JDN_13NL_20180323

Junior Doctors Network
Newsletter
Index
Junior Doctors tackled Antimicrobial
Resistance (AMR) at their Annual
Meeting in Chicago ………………1
WMA JDN Working Condition Work-
ing Group ……………………………7
The Value of Leadership in Medicine:
Caring Physicians of the World Lead-
ership Course ………………………8
Report on the CMAAO General As-
sembly Tokyo and the JMA-JDN Fo-
rum …………………………………….9
Social Determinants of Health: Be-
yond Borders ……………………….11
A Mission to Help the Rohingya Refu-
gees……………………………………..14
A Word from the Chair …………18
Words from the Communications
Desk ……………………………………19
JDN Newsletter is a communication
place to share our views ………20
Junior Doctors Leadership and Publi-
cations Team 2017-2018……….21
The 2017 Junior Doctors Net-
work (JDN) meeting, which
was hosted by the American
Medical Association, was held
in Chicago, Illinois, USA, be-
tween October 9-10, 2017. An
estimated 30 junior doctors
from all five continents par-
ticipated in the meeting,
which was greeted by the
World Medical Association
(WMA) leadership, with Dr.
Otmar Kloiber, WMA Secre-
tary General, Dr. Ardis Hoven,
WMA Council Chair, and Dr.
Ketan Desai, WMA President.
Day 1
The meeting started with a
greeting by Dr. Kloiber, who
further delivered a thorough
presentation on the WMA his-
April, 2018
13th issue
ISSN (print) 2415-1122
ISSN (online) 2312-220x
Picture 1: Participants at the 2017 JDN meeting
Junior Doctors tackled Antimicrobial Resistance
(AMR) at their Annual Meeting in Chicago
Konstantinos Roditis*
, MD, MSc
* Resident, Department
of Vascular Surgery,
Korgialeneio-Benakeio
Hellenic Red Cross Hos-
pital, Athens, Greece /
Chair, JDN-Hellas /
Secretary, Junior Doc-
tors Network , World
Medical Association
roditis.k@gmail.com /
secretary.jdn@wma.net
tory, structure, collabora-
tions, and focus areas. He
stressed the topic of review-
ing the Declaration of Gene-
va at the 2017 WMA General
Assembly, which took place
in Chicago at the same time.
He explained that the mod-
ern Hippocratic oath would
most likely be renamed to
the modern Physicians’
Pledge. He also answered a
few questions of partici-
pants, specifically on how
WMA works on overseeing
the implementation of its
policies in different coun-
tries and how interactions
with other international or-
ganisations (e.g., Interna-
tional Physicians for the Pre-
vention of Nuclear War,
IPPNW; World Federation
for Medical Education,
WFME) are formed. The par-
ticipants were then split into
small working groups
(SWGs) and rotated between
all three groups, each lead
by a WMA leadership officer.
Discussion topics were: 1)
Women in global health and
organized medicine (Dr. Ar-
dis Hoven); 2) Medical eth-
ics and codes of ethics (Dr.
Otmar Kloiber); and 3) Self-
governance of physicians
(Dr. Ketan Desai).
As the antimicrobial re-
sistance (AMR) problem was
the main theme of the meet-
ing, an introduction to AMR
and what is at stake on a
global scale was delivered by
Dr. Caline Mattar, JDN
Chair.
A presentation of the WHO
Global Action Plan was given
via teleconference by Dr.
Elizabeth Tayler. In her
presentation, she empha-
sized the need to focus on
the use of antibiotics in pa-
tients and animals. She also
called upon solidarity among
nations worldwide to work
on addressing AMR, noting
that developing countries
would be significantly im-
pacted by AMR due to lack of
resources and financial ca-
pacity to access new medi-
cines and technologies de-
veloped to fight multi-
resistant pathogens. In re-
gards to the influence of the
global sepsis burden on the
need for early antibiotic use
and AMR challenge, she ex-
plained that sepsis requires
early administration of anti-
“Calling upon solidarity among nations worldwide
to work on addressing AMR”
2
biotics and the knowledge
of when to stop their ad-
ministration. She stated,
“We must stop giving anti-
biotics “just in case”, add-
ing that effective steward-
ship programmes are
needed to better guide
physicians when to use
and when to appropriately
prescribe antibiotics in
clinical practice .
Dr. Anthony So (ReAct
Group) presented on strat-
egies to tackle AMR, refer-
ring to challenges in re-
search and development
of new antibiotics by the
Pharma industry, the re-
direction of financial re-
sources to neglected re-
search areas, intersectoral
collaborations, and treat-
ment alternatives for viral
infections. He stressed
that patients also need to
understand why AMR is
important for the commu-
nity and their health.
Dr. Roach, Food Safety
Program Director and
Food Animal Concerns
Trust and Senior Analyst
for Keep Antibiotics Work-
ing, addressed AMR focus-
ing on the use of antibiot-
ics in animal industry and
best strategies to mini-
mize AMR. He stressed
that AMR is a cause that
must engage all stakehold-
ers, including the Interna-
tional Food Standards
(e.g., Codex Alimentarius,
WHO, Food and Agricul-
ture Organisation of the
U.S.), national govern-
ments (e.g., Food and Ag-
riculture Ministries), and
3
Picture 2: JDN participants at the WMA GA Gala Dinner at the Field Museum
food corporations (e.g.,
McDonalds).
Matthew Wellington, Anti-
biotics Program Director at
U.S. Public Interest Re-
search Group (PIRG) pre-
sented on how to pressure
major meat consuming
chain restaurants to move
away from meat providers
that use excessive antibiot-
ics in their production. He
referred to a tool his team
created, called “Chain Re-
action”, that rates chain
restaurants according to
their antibiotic policies and
practices. He added that
they have also developed a
pool of 40,000 physicians
advocating for antibiotic
stewardship, believing that
healthcare professionals
have a strong voice and im-
pact towards changing pub-
lic opinion. Finally, he sug-
gested that participants
learn more on the U.S.
PIRG website
(www.uspirg.org).
Dr. Ardis Hoven, Chair of
Council of WMA, opened a
panel discussion on
“Stewardship for AMR”.
Dr. Sameer Patel presented
on approaches to best con-
vince our colleagues to
change their practices to-
wards a more AMR-aware
attitude. She stated that
changing practices is like
“convincing children to eat
their vegetables”, where all
physicians understand that
they should use antibiotics
appropriately, but fail to
consistently follow these
practices. Notably, availa-
ble stewardship pro-
grammes vary. He men-
tioned that the U.S. guide-
lines from the Infectious
Diseases Society of America
refer mostly to in-patient
scenarios. He suggested
low-cost interventions,
such as educational out-
reach visits and rapid diag-
nostic tests, are key for
outpatient settings. Stress-
ing the importance of na-
tional antimicrobial sur-
veillance, he referenced the
WHO guidelines on AMR
management, focusing on
population education, re-
duced use of antibiotics,
and cost-effective, high-
quality diagnostic tests.
Dr. Aparna Bole, Health
Care Without Harm Board
Member, Medical Director
of Community Integration,
and pediatrician at Univer-
sity Hospitals Rainbow Ba-
bies and Children’s Hospi-
tal in Ohio, spoke about her
experiences in exploring
ways to reduce the use of
meat and increase the use
of “secure” meat (e.g.,
meat with minimal use of
“Healthcare professionals have a strong voice and impact
towards changing public opinion.“
4
antibiotics) in hospital res-
taurants and cafeterias.
She discussed the
“Healthcare without Harm”
initiative, where she serves
as a board member.
Dr. David Wallinga, Senior
Health Officer in the NRDC
(Natural Resources Defense
Council) Health Program,
talked about “Why health
professionals can, and
must, help save antibiot-
ics”.
An open discussion facili-
tated panelists and JDN
participants to exchange
perspectives on the AMR
challenge. They described
the credibility of physicians
as advocates in the field of
AMR and antibiotic use in
livestock and food market
as well as the need to con-
vince legislators that the
profit of the pharma indus-
try is only one part of the
economic equation.
Participants were then split
again into five SWGs,
brainstorming about
“Planning the next steps”
for JDN on AMR, namely:
1) Innovative Ideas for Re-
search & Development
to combat AMR (Dr.
Paxton Bach)
2) Surveillance for AMR
(Dr. Mariam Parwaiz)
3) Physicians’ Action on
AMR Stewarship Pro-
grammes (Dr. Yassen
Tcholakov)
4) Food Industry & AMR
5) One Health approach &
AMR (Dr. Saahil Vij)
Day 2
The second day of the
meeting started with JDN
Elections for the manage-
ment team of 2017-2018.
The Elections Committee,
consisting of Dr. Paxton
Bach, Dr. Maki Okamoto,
and Dr. Nauman Malik, ex-
plained the procedure to
participants, which were to
be performed under the
official JDN Elections
Terms of Reference, previ-
ously prepared in collabo-
ration with the WMA Legal
Advisor and approved by
the WMA Executive.
Candidates had three
minutes to present their
candidatures, either via
conference presentation or
teleconference, and re-
ceived questions from the
participants. JDN members
voted for positions that re-
ceived more than one can-
didature by ballot voting.
The results are in Box 1.
In the session, “Research in
post graduate medical edu-
cation”, Professor David
Gordon, President of the
WFME, presented on Re-
search in Postgraduate
Medical Education (PGME),
under the facilitation of
5
Picture 3: Newly elected JDN management team, 2017-2018
JDN’s past Chair, Dr. Ahmet
Murt. Dr. Joe Hayman
briefly presented on WMA
Associate Members and
their plans for this WMA
General Assembly. He also
answered questions from
the JDN participants on the
WMA’s Associate Member-
ship.
An “Ideas Cafe” followed,
and the group was split in-
to four SWGs, where they
rotated every ten minutes
to each group: 1) JDN
working groups terms of
reference (Dr. Yassen
Tcholakov); 2) Next steps
for the JDN and strategic
planning (Dr. Paxton
Bach); 3) How to increase
the added value of JDN
membership (Dr. Chiaki
Mishima); 4) JDN working
conditions (Dr. Mariam
Parwaiz); and 5) Interna-
tional Hippocratic Oath
new project proposal (Dr.
Kostas Roditis). Next, a
session on “New ideas” in-
cluded two presentations:
1) Global Database on
PGME (Dr. Jean-Marc Bour-
que); and 2) International
medical graduates reciting
the Hippocratic Oath in
Kos, Greece (Dr. Kostas
Roditis).
Moderated by two JDN
founding members, Dr.
Xaviour Walker, past JDN
Chair, and Dr. Lawrence
Loh, past JDN Deputy-
Chair, a presentation was
given on the seven-year
JDN history. Since the ini-
tial discussion in Osaka,
Japan, in March 2007, to
its official establishment in
Montevideo, Uruguay, in
2010, the JDN has strength-
ened communication and
interactions with junior
doctors from all over the
globe, providing essential
input on policy making to
the WMA.
A panel discussion on
“physicians’ collective ac-
tion, education, and well-
being” followed, and panel-
ists, Dr. David Gordon
(WFME), Dr. Armin Ehl
(Marburger Bund, German
Association of salaried doc-
tors), and Dr. Kimberly
Williams (JDN member,
past Chair of Resident Doc-
tors of Canada, RDoC)
talked about PGME and the
Collective Action of Physi-
cians and Physician wellbe-
ing, respectively.
First, Dr. Gordon presented
on PGME in several parts
of the world, using Den-
mark, Finland, and the
United Kingdom as exam-
ples, and mentioned the
current WFME’s work on
streamlining PGME world-
wide. He stressed the im-
portance of accreditation of
medical teaching centers as
well as the board certifica-
tion of specialists. Second,
Dr. Ehl described the Mar-
burger Bund’s collective
activities in Germany, in-
cluding maximum weekly
working time and physi-
cians as employees. He fo-
cused on Union policy, le-
gal and informal require-
ments for collective action
by physicians and reflected
on the outcomes of the past
6
2017-2018
JDN Management Team:
 Chair: Dr. Caline Mattar
 Deputy Chair:
Dr. Chukwuma Oraegbunam
 Secretary: Dr. Kostas Roditis
 Socio-Medical Affairs Officer:
Dr. Yassen Tcholakov
 Education Director:
Dr. Audrey Fontaine
 Medical Ethics Officer:
Dr. Sydney Mukuka
 Membership Director:
Dr. Chiaki Mishima
 Communications Director:
Dr. Chibuzo Ndiokwelu
 Publications Director:
Dr. Kazuhiro Abe
 Immediate Past Chair:
Dr. Ahmet Murt
 Immediate Past Deputy Chair:
Dr. Paxton Bach
Box 1
Germany-wide doctor strikes.
He also mentioned the recent-
ly organized International
Conference of Doctors’ Un-
ions. Finally, Dr. Williams
spoke about the importance of
physician wellbeing. At RDoC,
they have focused on wellbe-
ing, including fatigue and
burnout syndrome, through-
out many of their activities.
She further talked about a re-
siliency training program, de-
signed especially for resi-
dents, and the Big Four+ con-
cept for improving residents’
wellbeing.
In an open discussion from
the audience, Dr. Gordon de-
scribed “competency-based
curricula”, striving for com-
petent physicians with the
basic theoretical knowledge
of medicine in an ever-
changing world. Dr. Ehl
stressed that as physician ad-
vocates, we must always edu-
cate society by “telling the
story” about our challenges in
the healthcare environment.
He also mentioned that the
MB’s female membership has
reached 55%, pushing poli-
cies including family time and
part-time work in Germany.
Dr. Williams mentioned sev-
eral examples where the JDN
could activate policy on physi-
cian wellbeing by turning pol-
icy into action on local, na-
tional and global level.
As a closing remark, Dr. Pax-
ton Bach, JDN’s outgoing Dep-
uty Chair, reflected on the
two days of the 2017 JDN
meeting. He asked that every-
one reflect on the presenta-
tions and open discussions
and think about how to better
use the knowledge and exper-
tise gained at the meeting,
upon returning home as well
as for the future of JDN col-
laborations.
7
The initial idea of forming a working group
was conceived during the Asia-Pacific
Regional Meeting in Taipei. The World
Medical Association (WMA) Junior Doctors
Network (JDN) had several working groups;
however, there was no Working Group for
Working Conditions of Junior Doctors.
Dr. Leo Heng-Hao Chang from Taiwan
suggested the creation of a new working
group, which led to the creation of a Google
group and subsequent call for members to
join the working group. Dr. Wunna Tun
from Myanmar and Dr. Leo Heng-Hao Chang
served as Co-Chairs of the Working Group
and the first teleconference meeting of the
Working Group held after the WMA Council
meeting in Zambia.
The Working Group was designed to raise
awareness, improve working conditions of
junior doctors globally, and publish data in
peer-reviewed academic journals and/or
policy statements.
The focus areas are physician working
hours, physician suicide, psychological
wellbeing, prevention of burnout, safe
working environments (free from
harassment, bullying, and discrimination)
and providing avenues for help. The areas of
work and output are systematic literature
reviews of working conditions in a variety
of countries. Surveys on working conditions
for junior doctors to national member
associations (NMAs) and JDN will be
distributed via email and social media.
To join the working group (jdn-working-
condition@googlegroups.com), please
contact the Working Group Co-Chairs
Wunna or Leo.
* Fellow in Medical Education/ Secretary
(Organization and Communication), Myanmar
Medical Association
onlinewunna@gmail.com
WMA JDN Working Condition Working Group
Wunna Tun*, MBBS, MD
8
How valuable are leadership
skills to doctors? No matter
what part of the world we are
from, the job of doctors every-
where is growing more com-
plex. In a world where patients
can look up their symptoms
online, where doctors frequent-
ly come on TV and write books
to educate the public, and in a
world where hospitals and
healthcare organizations are
becoming ever more complex in
their structures, it is becoming
increasingly important for doc-
tors to speak up and engage
with the public. That is why eve-
ry year, the World Medical As-
sociation (WMA) holds an annu-
al Caring Physicians of the
World Medical Leadership,
Communications, and Advocacy
course. This year, several doc-
tors both from the Junior Doc-
tors Network (JDN) as well as
from National Medical Associa-
tions participated.
Organized by Dr. Yank Coble,
past president of WMA, and Dr.
Otmar Kloiber, Secretary Gen-
eral of the WMA, this one-week
intensive course focused heavily
on leading change in organiza-
tions, strategic thinking, build-
ing collective intelligence, for-
mal media training and using
effective leadership styles to
impact change in our home
countries. The course was held
at the Mayo Clinic, in Jackson-
ville, Florida, USA. Teaching
consisted of several didactic
and workshop components with
simulated scenarios. The sce-
narios covered topics ranging
*1 Member, Canadian Medical
Association, Resident in Radia-
tion Oncology, University of To-
ronto
*2 Vice Chair, Myanmar Medical
Association, Young Doctor Socie-
ty
*3 Chair, Japan Medical Associa-
tion Junior Doctors Network
(JMA-JDN)/ Membership Direc-
tor , Junior Doctors Network ,
World Medical Association
Correspondence: Nauman Malik
nauman.malik@rmp.uhn.ca
The Value of Leadership in Medicine: Caring Physicians of the World
Leadership Course
Nauman Malik, MD*1
, Wunna Tun, MBBS, MD*2
, Chiaki Mishima, MD*3
Picture
1. What is CMAAO?
The Confederation of Medical
Associations in Asia and Oce-
ania (CMAAO) was estab-
lished in 1956. The 1st
CMAAO
Congress was held in Tokyo in
1957, attended by organiza-
tional founders from Japan,
Australia, Burma (now Myan-
mar), Taiwan, Indonesia, and
the Philippines. They aimed to
improve the health levels of
local residents through the
promotion of medical ex-
changes in Asia and Oceania,
establishment of relationships
with international associa-
tions, and informational ex-
changes. At present, medical
associations from 18 countries
have joined this organization,
in efforts to enhance the voice
of Asia as a local medical as-
sociation of the World Medi-
cal Association (WMA). Gen-
eral assemblies are held once
a year, and local medical is-
sues are reported by the med-
ical association of each coun-
try through symposiums and
country reports. The Takemi
Memorial Oration is also ad-
dressed. Results are docu-
mented and adopted as a reso-
lution. The resolutions are
shared by medical associa-
tions of all the participating
countries, and they report
back to the WMA.
2. CMAAO 2018 “End-of-Life
Questions” in Tokyo
This general assembly was
held in Tokyo from September
13th
to 15th
, 2017. A total of
about 220 people attended,
consisting of participants
from medical associations of
Japan and all participating
countries. The current WMA
President, Yoshitake Yokoku-
ra, was inaugurated as the
35th President of CMAAO.
Using the theme, “End-of-Life
Questions,” medical associa-
tions of all participating coun-
tries were asked to complete a
questionnaire with a variety
of questions, such as “Is eu-
thanasia legalized in your
country?” Medical associa-
tions of 19 countries complet-
ed the questionnaire, and the
results from 17 countries
were publicized at a symposi-
um. Overall, Asian countries
showed negative attitudes to-
wards “active euthanasia,”
which is a topic that attracts
attention especially from Eu-
ropean countries. We learned
from country presentations
and discussions that religions
and family life vary signifi-
cantly as well as how people
connect with their communi-
ties. We also learned that it is
important to understand these
different perspectives. We un-
derstand that each country is
making progress through the
* Chair, Japan Medical Associ-
ation, Junior Doctors Network
(JMA-JDN)
Membership Director, Junior
Doctors Network, World Med-
ical Association
chair@jmajdn.jp
from patient-centered commu-
nication to testing strategic
thinking through a subarctic
survival scenario, to infiltrating
an organization and leading
change through a complex
computer-based scenario.
Our fellow course participants
were highly regarded physicians
from around the world, and it
was truly a wonderful experi-
ence learning amongst them.
We made many new friends
and we, as JDN members, felt
very engaged. We hope to use
our new skills to further the
work of the JDN in the future,
and look forward to continuing
our leadership endeavors at
home in our countries as well.
9
Report on the CMAAO General Assembly Tokyo
and the JMA-JDN Forum
Chiaki Mishima, MD*
formation of laws and
guidelines about end-of-life
care. Country updates pre-
sented recent developments
in Asia. For example, the
“Patient Autonomy Law”,
which allows terminal pa-
tients to choose treatments
for themselves, will be im-
plemented in the next year.
In Korea, advance direc-
tives concerning life sup-
port treatment will be com-
piled in a national comput-
er database. (The publi-
cized content can be viewed
at the official CMAAO web-
site: http://cmaao.org/news/
symposium2017_32nd.html)
The WMA is scheduled to
summarize opinions from
each region and facilitate
discussions on the policy
document. We should be
aware about this further
development. On the final
day, the Japan Medical As-
sociation (JMA) organized a
dinner party, and partici-
pants, including Junior
Doctors Network
(JDN) members and Inter-
national Federation of Med-
ical Students’ Associations
(IFMSA) medical students,
enjoyed cruising on the To-
kyo Bay. This allowed fur-
ther exchanges and net-
working with members of
the Asian region.
3. The holding of the JMA-
JDN forum
Supported by the JMA and
the Tokyo Medical Associa-
tion (TMA), the JMA-JDN
Forum was held for physi-
cians and medical students
at the TMA hall after the
CMAAO General Assembly
ended. A total of about 70
people, including junior
doctors and medical stu-
dents, participated in this
meeting. The forum was
divided into two parts. In
the first half, JDN members
from Germany, South Ko-
rea, Myanmar, and Japan
made speeches on the
theme, “Global Ca-
reer.” (Speakers: Dr. Thor-
sten Hornung from Germa-
ny, Dr. Yuji Jeong from
South Korea, Dr. Wuuna
Tun from Myanmar, Dr.
Makiko Yamada and Dr.
Haruka Sakamoto from Ja-
pan). In the second half, Dr.
Osamu Kunii, the head of
the Strategy, Investment
and Impact Division of the
Global Fund, presented a
reflection about his career
and described his experi-
ences that motivated him to
work at an international
organization during his
training. He gave valuable
advice to young physicians
and medical students,
which encouraged partici-
pants to consider a career
in global health.
4. Future plan
Future general assemblies
will be held in Malaysia in
2018 (Theme: Universal
Health Coverage), India in
2019, and Taiwan in 2020.
Discussions about topics
relative to the Asia-Pacific
area are very interesting
and seem to provide many
learning opportunities to
young physicians. Under
the cooperation of CMAAO
and the national medical
associations of all coun-
tries, more medical stu-
dents and young physicians
had opportunities to partic-
ipate in this event than ev-
10
Picture 1: 32nd
CMAAO General Assembly and 53rd
Council Meeting (Tokyo, Japan)
As dedicated medical profes-
sionals, you may encounter
the same patients, hospital-
ized in your clinical ward
once, twice, or even more. In
spite of providing medical ad-
vice to maintain a healthy
lifestyle and cease any toxic
behaviors, such as tobacco use
or binge drinking, some pa-
tients may not listen or follow
your advice. Sometimes, they
may argue with hospital staff
and consequently be escorted
from the hospital. However,
because of their deteriorating
symptoms, their hospitaliza-
tion may repeat frequently.
After reading this clinical sce-
nario, do you think that our
health is our personal respon-
sibility? What actions can we
take to help patients with re-
peated hospital visits and de-
teriorating health?
According to the World Health
Organization (WHO), social
determinants of health (SDH)
are defined as: “The social de-
terminants of health are the
conditions in which people are
born, grow, live, work and age.
These circumstances are
shaped by the distribution of
money, power and resources at
global, national and local lev-
els. The social determinants of
health are mostly responsible
for health inequities − the un-
fair and avoidable differences
in health status seen within
and between countries.”(1)
Ac-
cording to the SDH context,
our health is influenced by
socio-economic status, em-
ployment, religion, race,
childhood environment, poli-
cy, and public participation.
However, what role does per-
sonal responsibility play?
Since effective change re-
quires a system-wide, multi-
er before, leading to an ex-
panded JDN network. By mak-
ing use of this network, we
would like to encourage more
junior doctors to participate
in the next CMAAO general
assembly and continue to in-
teract with WMA-JDN.
* Junior Resident of Toyo-
hashi Municipal Hospital,
Aichi, Japan
sunfryer@gmail.com
11
Social Determinants of Health: Beyond Borders
Jumpei Shibata, MD*
Picture 2: JMA-JDN Forum (Tokyo, Japan)
level approach, the SDH
concept should be incorpo-
rated into our daily clinical
practice and broader socie-
tal roles. However, future
actions by stakeholders,
such as health profession-
als and professional health
associations, may be lim-
ited by health expenditure,
leadership challenges, and
weak political will(2)
. On
the other hand, since social
movements have evolved
from one initiator with a
few followers, young physi-
cians can be part of this
national and global change.
In efforts to increase
awareness of SDH and
health equities in medicine,
Junior Doctors Network, of
the Japan Medical Associa-
tion (JMA-JDN), launched
the SDH working group.
Our JMA-JDN meetings can
incorporate the findings of
one scientific report, which
described seven steps to
facilitate sharing concepts,
information, and tasks(3)
.
In 2017, JMA-JDN members
coordinated two events. On
February 12, 2017, the first
event was an introductory
meeting. On November 25,
2017, the second event was
a special invited lecture by
Sir Michael Marmot, inter-
nationally recognized for
his epidemiological re-
search accomplishments
and leadership position as
Chair of the WHO Commis-
sion on Social Determi-
nants of Health(4)
. Audience
participation was limited
to 30 people, in efforts to
promote a more focused,
interactive discussion. Ta-
ble 1 presents the event
schedule. The sessions in-
tegrated case presentations
to describe and discuss real
-life clinical scenarios in
medical practice. For ex-
ample, one case scenario
was a 25-year-old woman
who complained about a
persistent cough. In addi-
tion to her clinical symp-
toms, she has faced multi-
ple challenges in her home
and work environments
that have affected her
health status.

A 25-year-old woman visits
your clinic because of a
prolonged cough. She is a
single mother who has
three daughters (ages 5, 8,
and 10) and is a current
smoker. She divorced her
husband two years ago due
to domestic violence. After
graduating from high
school, she started provid-
ed domestic cleaning ser-
vices in several neighbor-
hood houses. For the last
five years, she and her sis-
ter (age 30) have worked
as janitors in an office
building. Her three chil-
dren attend elementary
school during the day and
spend their leisure time
playing video games. They
are not up-to-date on their
vaccination schedules. Liv-
ing nearby, her father (age
50) is unemployed and a
former smoker, currently
on domiciliary oxygen ther-
apy to manage his chronic
obstructive pulmonary dis-
ease (COPD). Her mother
(age 45) is a shelf stocker
at a supermarket, suffering
from chronic lower back
pain. As a child, she wit-
nessed domestic abuse,
where her father physically
abused her mother. Her
parents serve as caregivers
for her paternal grandfa-
ther (age 80), who is a cur-
rent smoker and alcoholic
and has been diagnosed
with COPD and dementia.
12
10:00-10:05 Opening remarks from JMA-JDN Chair
10:05-10:15 Seminar overview: Brief introduction about SDH
10:15-10:25 Greeting from Sir Dr. Marmot
10:25-10:40 SDH case presentation
10:40-11:30 Small group discussion
11:30-11:50 Group presentation
11:50-11:55 Closing remarks from Sir Dr. Marmot
11:55-12:00 Wrap-up
12:00-12:10 Break
12:10-13:00 Luncheon discussion
Table 1: schedule
Picture: SDH Seminar
She does not have a positive
relationship with her parents
or grandfather.
After the case presentation,
Figure 1 was shared to display
her family chart. Participants
discussed the concept and role
of SDH in health and well-
being and facilitated an open
dialogue on how we can pro-
duce change in clinical prac-
tice. Throughout the session,
Sir Marmot empowered us by
stating, “You are the educators
of the future.” He continued to
say, “As medical professionals
in society, our role requires us
to be a truth-teller. The truth
is our currency.” Finally, he
recommended that as health
professionals, we should de-
termine the diagnosis of the
physical or psychosocial
health risk, assess for any so-
cial or economic risks, and in-
tervene as needed during am-
bulatory care or hospitaliza-
tion.
Overwhelmed by the high pa-
tient flow to health facilities,
we may overlook all possible
disease causes(5)
. As medical
professionals, we must active-
ly seek and identify health dis-
parities and subsequently take
action to improve health out-
comes in all communities.
References
(1) World Health Organization. Social
determinants of health [Internet].
2018 [cited 2018 Jan 22]. Available
from:
http://www.who.int/social_determinants/
sdh_definition/en/.
(2) Thomas S. Doctors for health eq-
uity. 2016 [cited 2018 Jan 22]. Availa-
ble from:
http://www.instituteofhealthequity.org/
resources-reports/doctors-for-health-equity-
world-medical-association-report/doctors-for-
health-equity-wma-full-report-pdf.pdf.
(3) The Health Care Science Institute.
7 rules for the measurement against
health disparities [Japanese]. 2017
[cited 2018 Jan 22].
http://www.iken.org/project/sdh/
pdf/17SDHpj_ver1_1_20170803.pdf
(4) World Health Organization. Social
determinants of health: Sir Michael
Marmot. 2008 [cited 2018 Jan 22].
Available from:
http://www.who.int/social_determinants/
thecommission/marmot/en/
(5) McKinlay JB. A case for refocusing
upstream: The political economy of
illness. In: Gartley J, ed. Patients,
physicians and illness: A sourcebook
in behavioral science and health. New
York: Free Press; 1979; p. 9-25.
13
Figure 1: Family chart
14
When the call came from
MERCY Malaysia one fine day
in October 2017, I was caught
off-guard. They were seeking
medical volunteers to Cox’s
Bazar, Bangladesh, in aid of
the hundreds of thousands of
Rohingya refugees who had
fled Myanmar for safety after
the military crackdown.
I had yet to submit my leave
form, and even if I managed
to, I still had to get it ap-
proved. Time was running
out, and I had to provide a
quick reply. Just as I was
about to give up, the green
light came and everything just
fell into place. I was so excit-
ed to be one step closer to
achieving my bucket list of
serving on a humanitarian
mission.
As a newbie, I was at a loss as
to how to prepare for the trip.
Fortunately, MERCY Malaysia,
a humanitarian relief organi-
zation with 19 years of experi-
ence, had everything worked
out. They provided me with a
check-list of essentials to
bring along, and arranged for
a briefing at their headquar-
ters, where I met my two oth-
er fellow comrades, a medical
officer and an assistant medi-
cal officer. I was the youngest
among the three.
The MERCY Malaysia staff re-
peatedly cautioned us to be
mentally prepared, as there
had been cases in the past
where medical volunteers had
to return home when they
were found to be mentally un-
fit for their mission. Braving
myself for the worst, we
boarded the Malindo Air flight
to Dhaka.
Upon arrival, a MERCY Malay-
sia staff who had arrived ear-
lier received us at the airport.
Dhaka was choked with heavy
traffic – none of the drivers
obeyed traffic rules, and eve-
ryone seemed to ignore the
traffic lights. The loud horns
and massive potholes kept
awakening me rudely each
time I dozed off due to jetlag.
We arrived at a guesthouse
with closed shutters, which
we found later was a common
security measure to prevent
trafficking or kidnapping. We
woke up the next morning to
catch the flight to Cox’s Bazar
after a good breakfast.
* Malaysian Medical Associa-
tion
myelone@hotmail.com
A Mission to Help the Rohingya Refugees
Myelone Tharmaseelan*
, MD
Picture 1: The MERCY Malaysia team
The airport was dilapidated
and we had to carry our
bags from the aircraft, as
the baggage carousel ser-
vice was non-functional.
The distance from Dhaka to
Cox’s Bazar was 400 km,
and would have taken us 10
hours by vehicle. The flight
lasted only 50 minutes.
We were among the first
foreign medical teams to
arrive at the refugee
camps. MERCY Malaysia’s
primary healthcare clinics
were at the Balukali and
Tenkali camps at that time,
and medical services were
provided daily from 9am to
5pm. Each volunteer
worked on a two-week ro-
tation to avoid burn-out.
The first day was a real eye
opener for me. As I waited
for the others beside the
van that would ferry us to
the refugee camps, I had
been thinking that my
shoes would get dirty from
the muddy streets. At that
moment, a beggar crawled
towards me barely wearing
any clothes, drenched in
sweat and soaked in mud,
extended his hands to ask
for alms.
It was heart-breaking when
I realized our 21st century
problems barely scratched
the surface. My problems
were miniscule in compari-
son, and I realized we are
so preoccupied with mate-
rialistic gains that we for-
get to appreciate the little
things in life. This man was
not even a Rohingyan, as
much of Bangladesh is also
swaddled in poverty.
I was appalled by what I
saw at the refugee camp.
The densely populated area
had hardly any amenity,
and no words or pictures
could describe the suffer-
ing I witnessed. The refu-
gees were living in condi-
tions below any interna-
tionally acceptable levels.
By the time we arrived at
our clinic, over 50 patients
were already waiting. We
swung into action immedi-
ately with the help of
translators provided by our
local non-governmental
organization, COAST Trust.
Due to the limited re-
sources, initially we were
only able to provide symp-
tomatic treatment. The de-
15
Picture 2: Dispensing medication at our clinic
Picture 3: Taking Shelter
mand for medical care was
overwhelming, that we ran
out of drugs on the first
day after just three hours
of service. The daily influx
of about 2000 refugees per
day complicated the situa-
tion, adding to our frustra-
tion. The conditions eased
later on, as the organiza-
tion managed to secure ad-
ditional funding and medi-
cines.
The Balukali camp was
busier than the Tenkali
camp, where we examined
an average of 400 patients
a day. The situation at the
camp was chaotic, where
the refugees often fought
to skip the queues for med-
ical treatment. They were
impatient and restless un-
sure of the fate that await-
ed them if they were forced
to return to their home-
land.
The most common condi-
tions treated were gastro-
enteritis, upper respiratory
tract infections, skin dis-
eases and malnutrition.
Healthcare for the Rohing-
ya seemed to be a privilege
rather than a necessity,
which again made me real-
ize how lucky we are to
have access to quality
healthcare back home. For
some Rohingyans, it was
the first time they ever saw
a doctor.
The Rohingyans share a
bleak future, unlike most of
us who are empowered to
control our lives with edu-
cation, which allows us the
luxury of vision and ambi-
tion. For them, just getting
through another day is an
issue, not to mention get-
ting a job, food or shelter.
The condition at the camps
in Cox’s Bazar continues to
change from month to
month, but seasoned hu-
manitarian organizations
such as MERCY Malaysia
predicts that it would take
“Every small effort will make a difference
in the lives of the Rohingyans ”
16
Picture 4: Hardship made a 33-
year-old look much older
Picture 5: Densely populated refugee camps
years before any form of
resolution could be
reached. According to the
United Nations High Com-
missioner for Refugees
(UNHCR), it could take up
to 17 years for any refugee
crisis to settle.
For now, MERCY Malaysia
will continue providing
medical services for as
long as possible, with the
latest being the establish-
ment of a Maternal and
Child Healthcare Clinic to
serve the needs of the
women and children.
With safety and security
being a serious issue, the
organization has also set
in place plans to establish
Child-Friendly Spaces
(CFS) and Women and
Girls Safe Spaces for
women and children.
These include places
where they can seek ref-
uge or assistance when
they feel threatened, or
simply need somewhere
safe to learn and interact
with others.
The refugee problem ap-
pears enormous, and
many would simply stay
away thinking that little
help would appear like a
drop in a vast ocean. How-
ever, every small effort
will make a difference in
the lives of the Rohing-
yans, who are described
as the ‘most persecuted
people in the world’.
Teachers, journalists,
medical and non-medical
personnel could all play a
part in helping this mar-
ginalized community and
bring some dignity and
hope to them, even for a
moment, day, week or
month. Everyone can be of
help in their respective
capacities.
The mission had been a
life-changing experience
for me, as it changed my
perspective and views
about life. Providing ser-
vice to humanity is like
providing service to God.
The satisfaction from
touching the lives of those
vulnerable people rein-
forced my commitment to
more humanitarian work
in the near future. I re-
turned home, not only a
better doctor but also a
better human being.
17
“The mission had been a life-changing experience for me,
as it changed my perspective and views about life.”
Picture 6: Examining a patient
The Junior Doctors Network (JDN) this
year celebrated its 7th
anniversary. This
adventure started in 2010 in Vancouver,
and has continued to grow exponentially.
Every day, more young doctors are joining
the JDN to connect with colleagues and
work towards matters of interest to them
locally and nationally, but also current is-
sues in the global health realm.
Internally, last year has seen tremendous
progress towards an increase in standardi-
zation of processes in this rapidly growing
organization, widened engagement within
the World Medical Association (WMA), and
successful partnerships to improve the
quality and content of our meetings.
On the external front, the JDN is increas-
ingly recognized as an important player on
various advocacy matters relating to Phy-
sician Wellbeing, Medical Education, Anti-
microbial Resistance to name a few.
This year again, I would like us to remem-
ber the mission we set for our network to:
“Empower young physicians to work to-
gether towards a healthier world through
advocacy, education and international col-
laboration”.
I am looking forward to another great year
for the JDN, with an increase in collabora-
tion with existing regional platforms, new
partnerships, but more importantly to
bring your voice forward in matters of im-
portance to you.
Please remember that the JDN team is al-
ways open to your suggestions and feed-
back.
Looking forward to meeting many of you
in Riga.
18
A Word from the Chair
Caline S. Mattar, MD
Chair, Junior Doctors Network,
World Medical Association
Dear colleagues from around the world,
I welcome you to the 13th
issue of the Jun-
ior Doctors Network (JDN) newsletter, our
trademark editorial and academic collabo-
ration. I am very pleased to be part of the
Publications Team, as we work hard to
continue the legacy and raise awareness
on important global issues for junior doc-
tors and stakeholders across all sectors
and disciplines.
The newsletter aims to enlighten, provide
additional insight, and create a virtual link
and identity among junior doctors world-
wide. We are encouraged to facilitate the
academic dialogue by preparing articles
about emerging medical trends and chal-
lenges facing doctors across the world.
I would like to acknowledge the Publica-
tions Director (2017-2018), Dr. Kazuhiro
Abe, for his concerted efforts in driving
the editorial process as well as my prede-
cessor Dr. Mardelangel Zapata Ponze de
León (2016-2017) for her guidance. We
hope that you will enjoy reading this edi-
tion.
19
Words from the Communications Desk
Chibuzo Ndiokwelu, MD
Communications Director, Junior Doctors Network,
World Medical Association
My fellow Hippocratic brethren,
20
JDN Newsletter is a communication place to
share our views
Kazuhiro Abe, MD
Publications Director, Junior Doctors Network,
World Medical Association
I am pleased to deliver the 13th issue of
the Junior Doctors Network (JDN) News-
letter to junior doctors around the world.
As one of our essential communication
tools, this newsletter provides an oppor-
tunity to learn about the scientific per-
spectives and related activities of junior
doctors from other countries. The content
tends to focus on topics that were not elab-
orated on during the proceedings of the
JDN online monthly meetings or the World
Medical Association (WMA) General As-
sembly and Council Meetings.
In addition to the reliable scientific jour-
nals and news media across the world, the
JDN Newsletter provides an open forum
for junior doctors to share their individual
perspectives and coordinated health initia-
tives. Since junior doctors are aware of the
local environmental, health, political and
social determinants that influence health,
their contribution to the JDN Newsletter
would add value and insight for all read-
ers. Hence, I am passionate about creating
a safe communication space, where junior
doctors can express their views and share
their experiences.
In publishing this issue, I sincerely express
my appreciation for the efforts of all edi-
tors of the JDN publications team, officials
of the JDN management team, and leaders
of the WMA. Please enjoy the articles pub-
lished in this 13th
issue.
Dear JDN colleagues,
Caline S. Mattar, MD
Chibuzo Ndiokwelu, MD
Helena Chapman, MD, PhD, MPH
Konstantinos Roditis, MD, MSc
Mariam Parwaiz, MD
Mineyoshi Sato, MD
Ricardo Correa, MD, EsD
Wunna Tun, MBBS, MD
(alphabetical order)
Editors in the Publications Team 2017-2018
The Junior Doctors Net-
work (JDN) is made up
of junior doctors who in-
dependently join the
World Medical Associa-
tion (WMA) as Associate
Members, although many
are also representatives
of their respective Na-
tional Medical Associa-
tions.
Its mission is:
“Empowering young phy-
sicians to work together
towards a healthier world
through advocacy, educa-
tion and international col-
laboration”.
Junior Doctors Network
Newsletter
13th issue
ISSN (print) 2415-1122
ISSN (online) 2312-220x
Published by the Junior
Doctors Network, World
Medical Association on
April, 2018.
Opinions expressed in this
newsletter do not neces-
sarily reflect WMA and
JDN policy or positions.
Contact:
jdn@wma.net
Junior Doctors Leadership 2017-2018
Japan
Kazuhiro Abe
Publications Director
Caline S. Mattar
Chair
Lebanon
Chukwuma Oraegbunam
Deputy Chair
Nigeria
Konstantinos Roditis
Secretary
Greece
Yassen Tcholakov
Socio-Medical Affairs Officer Chair
Canada
Audrey Chloe Fontaine
Education Director
France
Sydney Chileshe
Medical Ethics Officer
Zambia
Chiaki Mishima
Membership Director
Japan
Chibuzo Obiora Ndiokwelu
Communications Director
Nigeria
21
Ahmet Murt
Immediate Past Chair
Turkey
Paxton Bach
Immediate Past Deputy Chair
Canada