, corporations, representations in committees, partnerships with
\nother organisations, networking and lobbying activities. DMA also
\nworks through the media \u2013 in an increasing degree the social media
\n(Facebook and Twitter) which gives a direct access to our members
\nand creates an opportunity to interact with the members.DMA also
\npublishes a scientific journal on the website (ugeskriftet.dk) and ev-
\nery second week on paper.It also serves as a channel for information
\nfor members and society. DMA supports our members with differ-
\nent kinds of advice and services regarding their daily life as doctors
\nand their obligation to be continuously professional educated.
\nKristianiagade 12, DK-2100 Copenhagen
\nwww.laeger.dk
\nwww.ugeskriftet.dk
\nFinnish Medical Association (FMA)
\nOffice Bearers
\nDr.Tuula Rajaniemi (President)
\nDr. Heikki P\u00e4lve (CEO)
\nDr. Hannu Halila (Vice-CEO)
\nMs. Mervi Kattelus (Health Policy Adviser, International Affairs)
\nNMA news
\n107
\nThe FMA employs approximately 70 people (including Finnish
\nMedical Journal)
\nMembership: The Finnish Medical Association, established in
\n1910, is a professional organization of which almost all (94%) doc-
\ntors practicing in Finland are members. Membership is voluntary
\nand available for all physicians practicing in Finland. In the begin-
\nning of 2014 the number of members was 24\u00a0600.
\nThe FMA binds its members together to support common values
\n(advancement of medical expertise, humanity, ethics, and collegial-
\nity), and represents their common professional, social and economic
\ninterests. Member services include a patient injury and liability in-
\nsurance, legal advice, membership in unemployment fund, CPD\/
\nCME-training, network of trusted physicians, Finnish Medical
\nNetwork (Fimnet) Internet portal, and grants for training, research
\nand for international co-operation.Members are also offered certain
\nproducts, discounts and social activities.
\nActivities
\n\u2022 We involve our members at regional and local level to participate
\npolicy-making of the association.
\n\u2022 We negotiate the salaries of the physicians working in the public
\nsector.
\n\u2022 We follow actively health policy issues in the society and do ad-
\nvocacy work towards and together with the ministries in order to
\ndevelop health and health care system and patient\u00b4s rights in the
\ncountry.
\n\u2022 We provide official and reliable data concerning physician work
\nforce both to the governmental agencies as well as to the media.
\nThe views of the FMA are frequently quoted in the Media. The
\nFMA is a member of the Confederation of Unions for Profes-
\nsional and Managerial Staff in Finland (AKAVA).
\nP.O. Box 49 (M\u00e4kel\u00e4nkatu 2 A)
\nFI-00510 Helsinki, Finland
\nwww.laakariliitto.fi
\nThe French Medical Council
\nThe French Medical Council in a nutshell
\nThe French Medical Council brings together all doctors in France
\nwhatever their speciality and their mode of practice, defends the
\nhonor,protects the independance and represents the medical profes-
\nsion. By taking on a moral, administrative, consultative, mediation
\nand jurisdictional role, the French Medical Council is the guarantor
\nof the doctor\/patient relationship. The commitment of the French
\nMedical Council in its everyday activities is being at the service of
\ndoctors in the best interest of patients.
\n\u2022 The French Medical Council is a private body charged with a
\npublic service obligation whose existence is established in the
\nFrench Code of Public Health.
\n\u2022 In France, doctors must be registered to be allowed to provide
\nitems of medical service.According to the French Law,the French
\nMedical Council is the one managing the whole process of regis-
\ntration of doctors (including the establishment and maintenance
\nof the official register of doctors), monitoring their conditions of
\npractice as well as taking care of the recognition of their profes-
\nsional qualifications.
\n\u2022 The French Medical Council consists of one Departmental Coun-
\ncil per French Department (95 in total), one Regional Council
\nper French Region (22 in total). The French National Council
\nis made up of 54 members (from each Region), elected by the
\nDepartmental Councils, a member appointed by the Academy of
\nMedicine, and a Councillor of State appointed by the Minister
\nof Justice.
\n\u2022 Members of the National Council meet in four different sections:
\nEthics and good medical practice, Professional practice, Medical
\ntraining and competence and Public health and medical demog-
\nraphy.
\n\u2022 The Council write and update the French Code of Medical Eth-
\nics,which is an integral part of the French National Code of Pub-
\nlic Health.
\n\u2022 The French Medical Council also acts as a disciplinary body for
\ndoctors
\n\u2022 The Council has set up 2 Delegations: one for internal affairs\u00a0(to
\nsupport and oversee the Departmental and Regional Councils)
\nand one for European and International Affairs (DAEI) (to work
\nwith other European and international bodies).
\nEuropean and International Commitments\u00a0
\n\u2022 Since 2012, the French Medical Council is an official member of
\nthe World Medical Association
\nXavier Deau President
\nof the International
\nRelations Delegation
\nand President-Elect
\nof the WMA
\nPatrick Bouet
\nPresident of the French
\nMedical Council
\nWalter Vorhauer
\nSecretary General of
\nthe French Medical
\nCouncil and Council
\nMember of the WMA
\nNMA news
\n108
\n\u2022 The French Medical Council runs the General Secretariat of:
\n– The European Council of Medical Orders (CEOM) which
\nbrings together Medical Councils and regulatory bodies from
\n16 European Ccountries. It aims at promoting the practice at
\nEuropean level of high quality medicine respectful of patients\u2019
\nneeds
\n– The Conference of Medical Councils from French-speaking
\ncountries (CFOM) which is a collegial forum for discussion
\namong medical regulatory bodies from French-speaking coun-
\ntries.
\nBrussels representative office
\nThe French Medical Council opened in 2008 a representative of-
\nfice to the European Institutions in Brussels in order to closely
\nmonitor European legislation on health. Since 2011, this office
\nhas been shared with the Spanish, Italian and Portuguese Medical
\nCouncils.
\nGeorgian Medical Association
\nOffice Bearers:
\nProf. Gia Lobzhanidze M.D., Ph.D., Sc.D. \u2013 Chairman of the Di-
\nrectors Board
\nGia Tsilosani M.D., Ph.D.\u2013 Vice Chairman of the Directors
\nBoard
\nZaza Khachiperadze M.D. \u2013 Secretary-General
\nProf.Besarion Kilasonia M.D.,Ph.D.,Sc.D.\u2013 Past Honorary President
\nProf. Dimitri Kordzaia M.D., Ph.D., Sc.D. \u2013 Honorary President
\nTamaz Maglakelidze M.D.,Ph.D.,Sc.D.\u2013 Honorary President-Elect
\nLia Kovziridze \u2013 Treasurer
\nKetevan Medvedskaia \u2013 Office Manager
\nMembership: Voluntary; Total Number of Members: 4017;
\nNumber of Junior Doctors: 357; Number of Medical Students
\n(EMSA-TSU): 210
\nDetails of who can join, how many join and what services are
\navailable to Members:
\nAll licensed physician practicing in Georgia, living overseas doctors,
\nresidents and students of the Faculty of Medicine. The number of
\nmembers is unlimited.
\nGeorgian Medical Association offers its members: continuing
\nmedical education; Professional liability insurance; Protecting the
\nrights of medical personnel; Recommendation-petitions for public,
\nprivate and non-governmental agencies (in case of necessity); Par-
\nticipation in the conferences and congresses with affordable prefer-
\nential price, etc.; Printing articles in its journal \u201cGeorgian Medical
\nJournal\u201d at reasonable prices; Active involvement in various social
\nprograms and charity events; inclusion and participation in Re-
\nsearch and grant programs; provide support to send abroad to work
\nand for internship, and so forth.
\nActivities:
\n\u2022 With Members: Annual Conferences; Continuing Medical
\nprograms; Work on guidelines and protocols; Protecting the
\nrights of medical personnel; Professional help in orientation
\nand the graduate pre- and postdiploma medical education
\nstages.
\n\u2022 With the Public: Introducing the annual number of days\/week
\nof celebration by the World Health Organization; Delivering
\nInformation on patients\u2019 rights in relation to the work per-
\nformed; Promotion of Healthy Lifestyle and trainings; Provid-
\ning free medical research and assistance to the population of
\nthe regions; Providing benefits to medical personnel and their
\nfamily members at University Clinic to make Research and
\ntreatment.
\n\u2022 With the Governments: Participation in the development and
\nimplementation of guidelines and protocols; Participation in
\ncompilation test questionnaires and exams in qualification and
\nlicensing exams; Participation in different councils\u2019 work of
\nmedical profile; Legislative initiatives relevant to the commit-
\ntees of Parliament; Providing the Secondary schools with the
\neducational programs dedicated to a healthy lifestyle together
\nwith the students of Tbilisi State University (TSU) Faculty of
\nMedicine; The expertise of incidence of medical errors and com-
\nplaints.
\n\u2022 With the Media: Participation in TV and radio programs to
\ndiscuss issues related to health; Exclusive weekly radio program
\nbroadcast on the topical issues of interest to the population on the
\nactual issues; Intensive cooperation with the Press on the other
\ntopical issues.
\n\u2022 Others e.g: Active participation in the rehabilitation victims of
\ntorture; Active participation of the development of the systems
\nin Penitentiary institutions; Work of Ethical Council in medi-
\ncal researches; Foundation and management of the University
\nClinic together with the TSU; The implementation of joint
\nprograms with Tbilisi State University Faculty of Medicine;
\nPublishing the \u2018Georgian Medical Journal\u201d together Faculty
\nof Medicine of TSU; Organizing joint projects with Students
\nof the Faculty of Medicine of TSU; Active cooperation with
\nGeorgia-based industry trade associations, societies, and funds;
\nActive involvement in the country\u2019s domestic and international
\ngrants; Workout and implementation of Professional Liability
\ninsurance program across the country.
\n11 Budapeshti str.
\n0169 Tbilisi, Georgia
\nNMA news
\n109
\nThe Hong Kong Medical
\nAssociation
\nOffice Bearers (2014\u20132016)
\nPresident Dr. SHIH Tai Cho, Louis, JP
\nVice-Presidents Dr.CHANYee Shing,Alvin,Dr.CHOW Pak Chin,JP
\nHon. Secretary Dr. LAM Tzit Yuen, David
\nHon.Treasurer Dr. LEUNG Chi Chiu
\nImmediate Past President Dr.TSE Hung Hing, JP
\nTo Safeguard the Health of the People
\nFounded in 1920, the Hong Kong Medical Association brings to-
\ngether all medical practitioners practising in, and serving the peo-
\nple of Hong Kong. The Association is managed by a Council of
\n28 members elected from the general membership. The Council is
\nassisted by over 50 standing and ad hoc committees to oversee vari-
\nous issues relating to the medical profession, membership welfare
\nas well as public medical education. With a membership of over
\n10,000 which comprises the majority of registered medical practi-
\ntioners in Hong Kong, the Association represents the medical pro-
\nfession in the territory both locally and in the international scene.
\nIn recent years, the Association promotes healthy life styles such
\nas safe driving, exercise for health, DASH diet, disease prevention
\nby vaccination and \u201cSay No to Drugs\u201d to the younger generation. It
\nalso participates in various organ donation campaigns.The HKMA
\nspearheaded the first computerized organ donation registry in
\nHong Kong in 1994.In order to pool all possible efforts,the job was
\ntaken up by the Department of Health by setting up the Centralised
\nOrgan Donation Register.
\nThe medical professionals show their concern to the public not only
\nwithin but also outside their clinics and hospital wards.The Association
\nhas been raising funds for community projects over the past 20\u00a0years
\nthrough public performances of the HKMA Choir and Orchestra.The
\nHong Kong Medical Association Charitable Foundation was founded
\nin 2006 for better promotion and organization of charitable activities
\nfor helping the underprivileged with special medical needs.
\nA Platform for the Members
\nThe Association runs regular continuous medical education (CME)
\nactivities in form of lectures, seminars, workshops, discussion group,
\nclinical attachments in hospital and exchange conference. Various
\nCommunity Networks set up by the Association have also exerted
\ngreat efforts in the training of doctors.
\nEvery year members have the opportunity to compete with each oth-
\ner on arenas in various sports tournaments including badminton,golf,
\nsnooker, squash, table-tennis, tennis, tenpin-bowling and football.
\nThe annual Family Sports Day and the Swimming Gala are the major
\nsports events and well supported by members. The Association also
\noffers a variety of recreational and cultural activities, e.g. photography
\nexhibition, singing competition and gourmet dinner etc.
\nThe Annual Ball, which is mostly held in New Year\u2019s Eve, is defi-
\nnitely one of the most joyous occasions of the year. Members relish
\nthe good food, fine music and delightful dance with their partners
\nand friends.
\nYoung members, especially students are the future of the profession.
\nThe Association organises the Career Seminar for young graduates
\nbefore they start internship. In addition, medical exchange tours to
\nMainland China are hold annually for young members and medical
\nstudents for them to know about the healthcare system of China.
\nBesides, monthly Newsletter reporting the Association\u2019s activities
\nand commenting on controversial medical issues is published to en-
\nhance communication between members and the HKMA Council,
\nand amongst the membership.
\nA Bridge for the Public
\nThe Association disseminates health information to the public
\nthrough press releases, radio programmes, TV programmes, public
\nhealth awareness events, exhibitions, pamphlets and video.
\nTo facilitate the public to find a suitable doctor, the Association
\ndevelopes the Doctors Homepage which contains essential infor-
\nmation including doctor\u2019s specialty and means of contact of all reg-
\nistered doctors in Hong Kong.
\nAn Active Player in Hong Kong
\nWith the unfailing support from the members, the Association
\ncontinues to speak for the profession and safeguard the health and
\nwelfare of the public. It works closely with the Government, the
\nHospital Authority (HA) and the Department of Health (DH)
\non public health issues, for instance, regulation of medical proce-
\ndures,public-private partnership programme (PPP),revamp of HA,
\nHealth Protection Scheme (HPS), nutrition labelling, adult and
\nchildhood vaccination etc.
\nLegislative Councillor who is elected by the Medical Functional
\nConstituency is also invited to serve in the Council of the Associa-
\ntion as a representative voice.
\nLooking outside Hong Kong
\nThe Hong Kong Medical Association and the Chinese Medical As-
\nsociation of Mainland China organize annual exchanges to promote
\nfriendly relationship and understanding of medical development in
\nthe two localities.
\nInternationally, the Association joins the medical experts worldwide
\nin the WMA General Assembly and the CMAAO Council Meeting
\nevery year.
\n5th
\nFloor, Duke of Windsor Social Service Building,
\n15\u00a0Hennessy Road, Hong Kong
\nPhone: (852) 2527 8285
\nE-mail: hkma@hkma.org
\nNMA news
\n110
\nHungarian Medical Chamber
\nOffice Bearers (2011\u20132015)
\nPresident: Dr. Istv\u00e1n \u00c9ger
\n1st
\nVice President: Prof. Dr. J\u00e1nos Banai; 2nd
\nVice President: Dr. J\u00e1-
\nnos Gerle; 3rd
\nVice President: Dr. Attila Kov\u00e1ts
\nSecretary General: Dr. Ferenc Nagy
\n1st
\nSecratary: Dr. G\u00e1bor Holl\u00f3s; 2nd
\nSecretary: Dr. J\u00e1nos Lengyel
\n3rd
\nSecretary: Dr. Zsolt Pataki; 4th
\nSecretary: Dr. P\u00e9ter Tak\u00e1cs
\nMembership:Any medical doctor from all States of Hungary can join
\nthe Hungarian Medical Chamber as a regular member.Since 1994 the
\nHungarian law says all medical doctor, who is practicing have to join
\nthe Hungarian Medical Chamber. Between 2007 and 2011 the mem-
\nbership temporarily was voluntary. In 2011 the law have been recon-
\nstructed and since then the membership is mandatory.
\nServices Provided: The Hungarian Medical Chamber is an inde-
\npendent, democratic body which preserve professional, moral and
\nsubstantial interest of doctors. Functionally it is a public body as a
\nrepresentative democracy. With an open structure and influence it
\nserves people and people\u2019s health.
\nActivities:
\n\u2022 With Members: A monthly newspaper with scientific and health
\npublications for all member of the Hungarian Medical Chamber.
\n\u2022 With the Public: Serves people\u2019s health with the principle of \u201csal-
\nvation of patient is the primary law\u201d.
\n\u2022 With the Governments: Law proposal and estimate, lobby at the
\nMinistry of Health for better medical basic services.
\n\u2022 With the Media: Press releases and interviews to health issues of
\npublic interest and promotion of debates related to health policies.
\n\u2022 With Strategic Partners: Collaboration with Chamber of Nurses,
\nChamber of Pharmacies health insurance companies and promo-
\ntion of public health.
\nSzondi street 100., Budapest 1068, Hungary,
\nPhone: +36\u20131\/302\u20130065
\nEmail: elnok@mok.hu; www.mok.hu
\nIcelandic Medical Association
\n(IMA)
\nBoard of the IMA (2013\u20132014): Officers:
\nChairman: \u00deorbj\u00f6rn J\u00f3nsson;
\nVice-chairman: Orri \u00de\u00f3r Ormarsson;
\nTreasurer: Magn\u00fas Baldvinsson;
\nSecretary Salom\u00e9 \u00c1. Arnard\u00f3ttir;
\nDirectors: Bj\u00f6rn Gunnarsson, Gu\u00f0r\u00fan J\u00f3hanna Georgsd\u00f3ttir,
\nMagdalena \u00c1sgeirsd\u00f3ttir, \u00de\u00f3rarinn Ing\u00f3lfsson, \u00d3l\u00f6f Birna Mar-
\ngr\u00e9tard\u00f3ttir (appointed to the board by the Association of General
\nPhysicians).
\nIMA is an umbrella organisation of physicians who are members
\nof the IMA\u2018s member associations or who have an individiual
\nmembership to the IMA. In August 2014 there are around 1100
\npractising doctors in Iceland. Of these 98,5% are members of the
\nIMA. A total of 229 are members of the Association of Elderly
\nPhysicians.
\nA large proportion of them have retired. Furthermore, several hun-
\ndred Icelandic doctors are living and working solely abroad, mostly
\nin Scandinavia.
\nThe purpose of the IMA is according to Article 2 of its bylaws:
\n\u2022 To promote the status of the medical profession in Iceland and
\nenhance the professional development of its members.
\n\u2022 To safeguard the independence and interests of the medical pro-
\nfession.
\n\u2022 To work for the enhanced education of doctors of medicine
\nand to encourage their interest in matters pertaining to their
\nwork.
\n\u2022 To promote co-operation between doctors on everything conduc-
\ntive to progress in publich health affairs.
\n\u2022 To participate in international co-operation between doctors on
\ncommon issues.
\n\u2022 To contribute to increased public health in Iceland and to pro-
\nmote policy issues in the health sector.
\nThe IMA offers its members various assistance not least pertaining
\nto interpretation of collective wage agreements. Furthermore the
\nIMA offers its member legal assistance on matter related to their
\nwork.Through the IMA its members have access to holiday homes,
\nsummer houses and flats in Iceland. Furthermore the IMA\u2018s Fam-
\nily Fund gives financial support to its members and families when
\nsupport criterias are met, such as major illness or death as well as
\nsupporting leave due to childbirth.
\nWhen necessary the IMA voices its opinion on various issues in the
\nhealth sector both related to health care services, medical ethics and
\npatients\u2018 safety. This is done directly with dialogue with the Gov-
\nernment or through the media to the general public. IMA further
\nexpresses regularly to the Parliament its opinion on draft legisla-
\ntions related to health care, health care issues and patients\u2018 safety
\nand care issues.
\nThe IMA is actively involved with cooperation with other Nordic
\nMedical Associations. It further takes part in the works of CPME,
\nUEMS and WMA.
\nHl\u00ed\u00f0asm\u00e1ri 8, 4th
\nfloor,
\nIS-200 K\u00f3pavogur, Iceland
\nNMA news
\n111
\nIsraeli Medical Association
\nPresident: Dr Leonid Eidelman
\nSecretary General: Adv Leah Wapner
\nThe Israeli Medical Association (IMA),
\nfounded in 1912, is an independent pro-
\nfessional organization advocating for the
\nrights of physicians and patients, serving
\nas the official representative body of phy-
\nsicians and acting as an arbiter of health
\npolicy and medical ethics in Israel. The
\nIMA is responsible for setting professional
\nnorms and ensuring the highest standards
\nof medicine and professional integrity.
\nAlthough membership in the IMA is vol-
\nuntary,over 90% of publicly employed physicians in Israel are mem-
\nbers.The IMA also acts as the umbrella association for 155 scientific
\nassociations, societies and workgroups. The IMA\u2019s 21,409 members
\nhave access to educational courses, medical journal subscriptions,
\nlegal, tax and insurance assistance, information about rights and
\nentitlements, scholarships, pension services, welfare activities and
\nmore. Israel is characterized by its ethnic diversity; medical doctors
\nin all ethnic groups make up the members of the IMA.
\nThe IMA Scientific Council is responsible for the planning and su-
\npervision of all post-graduate training and for continuing education
\nprograms in medicine in Israel. Their work also includes approving
\nmedical specialist certification in 56 medical fields, accrediting hos-
\npitals and clinics for medical specializations, overseeing residency
\nprograms, devising curricula, formulating and administering exams,
\naccrediting departments for residency purposes and recommending
\nthe award of specialty certificates.
\nThe IMA Ethics Board,comprised of senior physicians from a variety
\nof fields, convenes on a monthly basis to discuss ethical issues aris-
\ning in the field, and to approve principle decisions concerning medi-
\ncal ethics. The Board disseminates position papers, promotes ethical
\nissues, reviews complaints lodged against physicians and organizes
\nconferences on various issues of interest to physicians and the public.
\nThe Ethics Board formulates the physician\u2019s code of ethics which
\nis binding following the approval of the national convention. The
\nEthics Board also takes positions on all major medical issues in Is-
\nrael, including, most recently, convening a consensus conference to
\nestablish a position on treating prisoners participating in hunger
\nstrikes.
\nSince 1995, when the National Health Insurance Act was passed,
\nthe IMA has expanded its function to take a greater role in shaping
\nnational health policy, influencing the legislative process and pro-
\nmoting public health and quality assurance. Recent related activities
\ninclude hosting a \u201cHealth Day\u201d at the Israeli Parliament and suc-
\ncessfully co-submitting a bill to ban smoking in public playgrounds
\nand within 10 meters of the entrance to kindergartens.
\nIn 2011, citing a decline in Israel\u2019s public health care system, the
\nIMA publicly announced \u201ca mission to save public medicine,\u201d de-
\nmanding additional staff, more beds in hospitals, an increase in phy-
\nsician salaries in the periphery and incentive pay for doctors work-
\ning in specialties suffering from physician shortages. After many
\nmonths of a difficult and complex struggle, marked by intensive
\nnegotiations and strike action, on 25th
\nAugust 2011 a breakthrough
\nagreement was signed.The agreement included an additional almost
\n3 billion NIS in early funding, 1,000 new doctor positions in public
\nhospitals, a limit to the number of resident on-call shifts, significant
\nsalary and hourly wage increases and financial incentives for doctors
\nworking in the periphery and\/or in specialties with severe shortages.
\nThe IMA publishes two scientific periodicals, which are disseminat-
\ned to all IMA member physicians as well as to subscribers in Israel
\nand abroad. Harefuah is a Hebrew medical-scientific periodical that
\npublishes a wide variety of articles written by the most prominent
\nphysicians in Israel.The periodical has been published monthly since
\n1924. The Israel Medical Association Journal (IMAJ) is a medical-
\nscientific periodical in English, which publishes scientific articles in
\nall medical fields, written by renowned physicians from Israel and
\nabroad.The journal has been published monthly since 1999.
\nThe IMA has been an active member of the World Medical Asso-
\nciation since its inception, drafting and contributing to statements
\nand declarations and holding key offices within the organization.
\nThe IMA sends Israeli doctors on fellowships abroad, and is also
\nclosely connected with other NMAs and international medical or-
\nganizations such as the WHO, the International Committee of the
\nRed Cross and others, and frequently collaborates with medical and
\nhumanitarian efforts around the world.
\n2 Twin Towers, 35 Jabotinsky Street, PO Box
\n3566 Ramat Gan, 5213604 Israel
\nJapan Medical Association
\nOffice bearers: President; Dr. Yoshitake Yokokura, Vice Presidents
\n(3); Dr. Kenji Matsubara and others, Board Members (13), Execu-
\ntive Board Members (10); Dr. Masami Ishii and others, Auditors
\n(3), Chair and Vice-Chair of the House of Delegates
\nMembership: Voluntary,166,000 members.Total number of physicians
\nin Japan is about 300,000.Typesof members;Founders of clinic\/hospital\u00a0\u2013
\nabout 84,000; Employed physicians \u2013 about 81,000; Residents \u2013 825
\nAffiliated facilities: JMA Research Institute, Center for Clinical Tri-
\nals of the JMA, Woman Doctors Support Center of the JMA, and
\nJMA Certificate Authority
\nLeonid Eidelman
\nNMA news
\n112
\nActivities:The JMA\u2019s activities are extensive.
\nWith Members: Provide CME programs including JMA lecture
\nconferences, training program and symposium. Some of them are
\ne-learning. Provide the up-dated information by publication, video,
\nTV and radio programs. JMA medical library with about 93 thou-
\nsand books is open to the members.Enhance the awareness and
\nlevel of medical ethics. Assure a solid financial basis for medical
\npractitioners. Programs to support women doctors for their more
\npositive activities.
\nPrograms for the emergency disaster countermeasures
\n\u2022 With the Public: Let the public know the activities of the JMA
\nand provide them with useful medical information about topics
\nsuch as infectious diseases, disaster medicine and emergency care
\nmainly by Website and TV programs.
\n\u2022 With the Government: By being a member of the core committees
\nof the Ministry of Health Labor and Welfare, the JMA has a big-
\nger voice in the government\u2019s policy making process. Negotiate
\nwith the government for securing the medical fee to ensure the
\nmember\u2019s professional autonomy for their steady daily practice of
\nmedicine. Offer the government the JMA\u2019s opinions about im-
\nportant health issues of community health such as the counter-
\nmeasures against an aging society
\n\u2022 With the media: A press conference is regularly held to provide the
\nmedia with accurate idea of the JMA about national health policy
\nand other important health issues as well as action programs\/
\nplans and report of the achievements.
\n\u2022 Others e.g.: Strategic partnerships: Serve as Secretariat of the Con-
\nfederation of Medical Associations in Asia and Oceania since 2001.
\n\u2022 JMA has been collaborating with the Harvard School of Public
\nHealth to support the Takemi Program in International Health
\nwhich was established in 1983.
\n2\u201328\u201316,Honkomagome, Bunkyo-ku, Tokyo, 113\u20138621 Japan
\nNational Medical Association of
\nthe Republic of Kazakhstan
\nActivities
\n\u2022 Interaction with different ministries and bodies
\n\u2022 Represent the interests of the members of the NMA in govern-
\nmental, international and nongovernmental organizations
\n\u2022 Protect the rights and interests of their members upon conflict
\nsituations, legal proceedings
\n\u2022 Implements publishing activity
\n\u2022 During 1996\u20132000\u00a0 \u2013 prepared and issued weekly programme
\n\u201cDensaulyk\u201d(Health) onTV for population in Kazakh and Russian
\n\u2022 Initiated establishing of the Almaty Curative Centre, Institute
\nof post-graduate education for psychologists and physicians,
\nChairs on \u201cMedical psychology\u201d and \u201cMedical right and Bio-
\nethics\u201d
\n\u2022 Conducts city, republican, international conferences on actual
\nhealth problems
\n\u2022 Actively introduces and implements independent expertise in the
\nhealth system
\n\u2022 Initiates foundation of the avenue \u201cAve Vitae\u201din Almaty, devoted
\nto the memory of doctors-solders
\n\u2022 Developer of Ethical codex of physician of the RK, hymn and
\noath
\n\u2022 Established nominations:
\n– The best physician of the NMA (award \u201cAltyn Deriger\u201d)
\n– The best nurse (award \u201c\u041c\u0435\u0439\u0456\u0440\u0456\u043c\u201d (Miloserdie))
\n– The best clinic of the Year
\nNMA representatives are members of the National Coordination
\nCouncil on Health Care under the Government of the RK, on at-
\ntestation, conflict situations, awards and commissions of local ex-
\necutive bodies.
\nInternational collaboration
\nClose contact with National Medical Associations of Europe and
\nAsia
\n1994 \u2013 Member of the European Forum of Medical Associations
\n1997 \u2013 Member of the Eurasian Forum of Medical Associations
\n2003 \u2013 Member of the World Medical Association
\n2003 \u2013 Member of the EFGCP
\nAlmaty 050000, Kazakhstan,
\n117\/1 Kazybek bi str.
\nKorean Medical Association
\nPresident: Dr. Choo, Moojin
\nChair, Executive Committee of International Relations: Dr. Shin,
\nDong Chun
\nKMA, established
\nin 1908, is a statu-
\ntory organization
\nin accordance with
\nthe Medical Ser-
\nvice Act and is the
\nofficial organiza-
\ntion representing all
\nphysicians in Korea. Choo, Moojin Shin, Dong Chun
\nNMA news
\n113
\nUnder the Medical Service Act, all physicians who obtain a medi-
\ncal license must become a member of KMA and accordingly, KMA
\ncurrently represents more than 110,000 physicians in Korea.
\nKMA\u2019s top decision-making body is the House of Delegates.Within
\nits organization, KMA also includes the Korean Academy of Medi-
\ncal Sciences with 154 medical societies as its members, the Research
\nInstitute for Health Policy,16 regional medical associations,the mili-
\ntary medicine chapter and 2 overseas chapters. It also has councils
\norganized by occupation such as the private practice doctors\u2019 council,
\ngovernment-employed doctors\u2019 council, hospital doctors\u2019 council, in-
\ntern & resident council and public health doctors\u2019council.
\nThe founding goal of KMA is to contribute to the promotion of
\npeople\u2019s health and social welfare by enhancing medical ethics and
\ndeveloping medical science and technology.
\nTo achieve this goal, KMA has been providing its members with
\na code of ethics and has been developing and researching various
\ntraining and continuing education programs. Also, at the macro-
\nlevel, KMA has been actively participating in the process of devel-
\noping government\u2019s health policies as a professional organization
\nbased on its health policy surveys and research as a part of its efforts
\nto improve Korea\u2019s health system.
\nFurthermore, KMA has been very active in various community ac-
\ntivities including medical volunteering, environmental protection,
\nchild abuse prevention as well as medical exchange with North Ko-
\nrea. Recently, KMA has been focused on delivering objective and
\naccurate health and medical information to the public by strength-
\nening its public communication efforts in order to prevent people
\nfrom becoming confused or experiencing harm due to the flood of
\nunverified and inaccurate medical information.
\nKMA publishes Doctor\u2019s News, the official weekly newsletter for
\nactively communicating KMA\u2019s activities to the public and mem-
\nbers and the professional medical journal, The Journal of Korean
\nMedical Association.
\nKMA will continue to strive to better serve the public and its mem-
\nbers by further enhancing its capabilities and through close interna-
\ntional cooperation.
\nLatvian Medical Association
\nPresident Dr. P\u0113teris Apinis
\nVice-presidents Dr. Maris P\u013cavi\u0146\u0161, Dr. Vilnis Dz\u0113rve-T\u0101luts
\nLMA is governed by a board composed of 15 people and automati-
\ncally includes the President of Latvian Junior Doctors association
\nFirst medical association in Latvia was established in 1802 in Riga
\nbut there has not been any real heredity. During the Soviet occupa-
\ntion (1940\u20131991) professional organizations were banned. 1988 is
\nconsidered the founding year of currently existing Medical associa-
\ntion when it began operating illegally.
\nLMA unites all Latvian medical specialty associations (surgeons,
\nanaesthesiologists, gynaecologists, etc.) as well as individual mem-
\nbers. Individual members receive professional medical journal \u201cLat-
\nvijas \u0100rsts\u201d (Latvian Physician) monthly, take part in conferences,
\ncongresses and other events for reduced price. Journal is a 80\u201396
\npage long journal containing only medical articles, mainly reviews.
\nThe association publishes medical books on regular basis.
\nIn Latvia medical professionals may practice only when they have
\nacquired a certificate issued by LMA.The certification in each field
\nis entrusted upon a dedicated committee formed by LMA in coop-
\neration with specialty associations. Re-certification is required every
\nfive years and it is automatic if the physician can present 250 further
\neducation points (60% of them in relevant specialty).
\nLMA has the right of legislative initiative, thus almost all laws con-
\ncerning public health (restriction of smoking, alcoholism limita-
\ntion, trans fat limitation, etc.) are initiated and moved to parliament
\nLMA. A professional court operates under LMA and mainly deals
\nwith very complex medical treatment situations.Additionally,LMA
\nalso has an ethics committee.
\nThe association organizes nation-wide disaster medicine training
\nevents which take place in a different city every year. This year the
\nsituation was \u201ccapsized and burning train coaches with 50 victims,
\nmostly polytrauma patients\u201d.
\nEvery week LMA organizes discussions on important health or medi-
\ncal issues which are always attended by one of the highest officials of
\nthe Ministry.Over a year LMA organizes 20\u201324 conferences covering
\nvarious subjects (mainly, interdisciplinary). Latvian Congress of Phy-
\nsicians is held every four years. A video documentary is made before
\nthese congresses covering the medicine in Latvia in the particular year.
\nLMA is actively involved in the work of WMA, CPME, EFMA.
\nSkolas street 3, Riga, Latvia, LV-1010, Phone: (+371)67287321
\nE-mail: lma@arstubiedriba.lv; www.arstubiedriba.lv
\nMyanmar Medical Association
\nPresident \u2013 Professor Rai Mra
\nVice-President (1) \u2013 Professor Aye Aung
\nVice \u2013President (2) \u2013 Professor Myint Thaung
\nGeneral Secretary \u2013 Professor Saw Win
\nJoint General Secretary \u2013 Dr. Khaing Soe Win
\nTreasurer \u2013 Professor Mya Thida
\nAcademic Secretary \u2013 Professor Win Myat Aye
\nImmediate Past President \u2013 Professor Kyaw Myint Naing
\nMembers
\nProfessor S. Kyaw Hla; Professor Kyaw Zin Wai; Professor Thet
\nKhaing Win; Dr. Sein Thaung.
\nNMA news
\n114
\nMembership \u2013 All medical doctors registered with the Myanmar
\nMedical Council are eligible for membership. Pre-registration
\nhouse officers are given pre-membership.
\nActivities
\nWith members \u2013 All members are eligible to attend the annual
\nMyanmar Medical Conference and well as all speciality con-
\nferences and CME activities carried out by the association at a
\nreduced rate. The quarterly Myanmar Medical Journal and the
\nmonthly newsletter are distributed free of charge to members.
\nMembers have the privilege to use the facilities of the medical
\nassociation. All members have the right to vote at the election
\nfor the executive council of the medical association. They also can
\nenter the elections as candidates.
\nWith the public \u2013 the public is invited to attend the public health
\ntalks and health education talks held periodically at the associa-
\ntion. Important health issues are discussed and disseminated to
\nthe public.
\nWith the government \u2013 Myanmar Medical Association takes part
\nin the National Health Committee meetings held by the ministry of
\nhealth.MMA is also invited by the ministry of health to take part in
\ndiscussions on important health issues concerning the public as well
\nas policy issues related to all doctors.
\nWith the media- the media is invited to all important activities car-
\nried out by MMA. MMA also makes television broadcasts on many
\nimportant health issues.
\nOthers e.g. Strategic partnerships \u2013 The Myanmar Medical As-
\nsociation has strategic partnerships with the Ministry of Health,
\nGlobal Fund, 3MDG fund, UNFPA and Nippon foundation in
\nimplementing public health projects on malaria and tuberculosis,
\nsexual and reproductive health, IUD services, youth programme,
\nand mobile medical services in remote areas.
\nNo. 249, Theinbyu Road,
\nMingalar Taung Nyunt Township,
\nYangon, Myanmar
\nNew Zealand Medical
\nAssociation (NZMA)
\nOffice Bearers (2013\u20132015)
\nPresident: Branko Sijnja
\nChair: Mark Peterson
\nDeputy Chair: Stephen Child
\nGeneral Practitioners Council Chair: Kate Baddock
\nSpecialists Council Chair: Harvey White
\nDoctors-in-Training Council Chair: Sudhvir Singh
\nMembership: The New Zealand Medical Association (NZMA)
\nis the country\u2019s foremost pan-professional medical organisation in
\nNew Zealand representing the collective interests of all doctors.The
\nNZMA\u2019s members come from all disciplines within the medical
\nprofession, and include specialists, general practitioners, doctors-in-
\ntraining and medical students.
\nServices provided: The NZMA is a strong advocate on medico-
\npolitical issues, with a strategic programme of advocacy with politi-
\ncians and officials at the highest levels.
\nThe key roles of the NZMA are:
\n\u2022 to provide advocacy on behalf of doctors and their patients
\n\u2022 to provide support and services to members and their practices
\n\u2022 to publish and maintain the Code of Ethics for the profession
\n\u2022 to publish the New Zealand Medical Journal.
\nThe NZMA works closely with many other medical and health
\norganisations, and provides forums that consider pan-professional
\nissues and policies. The NZMA has a close relationship with, and
\nprovides support to, the New Zealand Medical Students Associa-
\ntion (NZMSA).
\nThe NZMA provides administrative, advocacy and communica-
\ntions activities for the New Zealand Branch of the Royal Australian
\nand New Zealand College of Ophthalmologists (RANZCO). It
\nalso provides support services to the Medical Benevolent Society.
\nActivities (some examples)
\n\u2022 With Members:
\n– Revision of the profession\u2019s Code of Ethics, which lays down
\nprinciples of ethical behaviour, applicable to all doctors. It also
\nincludes recommendations for ethical practice.
\n– Representing member practices in employment negotiations
\nwith the nurses\u2019 union.
\n\u2022 With the Public: Tackling Obesity: a policy briefing\u2014this publica-
\ntion recommended a suite of measure to be considered as part
\nof an approach to tackling New Zealand\u2019s obesity epidemic. This
\nwas a major piece of work for the NZMA, with several months\u2019
\nresearch into the latest evidence of the harms associated with obe-
\nsity and on the successful ways in which these can be addressed.
\n\u2022 With local and central Government: Advocacy on: local alcohol
\npolicies; support for plain packaging for tobacco products; a new
\nnational drug policy; non-medical prescribing; health equity and
\nsocial determinants ; health structure and funding, with particular
\nreference to primary care
\n\u2022 With the Media: Press releases related to health issues of public
\ninterest (obesity etc); promotion of debates related to health poli-
\ncies (fluoridation of community water supplies; alcohol policies
\netc);
\n\u2022 With Strategic Partners: Submissions to the Medical Council
\nof New Zealand on reviews of advertising, cultural competence,
\nregistration of foreign-trained doctors. Advocacy to the national
\nNMA news
\n115
\nfunding agency for pharmaceuticals (PHARMAC) on its ap-
\nproach to managing hospital devices, as well as various individual
\ndrug funding proposals; advocacy to the Pharmaceutical Society
\non the draft National Pharmacist Services Framework; workforce
\nplanning and sustainability (with Health Workforce New Zea-
\nland and other agencies)
\nL13, 39 The Terrace, Wellington 6140,
\nNew Zealand PO Box 156, Wellington 6140
\nE-mail: nzma@nzma.org.nz
\nwww.nzma.org.nz
\nNorwegian Medical Association
\n(NMA)
\nOffice Bearers: Hege Gjessing, President, Geir Riise, Secretary
\nGeneral
\nWho can join: All physicians with a Norwegian licence as well as
\nNorwegian medical students can join. At present NMA has 31 131
\nmembers.
\nServices available to members are: Central and locally negoti-
\nated agreements concerning salaries and working conditions both
\nfor physicians in private practice and employed physicians, provi-
\nsion of legal assistance to members, advice on educational matters,
\nleadership training as well as other courses, training and guidance
\nfor local representatives, Internet based medical courses, projects
\non quality improvement, health policy documents, reports on vari-
\nous health issues etc.. The members also receive NMA\u2019s Medical
\nJournal twice a month. Our Institute for Studies of the Medical
\nProfession produces research on physician\u2019s career choices, psy-
\nchological, ethical and social aspects of doctoring, and the physi-
\ncian role in general.
\nActivities:
\n\u2022 With Members \u2013 NMA works close with the members on most
\nareas that are of importance for physicians. NMA is organised
\nin seven occupational branches, one student association and 45
\nmedical societies. Locally NMA is organised in 4 regional and
\n19\u00a0county branches. The branches and the societies are consulted
\non matters that are of importance for them.
\n\u2022 With the Public \u2013 Articles of public interest published in our
\njournal are distributed to media to be used to inform the pub-
\nlic about various health issues. NMA also actively raise political,
\nmedical and societal issues considered of importance for public
\nhealth.
\n\u2022 With the Government \u2013 NMA cooperates closely with various
\ngovernmental bodies on subjects concerning our members such
\nas education, health politics, organisation of health care services,
\nhealth legislation etc.The organisation is also widely consulted on
\ngovernmental proposals concerning health related topics, medical
\neducation and health legislation.
\n\u2022 With the Media \u2013 NMA has a constructive and professional
\nrelationship with the media. Media is a possibility, not a threat.
\nOur strategy is to be visible in media to show our engagement in
\nhealth policy both as a professional association and as a union.We
\ngive support to members that are negatively exposed in media and
\norganise courses in how to cooperate with media for representa-
\ntives on various levels.
\n\u2022 Others e.g.: Strategic partnerships \u2013 NMA has strategic partner-
\nship with Federation of Norwegian Professional Associations,
\nAssociation of Pharmaceutical Industry, various health profes-
\nsional organisations and the labour union.
\nAkersgaten 2, 0107 Oslo, Norway,
\nE-mail: legeforeningen@legeforeningen.no
\nwww.legeforeningen.no
\nPhilippine Medical Association
\nNational Officers
\nPresident: Dr. Maria Minerva P. Calimag
\nVice President: Dr. Irineo C. Bernardo III
\nNational Treasurer: Dr. Benito P. Atienza
\nSecretary General: Dr. Marianne L. Ordonez-Dobles
\nAsst. Secretary General: Atty. Jose C. Montemayor
\nBoard of Governors
\nDr. Harry G. Soller, Dr. Raul E. Echipare, Dr. Francisco
\nB.\u00a0Ranada\u00a0III, Dr. Salvador G. Silverio, Dr. Ma. Realiza
\nG.\u00a0Henson, Dr.\u00a0Evangeline F. Fabian, Dr. Rebecca W. Deduyo,
\nDr. \u00a0Eduardo F.\u00a0Chua, Dr. Rufino A. Bartolabac, Dr. Ma. Cristina
\nC. Danac-Delfin, Dr. Victor Alan A.Torrefranca, Dr.\u00a0Ethel
\nA.\u00a0Lagria, Dr. Ma. Gay M. Gonzales, Dr. Ruben O. Go,
\nDr.\u00a0Maria Lourdes G. Monteverde, Dr. Karen Conol-Salomon,
\nDr.\u00a0Angelo L.\u00a0Dimaano
\nMembership: The PMA has 118 component medical societies,
\n8\u00a0Specialty Divisons, 73 Specialty Societies, and 39 Affiliate So-
\ncieties
\nIt\u2019s mission: A dynamic, responsive and united PMA, committed
\nto serve its members, through increased benefits, enhanced profes-
\nsional development, and the promotion and defense of the rights
\nNMA news
\n116
\nand privileges of the Medical Profession. These efforts, in partner-
\nship with other organizations and the Government, shall contribute
\nto excellent healthcare delivery and the community at large.
\n\u201cPMA: In a dedicated selfless and humane service of the Medical
\nProfession for a healthy Philippines and for the Glory of God\u201d.
\nIt\u2019s vision: Our vision in the Association is to have a fellowship
\nof Physicians united in the common goal of acquiring the highest
\nlevels of medical knowledge and skills through continuing educa-
\ntion and research, and to promote the healing ministrations of the
\nphysicians in the delivery of health care of patients. The PMA is a
\nco-founder of the Confederation of Medical Associations of Asia
\nand the Oceania (CMAAO). It is also a co-founder of the Medical
\nAssociations of Southeast Asian Nations (MASEAN).
\nServices Provided: Board certification through its 8 Specialty Divi-
\nsions; Subspecialty Training through its Specialty Societies, Annual
\nConventions, symposias supervised by the PMA-CME Commis-
\nsion; Quarterly Newsletters, Bi-Annual Medical Journals; holding
\nof International Conventions.
\nAdvocacies: Supports all government bills as the Clean Air Act,Sin
\nTax Bill, and the Reproductive Health Bill.The PMA also supports
\ntree planting, waste management, pest control, pollution control, as
\nwell as the safety of food and consumer products.
\nActivities and Events
\n\u2022 With the members: Continuing Medical Education through its
\nRegional Assemblies, Annual Conventions by it\u2019s specialty divi-
\nsions, specialty and affiliate and component societies.
\n\u2022 With the Public: Health Information on vital health issues, Lay
\nFora on Nutrition, Non-communicable diseases, and emergency
\nand disaster information. Adopt a Barangay Project of compo-
\nnent medical societies, nutrition feeding programs and lectures.
\n\u2022 With the Government: supports the government on all bills
\nadvantageous to public health and to the community, supports
\nprograms of the Department of Health, Philippine Health In-
\nsurance Corporation and the Professional Regulation Commis-
\nsion.
\n\u2022 With the Media: regular media releases and press conferences on
\nhealth issues and health policies of the Association.
\n\u2022 With Strategic Partners: special programs with Pharmaceutical
\nCompanies and Allied Professionals, in reaching out to all com-
\nmunities, and to our members.
\nNorth Avenue, Quezon City, Philippines 1105
\n+632\u2013929\u20137361;
\nTelefax: +632\u2013929\u20136951
\nE-mail: philmedas@yahoo.com;
\ninfo@philippinemedicalassociation.org
\nPolish Supreme Chamber of
\nPhysicians and Dentists
\n(Naczelna Izba Lekarska)
\nOffice Bearers (2014\u20132018)
\nPresident of the Supreme Medical Council: Maciej Hamankiewicz
\nVice-Presidents: Romuald Krajewski, Zyta Ka\u017amierczak-Zag\u00f3rska,
\nAgnieszka Rucha\u0142a-Tyszler (dental practitioner)
\nSecretary: Konstanty Radziwi\u0142\u0142
\nDeputy Secretary: Anna Lella (dental practitioner)
\nTreasurer: Wojciech Marquardt
\nThe Polish (Supreme) Chamber of Physicians and Dentists (Nac-
\nzelna Izba Lekarska) and the regional chambers of physicians and
\ndentists (okr\u0119gowe izby lekarskie) are the organizational bodies of
\nthe professional self-government of physicians and dental practitio-
\nners in Poland who are associated in the chambers with equal status.
\nThe professional self-government of physicians and dental practi-
\ntioners in Poland was founded in 1922, dissolved in 1952 and rees-
\ntablished in 1989.
\nThere are 23 regional chambers and a separate chamber of military
\nphysicians and dentists that has legal status of the regional chamber
\nalthough it is active in the entire country.
\nEvery physician and every dental practitioner who holds the right to
\npractice the profession in Poland is a member of one of the regional
\nchambers by virtue of the law.
\nCurrently the joint self-government associates 178\u00a0 000 physicians
\nand dentists in Poland, including appr. 125\u00a0000 practicing physicians.
\nThe highest authority of the Supreme Chamber of Physicians and
\nDentists is the General Medical Assembly whereas the regional
\nmedical assemblies are the highest authorities of the regional cham-
\nbers. In the period between assemblies\u00a0 \u2013 the Supreme Medical
\nCouncil and regional medical councils respectively.
\nThe Supreme Medical Council represents the medical and dental
\nprofessions at the state level, and regional councils at regional levels.
\nScope of activity
\nThe field of activities of the self-government of physicians and den-
\ntists, as laid down in the Law of 2 December 2009 on Chambers of
\nPhysicians and Dentists, include:
\n\u2022 supervising the proper and conscientious exercise of the medical
\nprofessions;
\n\u2022 determining the principles of professional ethics and deontology
\nbinding all physicians and dentists and looking after their compliance;
\nNMA news
\n117
\n\u2022 representing and protecting the medical professions;
\n\u2022 integrating the medical circles;
\n\u2022 delivering opinion on matters concerning public health, state
\nhealth policy and organization of healthcare;
\n\u2022 co-operating with scientific associations, universities and research
\ninstitutions in Poland and abroad;
\n\u2022 offering mutual aid and other forms of financial assistance to phy-
\nsicians and dentists and their families;
\n\u2022 administering the estate and managing the business activities of
\nthe chambers of physicians and dentists.
\nThe chambers of physicians and dentists:
\n\u2022 award the right to practice the profession of a physician or dentist
\nand keep the register of physicians and dentists;
\n\u2022 make decisions on matters relating to fitness to practice as a phy-
\nsician or dentist;
\n\u2022 act as medical courts in matters involving professional liability of
\nphysicians and dentists;
\n\u2022 deliver opinion on draft legislation concerning health protection
\nand exercise of the medical professions;
\n\u2022 deliver opinions and make motions regarding under- and post-
\ngraduate training of physicians and dentists;
\n\u2022 co-operate with public administration agencies, political organi-
\nzations, trade unions as well as other social organizations in mat-
\nters concerning protection of human health and conditions of
\nexercising the medical professions;
\n\u2022 defend individual and collective interests of members of the self-
\ngovernment of physicians and dentists;
\n\u2022 negotiate conditions of work and remuneration;
\n\u2022 co-operate in the field of continuous medical education.
\nul. Sobieskiego 110,
\n00\u2013764 Warsaw, Poland
\nPhone: (+48) 22 559 13 00
\nE-mail: zagranica@hipokrates.org
\nwww.nil.org.pl
\nSingapore Medical Association
\n55th
\nSMA Council
\nPresident A\/Prof Chin Jing Jih
\n1st
\nVice President Dr Wong Tien Hua
\n2nd
\nVice President Dr Toh Han Chong
\nHonorary Secretary Dr Chan Teng Mui Tammy
\nAssistant Honorary Secretary Dr Lim Kheng Choon
\nHonorary Treasurer Dr Lee Hsien Chieh Daniel
\nAssistant Honorary Treasurer Dr Lee Yik Voon
\nMembers:
\nDr Abdul Razakjr Omar, Dr Chong Yeh Woei, Dr Loo Kai Guo
\nBenny, A\/Prof Tan Sze Wee, Dr Tan Yia Swam, Dr Wong Chiang
\nYin, Dr Woon Yng Yng Bertha, Dr Anantham Devanand, Dr Lee
\nPheng Soon, Dr Noorul Fatha As\u2019art, Dr Tan Tze Lee, Dr Toh
\nChoon Lai, Prof Wong Tien Yin
\nFormed in 1959, the Singapore Medical Association (SMA) is the
\nnational medical organisation representing the majority of medi-
\ncal practitioners and medical students in both the public and pri-
\nvate sectors.The SMA is a not-for-profit, non-government funded,
\nmembers-based professional body for medical doctors in Singapore.
\nOur ordinary membership is opened to every medical practitioner
\nregistered or provisionally registered in the Register of the Medical
\nCouncil in Singapore.
\nWhile the Ministry of Health and the Singapore Medical Council
\nare tasked with the regulation of the medical profession, the SMA,
\nas neither the extension of the Ministry nor part of the Singapore
\nMedical Council, aims to maintain the honour and interest of the
\nmedical profession.To this end,SMA vigorously represent its mem-
\nbers\u2019 views and engage in a good and transparent practice of feed-
\nback, which comprise questions, discussion and dialogue. Repre-
\nsenting the medical profession, SMA raises concerns and questions,
\npresents feedback from the medical profession, and suggests alter-
\nnatives to the relevant policy-making bodies. Even though there
\nwere times when SMA\u2019s views and suggestions were not accepted
\nby the policy-making bodies, the subsequent explanation and edu-
\ncation that the medical profession received by these bodies on the
\ndecisions made have helped to shape a more inclusive and collab-
\norative healthcare landscape.A strong and well-represented SMA is
\nnecessary to maintain the honour of the medical profession and to
\nrepresent its interests, as well as to advocate the overall well-being
\nof patients in Singapore.
\nWith over 6,800 current members and growing, SMA has over the
\nyears experienced a healthy increase in membership numbers,which
\nattests to increasing recognition and support of our mission and val-
\nues by the medical profession at large. SMA Membership offers
\nvarious professional services, medical resources and lifestyle benefits
\nvia avenues such as the SMA Forum, Locum Listing, and Directory
\nof SMA Doctors, which help provide a reliable platform for doc-
\ntors to discuss and explore healthcare issues, have their voices heard,
\nsearch prospective contacts and make their profiles (including their
\nspecialisations and qualifications) searchable to enable easier patient
\naccess.
\nSMA Centre for Medical Ethics and Professionalism (SMA
\nCMEP) was formed in 2000 and since then, it has been instru-
\nmental in promoting continuing education and academic training in
\nNMA news
\n118
\nClinical Ethics, Health Law, Professionalism and Medical Practice.
\nSMA CMEP aims to provide leadership in the areas of academic
\ntraining, discussion, resource development and research, so as to
\nsupport a high standard of medical professionalism.
\nKey statistics for 2013:
\n\u2022 20 Council Members
\n\u2022 110 doctors in 21 standing committees serving 6905 SMA mem-
\nbers
\n\u2022 27\u00a0membership events with >2000 attendees
\n\u2022 83 courses conducted for 2572 participants with S$36,000 course
\nsubsidies disbursed
\n\u2022 43 citations in various local media
\n\u2022 228 articles published in the Singapore Medical Journal
\n\u2022 110,671 hits on PubMed LinkOut
\n2 College Road,
\nSingapore 169850
\nSwedish Medical Association
\nSwedish Medical Association is the union and the professional or-
\nganisation for medical doctors working in Sweden. Patient safety,
\nwork environment,salaries,working hours,training and research are
\nsome of the issues that are of great importance.
\nWe are 46\u00a0000 members; medical doctors and medical students.
\nThe Swedish Medical Association enters into collective agreements
\nin areas such as general employment conditions, which includes sal-
\naries, working hours, holidays, sick and parental leave and pensions.
\nMembership entitles you to:
\n\u2022 Advice and support in matters relating to your salary, contract,
\nand general working conditions as well as insurance and pen-
\nsions.
\n\u2022 Help with salary negotiations, and up-to-date salary statistics.
\n\u2022 Legal assistance on disciplinary matters,such as negligence claims
\nor probation, and on general matters of healthcare and labour law.
\n\u2022 Peer support for doctors undergoing personal crisis.
\n\u2022 Swedish Medical Association is a strong voice in Swedish media
\nand we work continuously with the politicians in power as well
\nas in opposition.
\nP.O. Box 5610
\nSE\u2013114 86 Stockholm, Sweden
\nPresident Heidi Stensmyren
\nSwiss Medical Association (FMH)
\nLeaders: Dr\u00a0J\u00fcrg Schlup (President), Anne-Genevi\u00e8ve B\u00fctikofer
\n(Secretary-General)
\nAs a professional association representing the medical profession
\nin Switzerland and an umbrella organisation for more than 70\u00a0core
\nand specialised organisations, FMH defends the interests of doctors
\nthroughout Switzerland. Both economically and politically inde-
\npendent, FMH has more than 38,000\u00a0members, representing more
\nthan 95% of all doctors currently practising in Switzerland. Only
\ndoctors who hold a federal medical diploma or an equivalent di-
\nploma who are currently practising or have practised in a particular
\nfield in the healthcare sector may join FMH.Ordinary members are
\nsimultaneously members of one of the core organisations.
\nIn order to facilitate the professional activities of its members,
\nFMH offers a wide range of services, including access to the online
\nmyFHM platform, as well as the list of downloadable documents
\n(contract templates and practical guides in particular), an informa-
\ntion service for points of law and questions about prevention, train-
\ning about rates,and a support network for crisis situations (ReMed).
\nMany of these services are also made available to external partners,
\njournalists,and the general public,especially the annual medical sta-
\ntistics, press releases, the doctorfmh.ch search engine, and advanced
\npatient directives, which are frequently consulted.
\nFMH does everything in its power to ensure that the entire popu-
\nlation of Switzerland can access high-quality care with sustainable
\nfunding.To achieve this objective, it attaches great importance to the
\ndialogue with the other partners in the healthcare sector and vmakes
\ndoctors\u2019 voices heard in the political and legislative decision-making
\nprocess through policy statements and consultations. FMH also par-
\nticipates in the development and updating of rate structures and has
\ntaken on the role of spokesperson for questions about prevention and
\nquality in the medical field that are raised at the national level.
\nFMH is currently focusing on the following topics: interprofession-
\nality in the healthcare system related to the acute fragmentation
\nof care and the need for clarification of responsibilities; the lack of
\ntraining places for medical students and the resulting shortfall in
\ncertain regions and disciplines; and barriers to the free practice of
\nthe profession and the increase in administrative tasks.
\nElfenstrasse\u00a018, case postale\u00a0300,
\n3000\u00a0Bern\u00a015, Switzerland
\nNMA news
\n119
\nTaiwan Medical Association
\n(TMA)
\nOffice Bearers
\nPresident Dr. Ching-Chuan SU
\nChairman of board of supervisors Dr.Tsung-Cheng KUO
\nSecretary General Dr. Ming-Chung TSAI
\nMembership
\nDetails of who can join, how many join
\nThere are 5 special municipality, 16 county and 3 city medical associa-
\ntions in Taiwan. All of them are entitled to join Taiwan Medical As-
\nsociation.According to Physicians Act,all practicing physicians are re-
\nquired to join the local medical association.Therefore,Taiwan Medical
\nAssociation has 43,318 physician members as the end of June, 2014.
\nWhat services are available to Members
\nTMA serves as a role of intermediate between physicians and gov-
\nernment.
\nAll members are available to free subscription of Taiwan Medical
\nJournal.
\nFree group life insurance for all physician members.
\nCME courses are opened to all members without charge.
\nActivities
\n\u2022 With Members: Supervising local medical association by holding
\nregional seminars or workshops.
\n\u2022 Schedule monthly nationwide Video Conference on patient safe-
\nty and healthcare quality.
\n\u2022 Annual Golf outing, Tennis tournament and Ping-pong game
\nnationwide for members.
\n\u2022 With the Public: Donate or finance vulnerable groups and charities.
\n\u2022 Hold blood donation activities and social welfare concerts.
\n\u2022 With the Governments: Advocate amending for \u201cHealth Care
\nAct\u201d to protect health professionals and patients\u2019 safety by ensur-
\ning a zero-violence health care environment.
\n\u2022 Legislate for \u201cLong-term Care Act and Long-term Care Insur-
\nance Act\u201d.
\n\u2022 Promote for \u201cMedical Practice Dispute Resolution and Compen-
\nsation Act\u201d.
\n\u2022 With the Media: Periodical press conference for announcing
\nTMA policies.
\n\u2022 Collaborated with cable TV network to produce health related
\nprograms.
\n\u2022 Others e.g.: Strategic partnerships: Strategic alliance with human
\nresource agency and with commercial bank.
\n9th
\nFloor, 29, Section 1, An-Ho Road, Taipei 10688, Taiwan
\nMedical Association of Thailand
\n(MAT)
\nOffice Bearers (2014\u20132016)
\nPresident: Assoc. Prof. Dr. Prasert Sarnvivad
\nPresident Elect: Prof. Dr. Saranatra Waikakul
\nVice-President: Prof. Dr.Teerachai Chantrarojanasiri
\nSecretary General: Prof. Dr. Ronnachai Kongsakon
\nDeputy Secretary: Major Dr. Chanrit Lawthaweesawat
\nTreasurer: Group Captain Dr. Paisal Chantarapitak
\nHouse Master: Dr. Sawat Takerngdej
\nScientific: Prof. Dr. Wachira Kochakarn
\nPublication: Prof. Dr. Amorn Leelarasamee
\nInternational Relations: Major. Gen. Assist. Prof. Dr. Kidaphol
\nWadhanakul
\nMedical Education: Assoc. Prof. Dr. Yothin Benjawung
\nEthics: Prof. Dr. Orawan Kiriwat
\nPublic Relations: Dr. Sakda Arj-ong Vallipakorn
\nRegistration: Dr. Komgrib Pukrittayakamee
\nWelfare: Dr. Nithiwat Gijsriurai
\nSpecial Affairs: Assoc. Prof. Dr. Juvady Leawpairat
\nChief Executive Officer: Prof. Dr. Somsri Pausawasdi
\nMembersof Committee
\nPol.Maj.Gen. Dr. Chumsak Pruksapong
\nDr. Pinit Hirunyachote
\nDr. Kavirach Tantiwongse
\nAssoc. Prof. Dr. Apichat Asavamongkolkul
\nDr. Somchai Thepcharoennirund (Regional Rept.)
\nDr. Varaphan Unachak (Regional Rept.)
\nDr.Thongchai Triviboonvanich (Regional Rept.)
\nDr. Banjerd Sukapipatpanont (Regional Rept.)
\nMembership: Any Thai medical doctor can join the MAT as a
\nregular member.
\nServices provided: The main services provided by the MAT to their
\nmembership are the Annual Academic Meeting as well as news and
\nscientific publications, representation of their interests in national
\nand international forums and participating as a member of World
\nMedical Association.
\nActivities (some examples)
\n\u2022 With Members: Receiving life long access to Journals of the
\nMedical Association of Thailand
\n\u2022 With the Public: Through Medical Knowledge programme
\nfor Thai People as FAQs decease problem TNN TV Channel
\nmonthly by the Famous MAT speakers
\n\u2022 With the Governments:As a Medical Counselor to support the Min-
\nistry of Health for adoption of a medical career in the public services.
\nNMA news
\n120
\n\u2022 With the Media: Press releases related to health issues of public
\ninterest, promotion of tdebates related to health policies,education
\non health related issues.
\n\u2022 With Strategic Partners: special research aiming to promote
\nhealth information to the public as well as to provide happiness
\nworking and safety to Thai physicians.
\n4th
\nFloor, Royal Golden Jubilee Building 2, soi Soonvijai
\nNewpetchbri Rd. Huay Kwang Bangkapi Bangkok 10310
\nE-mail: math@loxinfo.co.th
\nwww.mat.or.th
\nRomanian College of Physicians
\nExecutive Board
\nProf. Dr. Vasile Astarastoae \u2013 President
\nDr. Gheorghe Borcean \u2013 Vice-President
\nDr. Constantin Carstea \u2013 Vice-President
\nDr. Calin Bumbulut \u2013 Vice-President
\nDr. Viorel Radulescu \u2013 Secretary General
\nMembers: who can become a member,how many members are reg-
\nistered and what services are available for the members:
\nAny doctor who wants to practice medicine in Romania, according
\nto the law, may become member of the Romanian College of Physi-
\ncians. The Romanian College of Physicians has 10,000 members.
\nThey can:
\n\u2022 vote and can be elected,
\n\u2022 be informed about any action performed by the College,
\n\u2022 use all infrastructure belonging to the College,
\n\u2022 take part in any of the actions carried out by the College,
\n\u2022 litigate any sanction applied by the College,
\n\u2022 request material help from the College, for special situations, for
\nthem and their family.
\nActivities:
\n\u2022 with the members
\n\u2022 with public
\n\u2022 with the government
\n\u2022 with the media
\n\u2022 other, strategic partnerships
\nBLVD. Timisoara, No.15, Sector 6, Bucharest, Romania
\nPhone: +4 0214138800, +4 0214138803
\nFax: +4 0214137750
\nE-mail: office@cmr.ro
\nwww.cmr.ro
\nTurkishMedicalAssociation(TMA)
\nCentral Council (2014\u20132016)
\nPresident: Bayazit \u0130lhan
\nVice President: Ra\u015fit T\u00fckel
\nGeneral Secretary: \u00d6zden \u015eener
\n1st Treasurer: Filiz \u00dcnal \u0130ncekara
\n2nd Treasurer: Hande Arpat
\nMembers: \u0130smail Bulca, H\u00fcseyin Demirdizen, Deniz D\u00fclgero\u011flu,
\nNilay Etiler, \u015eeyhmus G\u00f6kalp, Fatih S\u00fcrenk\u00f6k
\nMembership: Obligatory for physicians working in private health
\ninstitutions including private offices. Physicians working in public
\nhealth institutions can also become members and most of them are
\nalready members of TMA.
\nServices provided: Turkish Medical Association mainly promotes
\nand struggles for the professional autonomy and the values of the
\nprofession. TMA publishes monthly or bimonthly journals in the
\nfields of Health Policies, Occupational Health and Continious
\nMedical Education. In addition to publications, educational ac-
\ntivities, certification programs, accreditation of continuous medical
\neducation and scientific congresses, provides to its members identi-
\nfication cards, protocol notebooks, etc.
\nActivities (some examples):
\n\u2022 With Members: TMA arranges continuous education programs
\nin various topics, such as \u201chealth of the health care workers\u201d,
\n\u201cSports Medicine,Tourism and Health\u201d,\u201cOccupational Medicine
\nin Workplaces\u201d,\u201cLegal Medicine\u201dand \u201cHealth Care in Disasters\u201d
\ncourses. TMA struggles for the rights of physicians and cooper-
\nates with the unions and associations of other health professionals
\nin Turkey.
\n\u2022 With the Public:Based on the legal establishment of TMA, it
\nprepares reports on emerging public health issues and tries to
\nraise public awareness on these matters.Radiation,environmental
\npollution, right to access to clean water, communicable diseases,
\ncritics about health reform, struggle against tobacco are some of
\nthe examples of these studies.
\n\u2022 With the Government:TMA is a direct member of Turkish Min-
\nistry of Health Central Ethics Committee and Committee of
\nSpecialty in Medicine. Additionally, TMA tries to form public
\nopinion on medical profession, informs the National Assembly
\nand the other institutions inlegislative procedures. It exchanges
\nviews with the institutions such as Turkish Ministry of Health,
\nSocial Security Institution that determine the health policies in
\nwhich many physicians work.
\n\u2022 With the Media: TMA uses mass communication tools, web
\nsites for public information. There is a press bureau at the central
\nNMA news
\nIII
\nbuilding of TMA. It provides information for press organizations
\nand journalists.
\n\u2022 With Strategic Partners:In recent years TMA conducted many
\nstudies with partners especially on the prevention of torture,
\nforced feeding in hunger strikes, the health of prisoners around
\nthe world. In 1997, due to these studies, PHR (Physicians for
\nHuman Rights) awarded TMA with human rights award.In
\n1991\u20131992, TMA has made a common project with Canadian
\nPublic Health Association about public health care and provided
\nsupport for multidisciplinary projects.In 1995\u20131996\u20131997, it has
\nperformed a project about Forensic Medicine that supported by
\nEU. TMA was a partner in Istanbul Protocol training programs
\nthroughout Turkey related to reporting issues on torture and in-
\nhumane treatment from government forces, patient rights, ex-
\namination of prisoners. TMA was nominated for 2014 Human
\nRights Prize of Parliamentary Assembly of European Commis-
\nsion (PACE).
\nGMK Bulvar\u0131 S. Dani\u015f Tunal\u0131gil Sok. No: 2\/17\u00a0\u2013 23 06570
\nMaltepe Ankara, Turkey
\nPhone: +90 312 231 31 79
\nE-mail: ttb@ttb.org.tr
\nwww.ttb.org.tr
\nSynopsis of Vietnam Medical
\nAssociation
\nVietnam Medical Association (VMA) is the biggest of non-gov-
\nernment organization in medical sector in Vietnam is founded in
\nApril 15, 1955.VMA is constituent member of World Medical As-
\nsociation since 2006 (in the General Assembly of WMA in Im-
\nperial Hotel\u00a0\u2013 Tokyo, Japan) and constituent member of Medical
\nAssociation of South East Asian Nations (MASEAN) since 1995
\n(in MASEAN conference\u00a0\u2013 Singapore).
\nIn 2014, VMA has 44 national specialities associations (Cardiology,
\nSurgery\u2026) and 52 regional associations (Hanoi, Hochiminh city,
\nDanang medical association,\u2026). VMA published 4 medical revues,
\nmedical magazines in French, in English and in Vietnamese. VMA
\norganized many MASEAN meetings in Vietnam. VMA has good
\nrelations with many national medical associations on the world since
\n60 years ago.
\nTran Huu Thang MD. PhD.
\nVice President Executive of VMA
\n68A Batrieu, Hanoi, Vietnam
\nE-mail: vgamp@hn.vnn.vn, vgamp@fpt.vn
\nDr. Bernard Mandel, was elected President-
\nElect at the 47th
\nGeneral Assembly of the
\nWorld Medical Association in Bali, Indo-
\nnesia and he was inaugurated as President
\nof the World Medical Association at the
\n48th
\nGeneral Assembly in Sommerset West,
\nSouth Africa. He served as President for
\none year 1996\u20131997.
\nDr. Bernard Mandell was co-opted onto
\nBorder Coastal Branch Council in 1992 and
\nserved on Council until 2002. He served as
\nBorder Coastal Branch Federal Councillor
\nfrom 1993\u20132000. He served as President
\nof Border Coastal Branch in 2001. He was
\nawarded The South African Medical Asso-
\nciation Gold Medal in 1996.
\nIn memoriam: Bernard Mandel
\nBorn: 22 May 1927, Passed away: 17 July 2014
\nNMA news
\nIV
\nContents
\nThe history of health research dates as far
\nback as the 1800\u2019s in South Africa, when
\nCape Town, Grahamstown, Durban, Pi-
\netermaritzburg and Kimberley were large
\nthriving towns in with many doctors in
\npractice. They formed their own associa-
\ntions as branches of the British Medical
\nAssociation. By the 1920\u2019s, these branches
\nhad spread throughout South Africa and in
\n1927, they joined to form a national asso-
\nciation, the Medical Association of South
\nAfrica (MASA). The MASA later joined
\nthe WMA when it was established. The
\nMASA was replaced by the South Afri-
\ncan Medical Association (SAMA) on the
\n21st
\nMay 1998.The SAMA as we know it
\ntoday is the result of the unification of the
\nfragmented pre-democracy medical groups.
\nAlthough medical research had been con-
\nducted in South Africa since the 1800\u2019s,and
\ndespite oversight mechanisms being set up
\nat individual institutional levels, there was
\nno national guideline or policy until 1979.
\nEven this document was limited in scope in
\nthat it applied only to researchers affiliated
\nwith the MRC, either as recipients of fund-
\ning from the MRC or as researchers within
\nits institutes, units or groups. Despite there
\nbeing no safeguards for participants in re-
\nsearch at a national level for many decades,
\ndoctors involved in research were bound by
\nthe World Medical Associations guidelines
\nand declarations.
\nFollowing the publication of a paper by
\nBeecher on unethical research being con-
\nducted by leading and respectable scien-
\ntists in the United States, the Committee
\nfor Research on Human Subjects (Medi-
\ncal), the first Research Ethics Commit-
\ntee (REC) in South Africa (SA), was
\nestablished at the University of the Wit-
\nwatersrand, Johannesburg in 1966. From
\nthe seventies, tertiary institutions at which
\nhealth research was conducted established
\nlocal RECs. In 1979, the Medical Research
\nCouncil (MRC), SA produced the first set
\nof guidelines at a national level.The protec-
\ntions espoused in those guidelines applied
\nto any research being funded by the MRC
\nor conducted by researchers affiliated to the
\nMRC. These guidelines have undergone
\nseveral revisions. While an important mile-
\nstone in the participant protections endeav-
\nours in South Africa, the MRC guidelines
\ndid not have regulatory authority for non
\nMRC associated research. Furthermore,
\nthere was no uniformity of functioning
\nbetween the local institutional RECs that
\nhad been set up.Standards of review ranged
\nfrom exceptionally high at some RECs to
\nvery poor at others and some RECs even
\nserved as mere \u201crubber-stamping\u201d com-
\nmittees. Hence, ethics \u201cshopping\u201d was not
\nuncommon in the country. The promulga-
\ntion of the National Heath Act (No 61 of
\n2003) brought about far-reaching changes,
\nwith research participant protections and
\nthe functioning of RECs now being regu-
\nlated by the country\u2019s statutory laws which
\nrequire the registration and audit of RECs
\nby the National Health Research Eth-
\nics Council, a statutory body established
\nto determine the standards for participant
\nprotections in health research.
\nThe importance of the principles in the
\nDeclaration of Helsinki in shaping South
\nAfrica\u2019s ethico-regulatory framework in
\nhealth research must be highlighted. The
\nDeclaration has greatly influenced our na-
\ntional guidelines from both the National
\nHealth Research Ethics Council and
\nthe Health Professions Council as well.
\nA\u00a0breach of ethics in health research could
\nresult in sanctions by both these bodies.
\nAmes Dhai
\nPresident SAMA
\nThe Evolution of Research Ethics
\nin South Africa
\nEditorial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
\nGeneva Report for WMJ . . . . . . . . . . . . . . . . . . . . . . . . . . 82
\nChild Abuse & Neglect in India: Time to Act . . . . . . . . . . 87
\nAcceptance Speech for the Paracelsus Medal on the
\nOccasion 117th
\nGerman Medical Assembly . . . . . . . . . 93
\nWhat We Can Learn From the Ukrainian Crisis . . . . . . . . 95
\nJunior Doctors\u2019Work Hours . . . . . . . . . . . . . . . . . . . . . . . . 98
\nOrder of Physicians of Albania . . . . . . . . . . . . . . . . . . . . . . 99
\nAmerican Medical Association . . . . . . . . . . . . . . . . . . . . . . 100
\nThe Australian Medical Association . . . . . . . . . . . . . . . . . . 100
\nAustrian Medical Chamber . . . . . . . . . . . . . . . . . . . . . . . . 101
\nBangladesh Medical Association . . . . . . . . . . . . . . . . . . . . 101
\nAssociation Belge des Syndicats M\u00e9dicaux . . . . . . . . . . . . 102
\nBrazilian Medical Association . . . . . . . . . . . . . . . . . . . . . . 102
\nBritish Medical Association . . . . . . . . . . . . . . . . . . . . . . . . 103
\nCanadian Medical Association . . . . . . . . . . . . . . . . . . . . . . 103
\nChinese Medical Association . . . . . . . . . . . . . . . . . . . . . . 104
\nConseil National De L\u2019ordre Des Medecins . . . . . . . . . . . . 104
\nNational Medical Union of Costa Rica . . . . . . . . . . . . . . . 105
\nNational Order of Physicians of Cote d\u2019Ivoire . . . . . . . . . . 105
\nCzech Medical Association . . . . . . . . . . . . . . . . . . . . . . . . 106
\nDanish Medical Association . . . . . . . . . . . . . . . . . . . . . . . . 106
\nFinnish Medical Association . . . . . . . . . . . . . . . . . . . . . . . 106
\nThe French Medical Council . . . . . . . . . . . . . . . . . . . . . . . 107
\nGeorgian Medical Association . . . . . . . . . . . . . . . . . . . . . . 108
\nThe Hong Kong Medical Association . . . . . . . . . . . . . . . . 109
\nIcelandic Medical Association . . . . . . . . . . . . . . . . . . . . . . 110
\nIsraeli Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . 111
\nJapan Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . 111
\nNational Medical Association of the Republic
\nof Kazakhstan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
\nKorean Medical Association . . . . . . . . . . . . . . . . . . . . . . . . 112
\nLatvian Medical Association . . . . . . . . . . . . . . . . . . . . . . . 113
\nMyanmar Medical Association . . . . . . . . . . . . . . . . . . . . . . 113
\nNew Zealand Medical Association . . . . . . . . . . . . . . . . . . . 114
\nNorwegian Medical Association . . . . . . . . . . . . . . . . . . . . . 115
\nPhilippine Medical Association . . . . . . . . . . . . . . . . . . . . . 115
\nPolish Supreme Chamber of Physicians
\nand Dentists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
\nSingapore Medical Association . . . . . . . . . . . . . . . . . . . . . 117
\nSwedish Medical Association . . . . . . . . . . . . . . . . . . . . . . . 118
\nSwiss Medical Association . . . . . . . . . . . . . . . . . . . . . . . . 118
\nTaiwan Medical Association . . . . . . . . . . . . . . . . . . . . . . . . 119
\nMedical Association of Thailand . . . . . . . . . . . . . . . . . . . . 119
\nRomanian College of Physicians . . . . . . . . . . . . . . . . . . . . 120
\nTurkish Medical Association . . . . . . . . . . . . . . . . . . . . . . . 120
\nSynopsis of Vietnam Medical Association . . . . . . . . . . . . . III
\nIn memoriam: Bernard Mandel . . . . . . . . . . . . . . . . . . . . . III<\/p>\n"},"caption":{"rendered":"

wmj201403 COUNTRY \u2022 World Health Assembly Week \u2022 WMA members vol. 60 MedicalWorld Journal Official Journal of the World Medical Association, INC G20438 Nr. 3, September 2014 Cover picture from LATVIA Editor in Chief Dr. P\u0113teris Apinis Latvian Medical Association Skolas iela 3, Riga, Latvia Phone +371 67 220 661 peteris@arstubiedriba.lv editorin-chief@wma.net Co-Editor Prof. Dr. […]<\/p>\n"},"alt_text":"","media_type":"file","mime_type":"application\/pdf","media_details":{},"post":null,"source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2017\/02\/wmj201403.pdf","_links":{"self":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/media\/6148"}],"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\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/comments?post=6148"}]}}