Public Health - Ibiblio

International Federation of Medical Students' Associations 1

May 1996

ISSN 1026-5538

Medical Student International2

Volume 1, Issue number 3

INTERNATIONAL TEAM1995-1996

Executive Board:

Board of Directors:

Lennert Veerman, The Netherlands, PresidentJean-Marc Cloos, Luxembourg, Secretary GeneralMaría do Rosario Gaspar, Portugal, Treasurer

Hanna Tapanainen, Finland, Professional ExchangeIvo Van Dooren, The Netherlands, Elective ExchangeWolfram Antepohl, Germany, Medical EducationNicholas Brodszki, Sweden, Public HealthJet Derwig, The Netherlands, Refugees and PeaceJelena Zajeganovic, Yugoslavia, AIDS and Sexually Transmitted Diseases

Peter Kubica, Slovakia, Public Relations and Marketing DirectorMichel Torbey, Lebanon, MSI Editor-in-ChiefLiaison Officers:

Clemens Potocnik, Austria, WHOKatja Nevala, Finland, UNESCOLuisa Brumana, Italy, UNICEFLars Hagander, Sweden, European UnionUlrika Dahl, Sweden, Health Action International

Oliver Hoffmann, Germany, Village Concept in GhanaGiovanni Landoni, Italy, Village Concept in CalcuttaLars Almroth, Sweden, Village Concept in SudanNishaban Talukdar, Sweden, Conference "Priorities in Health Care"

Kurt Hanevik, Norway, IPPNWGünther Eysenbach, Germany, CP & PWGNick Shenker, UK, WHO-EuropeEva Schimdtke, Sweden, EMSALuis Ramos, Spain, FELSOCEM

Project co-ordinators:

PR & Marketing Division:


May 1996

Page 24

◆ ◆ ◆ ◆ ◆ PublicHealth,Poverty andEmpowerment:a challenge

David Werner analyzes on our issue focus the problems of Public Healthfaced to underdevelopment and peoples’ disempowerment.Dr. Charles Boelen from the World Health Organisation tips the five rolesof the 21st century Doctors on page 32.

4

◆◆◆◆◆ Coming Events

Future events especially focus in Medicineand War; meet us on the next IFMSAWorkshop in Prague.Join our nuclear weapons abolitioncampaign.UN closes a cycle of World Summits inIstanbul with Habitat II, «The City Summit»,on page 36.

◆ ◆ ◆ ◆ ◆ The President's Corner ......4◆ ◆ ◆ ◆ ◆ Editorial .............................5◆ ◆ ◆ ◆ ◆ IFMSA News ......................6◆ ◆ ◆ ◆ ◆ Issue Focus.......................15◆ ◆ ◆ ◆ ◆ Coming Soon ....................34◆ ◆ ◆ ◆ ◆ Calendar of Events...........37

Volume 1, Issue nº 3May 1996

Editor-in-ChiefMichel Torbey

LayoutLuis-Alberto Ramos Neira

PhotosIFMSA archives, WHO Dept.

of Public InformationContributions

David Werner, HealthRightsCharles Boelen, WHO - Geneva

Ignacio Garrote, SpainLennert Veerman,The Netherlands

Peter Kubica, SlovakiaNicholas Brodszki, SCOPH

Wigs Bateman, United KingdomKurt Hanevik, Norway

Jolijn Bronwer, The NetherlandsEva Schmidtke, Sweden

AdvertisingPeter Kubica

[email protected]

Printed in Portugalby Litomédica-AEFMUP-Porto

Edited byIFMSA, The International Federationof Medical Students' AssociationsFaculteit der GeneeskundeAkademisch Medisch CentrumMeibergdreef 15NL-1105 AZ Amsterdam(The Netherlands)u Tel: +31-20-5665366uFax: +31-20-6972316u Internet: [email protected]://crick.fmed.uniba.sk/ifmsau Telex: 11944 AZUA NL

u The opinions expressed in the articlesare those of their authors. IFMSA Does notnecessarily assume or adopt the policiesexpressed by them.

u Articles may totally or partially bereproduced for non-profit purposes,provided the source is mentioned

© IFMSA 1996.ISSN 1026-5538



Lennert Veerman, IFMSA President 1995-1996.

Public HealthAs medical students we are destined to be

come doctors. We will be trusted with thehealth of people. But which are the peo-

ple that we will be responsible for? Will they bejust the ones that we see in our office when theypresent themselves with health problems, or arewe to care for all people, even before they havefound their way to our practice? How does onedefine a doctor? And how far stretches the re-sponsibility of our profession?

Take the example of child mortality. More thanhalf of the children die of simple diseases likepneumonia or diarrhea, and often an accompa-nying or even underlying cause is malnutrition.What to do about this problem? The Belgian phy-sician Van Moorter, who is clearly not unfamiliarwith the ideas Dr. Werner voices in this issue ofMSI, distinguishes three levels on which actioncan be taken.

The solutions at the micro level will sound fa-miliar: if the child is under nourished, give it somegood food and medicine and chances are that itwill be fine in no time.

At the intermediate level, we also take a look atthe community. The family may not have suffi-ciently varied and reliable sources of food, a lowincome, insanitary living circumstances, low edu-cational status and a large number of children.This kind of problems might be treated in inter-ventions of a Primary Health Care nature, whichare not purely medical-technical but take intoaccount the socio-economic environment.

The macro or global level is yet another story.Some on this earth, especially the southern part

of it, may not have enough to feed their children,but others have plenty. The differences betweenrich and poor are on the increase, both betweenand within countries. The world can easily feedthe whole population, it is simply a matter of dis-tribution. Empowerment of the poor and sober-ness and solidarity of the rich are possible solu-tions.

Now where lie our responsibilities once we aredoctors?

There will be little dispute about the micro level.This is clearly a responsibility for doctors work-ing in the curative care, together with the otherhealth personnel.

The intermediate level is a bit less typically medi-cal-technical, but physicians certainly do have animportant role to play. Together with a whole loadof other professions, such as teachers, local politi-cians, and last but not least the community itself.

Do physicians have a responsibility at the macrolevel? Or is this up to politicians, bankers andrevolutionaries? Are we interested in health or(curative) health care?

I think that the medical profession does have aresponsibility for the global distribution of wealthin the world. It shares this responsibility with manyother groups in society. In such a coalition we havethe specific task of pointing out the consequencesthe present inequities have for health and devel-opment of people.

IFMSA can help in this process by informingstudents, by offering them to participate in itsprojects and see for themselves, and by publish-ing information. And it does.


May 1996

Michel Torbey, Editor-in-chief

By the end of this century , the world isfacing one of its greatest challenges:“Health for all by Year 2000”.

"Are we any close to fulfilling thisdream ?" A question in the mind ofmany worldwide health organiza-t ions. Lots ofchanges are occur-ring throughout theworld with the purpose to providehealth to the largest number of peo-ple with the cheapest possible ex-penses. Among these changes, thedr i f t seen in se lect ion of medicalspecialties among medical students towardprevent ive and internal medic ine ratherthan other special t ies. Medical studentsknow that if they are planning to prac-tice in the next century they better beprepared for this change in medicalcare. Medical inst i tu t ions in theworld are helping these students tobe exposed as much possible to thischange by increasing the allotted timefor ambulatory medic ine and publ ichealth rotations .

Medical Student International and IFMSAbelieve that public health is a very im-portant tool in order to prevent diseasesbefore their occurrences rather thanfacing them when i ts already toolate. We dedicated this issue to ex-pose medical s tudents to Publ ichealth by its different aspects. We

hope to succeed in delivering the message .We would l ike a lso to thank Ms.

Matsumoto and Dr. Boelen fromWHO for their contribution to

this issue . Also a specialthanks to the News agency

"Europe To-day" inB r u s s e l s

that provided us with the lo-gistics for editing this issue.



IFMSA�s 2 annual meetings

Medical students unitedEvery year the federation has twogeneral meetings, where medicalstudents meet and plan the policiesof the organization. The mostimportant one is the GeneralAssembly (GA), which takes placein the beginning of August. At theGA the new board, that is to governIFMSA in the year to come iselected, the budget for that year isapproved, new members areadmitted... The Exchange Officers�Meeting (EOM) does not havethese powers, but is nonetheless ofmajor importance for the function-ing of IFMSA.

I t is difficult to describe the atmosphereduring these meetings. When youngpeople from many different countries and

backgrounds get together to work for the re-alization of their ideals, and to have a goodtime meanwhile, something very special hap-

IFMSA

Mme. Kearney, from UNESCO, during her address toour Plenary.

Leadership TrainingProgram in Rovinj

For the first time a “Leadership Training Pro-gramme” was organized after the EOM. The LTP is athree day course on management and leadership skills,such as motivation, project planning, fundraising, andteam building. The quality of IFMSA’s work dependson the qualities of the people that work for the organi-zation, and this programme is hoped to make IFMSAactivists better organizers. We learn a lot in medicalschool, but hardly how to organize and manage. Whilein real life not only medical knowledge counts, even for doctors.

The training programme took place in a large hotel in the smallcoastal town of Rovinj. There were 17 participants and 4 tutors,most of whom were medical students themselves. Quite a smallgroup, and this was perhaps one of the factors that contributed to

IFMSA

A detail of the official Group Photo during 89th. Exchange Officers' Meeting in Opatija.the success of the programme. The participants were enthusiasticabout the quality of the programme, and most declared afterwardsthe intention to implement changes in their way of working, and tostart fundraising - a topic that was very well covered in the pro-gramme.

pens. A friendly micro-cosmos is created, inwhich everyone feels related and new world-wide friendships are born and old onesstrengthened. The world seems a small placeafter all, full of weird but friendly people.

The 44th General Assembly of the Inter-national Federation of Medical Students’ As-sociations took place from 5 to 11 August 1995under the hot Spanish Sun in Barcelona. Withover 320 participants from 51 countries, it wasthe largest IFMSA meeting as far as memorygoes back. The participants were glad that aswimming pool was available, in so far as theyhad time to make use of it. Night time was notonly time for party and relaxation this meet-ing; the last plenary session continued until 5in the morning (but by that time there cer-tainly weren’t 320 people in the hall).

IFMSA welcomed the medical studentsassociations of South Africa, Armenia,Canada, Malta, Mexico, Tatarstan (Russia)and St.-Petersburg (Russia) as new members,bringing the total number of members asso-ciations at 53, of which 40 are full members, 7candidate, and 6 associate.

A special session about the perceived roleof doctors and medical education (as part ofhigher education) was organized with

UNESCO and given by Mme. Kearney.The GA also adopted a statement, declar-

ing the IFMSA strongly opposes all testing ofnuclear weapons, and calling for a total weap-ons test ban and the abolition of all nuclearweapons.

The 89th Exchange Officers’ Meeting(EOM) took place from 1 to 7 March inOpatija, Croatia, and had about 220 partici-pants from 44 countries. New in this meetingwas Indonesia, which was represented by 2delegates.

EOMs are in general more relaxed thanGAs, with more emphasis on the actual workof IFMSA. This mainly takes place in the sixStanding Committees, which meet in parallelsessions during the meetings of IFMSA todiscuss IFMSAs activities in the field of theirspecific mandate.

At the moment of writing, the 45th Gen-eral Assembly is approaching. The meetingwill take place in Prague, and the traditionalpre-GA workshop will focus on “Medicineand War”. Which promises to become a veryinteresting event, with guest speakers fromUNICEF, MSF and other international or-ganizations, and with financial support fromUNESCO.


May 1996

FELSOCEM and IFMSA come to a model of co-operation

Stronger togetherTen years after they were foundedin Chile, the Latin AmericanFederation of Medical Students'Scientific Societies (FELSOCEM)celebrated their Annual ScientificCongress and General Assembly inBuenos Aires, Argentina. For thethird time in the last five years,IFMSA sent representatives toanalyze the future co-operation;and came back with a challengingresult.

L atin American medical studentshave a clear compromise with theirregional progress: in order to

achieve higher scientific development theyneed to start by improving undergradu-ate scientific training.

After the first regional Congress in

By Aleksandar Micevski, IFMSA President 1994-1995

IFMSA

Cristian Baeza,and Aleksandar Micevski, Presidents of FELSOCEM and IFMSA in 1995.

Valparaíso, Chile, in 1985, a general struc-ture was developed that in the end hadmany similarities with IFMSA: Nationaland Local Chapters and an InternationalTeam with several Standing Committees,all dedicated to the different medicalapproaches of scientific research.FELSOCEM International Scientific Con-gress is undoubtedly the world's largest innumber of participants, researches pre-sented, and countries represented.

The Buenos Aires Agreement

Several previous contacts, brought usduring this Congress to the necessity tocreate a framework for the future co-op-eration between FELSOCEM and IFMSAthrough this agreement, which in the endit served not only to establish continuousand fluent links between both organisa-tions, but also as a model for other re-gional organisations to integrate IFMSAstructure in the future.

Establishing themodels for IFMSAin the 21st CenturyThe Buenos Aires Agreement signed

with FELSOCEM, together with similarco-operations signed later with Europeanand African Medical Students' Associa-tions, design the model of the Federa-tion after fifty years of our Foundation.This, together with the Barcelona Agree-ment with FAMSA and the second Bar-celona Agreement with EMSA, deter-mine the steps through which all mem-ber states represented in those regionalassociations will finally become IFMSAmembers. At the same time, IFMSA willfacilitate a better training for regionalofficers and will transmit their knowledgeand external contacts.

By the end of the Century, IFMSAcould then be represented in almost onehundred countries, with a wide range ofactivities from Scientific Congresses toMedical curricular initiatives. A majorimpulse will be given to our current de-centralised managerial system, sinceregional organisations will be dealing withthe more specific issues of their moreparticular interest, whereas on the inter-national level, a wider exchange of viewswill be made possible: partnershipsNorth-South for development projects,or educational campaigns on IFMSAmajor policy topics, and so on.

Prepared as a long-term agreement,the more concrete results that can be seenfrom now on will be the joint presenta-tion of all Medical Students in the Worldunder IFMSA umbrella, having one sin-gle voice towards our international part-ners, as well as having a specific visionand a specialised opinion on the regionallevel. Some of our usual relations, suchas the World Health Organisation orUNESCO, will not only hear from us intheir International Head Quarters afteran International event, but also at theirRegional Offices, after a Regional Meet-ing is held.



Implementing the Second Barcelona Agreement

EMSA as part of ourInternational Network

Since the EMSA General Assembly(GA) in Hamburg ratified theagreement in September 1995, TheEuropean Medical Students'Association is now IFMSA regionaloffice for Europe as well as amedical students� organisationsharing the IFMSA ambition forcreating solidarity and a better lifein this continent.

The GA was successfully hosted byEMSA Hamburg and attractedabout ninety participants including ap-

proximately ten “IFMSA people” out of whichtwo ended up in the European Board (EB):Natalya Digilova (Russia) and Eva Schmidtke(Sweden).

During the meeting several workshops wereheld covering the following topics: medicaleducation, internal rules, ethics and commu-nication/WWW. There were reports from therespective National Co-ordinators and theresigning EB and of course election of the newone;

Jan Schilling (Germany): president, NatalyaDigilova (Russia): vice-president, Cecilia odd-Pokropek (UK): secretary, ClementineMaddock (UK): treasurer, Joerg Ruppert(Germany): communications director, SilvinaShangova (Bulgaria): fund-raising director,Agnes Alinska (Poland): medical educationdirector and Eva Schmidtke (Sweden): gen-eral task force director.

The EB has since appointed three liaisonofficers; Nick Shenker (UK): World HealthOrganisation, Günther Eysenbach (Ger-many): Permanent Working Group of YoungDoctors/Standing Commitee of EuropeanDoctors, and Eva Schmidtke: IFMSA.

There has been three EB meetings sincethe GA. So what has been done implementa-

tion wise and otherwise since September1995? Regarding the EB a regular communi-cation with the IFMSA Executive Board hasbeen established as well as a growing co-op-eration between the respective directors onthe boards. On the national level there hasbeen activities to increase co-operation in anumber of countries including Germany,Slovenia, Sweden, Croatia, Spain, Denmark,Slovakia and the Netherlands among others.EMSA member countries that are not mem-bers of IFMSA (The UK, France and Bel-gium) have increased their communicationand are starting to build up networks for ex-changes, etc. The regular EMSA activities areof course also going on including a scientificsymposium in Antwerp, five Eurotalks (weak-ling courses on “medical” English, French orGerman) and a concert in Ljubljana.

The increased co-operation on national

level was one of the main EBs goals set for 95/96. Other efforts made to realise these goalsare: a grant application for EU funding, thereis joint work between EMSA and IFMSA go-ing on concerning the EMCAD (EuropeanMedical Curricula Access Disk) project, theOfficial Courier is being sent to more coun-tries as well as to the IFMSA Executive Board,two mailings have been sent to the NationalCo-ordinators of which the first also went toall IFMSA members and the EMSA eventsare advertised in the IFMSA Newsletter andvice-versa.

To conclude; steps are being taken toensure EMSAs representation of IFMSAin Europe as well as increased mutualbenefit on all levels ranging from execu-tive board to local committees and, as al-ways in our work, there are high hopesfor the future.

By Eva Schmidtke, Sweden

EMSA

Natalya, Jörg, Jan, Cecilia, Clementine, during the Board Meeting in Hamburg last February.


May 1996

One of the many nice things of beingin IFMSA is the opportunity to attendmeetings in fascinating parts of theglobe. I am now enjoying a holiday inSouth Africa. While trying to under-stand this country I will also see howthe FAMSA headquarters in CapeTown functions. The reason for mypresence here is the 21st GeneralAssembly of FAMSA, which tookplace in Johannesburg from 30March to 4 April, now a couple ofdays ago. It was a wonderful andstimulating experience.

The Federation of African MedicalStudents’ Associations (FAMSA)has quite a long history. It was

founded in 1968 in Ghana, upon a Ugan-dan initiative. In the far-from-completeIFMSA archives there is an article in the“IFMSA news” of 1971 about FAMSA, butapart from that I know of no evidence ofinteraction between IFMSA and FAMSA.This changed just over two years ago,when Ghana formed a bridge between thetwo federations, and contact intensifiedone year ago when the campaign of a re-gional structure for IFMSA was launched.This is the first time that an IFMSA EBmember attended a FAMSA GA (buthopefully not the last).

So far, yet so similar

There is a big emphasis placed on thestudent scientific research presentations.This meeting was centered around thetheme “Challenges facing Health Care inAfrica”. A major challenge was AIDS, buttuberculosis, chronic diseases and other

topics were also highlighted.Obviously most of the papers focused

on public health issues. A declaration onAIDS was adopted by the GA, which willguide FAMSA’s activities in that field forthe coming year.

FAMSA has three new Standing Com-mittees. Apart from the existing SCs onRefugees and Populations Activities(SCORPA), Publications (SCOPUB) andExchange and Research (SCOPER),there are now also Standing Committeeson Medical Education (SCOME), PublicHealth (SCOPH) and HIV-AIDS(SCOHA). Excellent news for IFMSA,since FAMSA structure is becoming morecompatible with that of IFMSA, which willfacilitate contact. The FAMSA-IFMSARefugee Project in Uganda is a break-through for FAMSA and an example forthe future. Next GA will allocate time forthe Standing Committees to meet; thisshould help to strengthen FAMSA SCs’.

Strenghthening our relations

The Barcelona agreement was amendedand accepted including these amend-ments. All proposed changes concern mi-nor points.

In all, 15 universities from the follow-ing countries were represented: SouthAfrica, Zimbabwe, Mozambique, Zambia,Uganda, Tanzania, Kenya, and Togo. Thisis very interesting for IFMSA, as onlySouth Africa and Kenya are representedin our federation at this moment. Thedelegates of the other countries expresseda vivid interest in attending our GA inPrague, so let’s hope they will manage tofind the required funds and visas.

From Charlemagne, the delegate fromTogo, I learned of the existence of a co-operation of francophone medical stu-dents in West Africa. A meeting was totake place mid April in Mali. Charlemagne

would present IFMSA and FAMSA thereand invite everybody to the General As-sembly in Prague. Hopefully we’ll soonhear more.

The contact with the FAMSA board hasbeen excellent over the past year; at thismeeting we also agreed on increasing co-operation in the future. FAMSA is pick-ing up the things they can use from theIFMSA structure and activities, andIFMSA can gain from fresh Africanthought. For FAMSA, this may meanchanges like those concerning proceduresin meetings, the structure of StandingCommittees, the system of address listsand official forms, etc. For IFMSA, Iwould conclude that we have to pay moreattention to research, and a nice idea isperhaps the official swearing in of the Ex-ecutive Board, which provided a nice of-ficial note at the final dinner.

By Lennert Veerman, The Netherlands

General Assembly of the Regional Office for Africa

Challenges facing healthcare in Africa

IFMSA

Geraldine Owor, from Uganda, swears in as FAMSApresident.



From January 07 to 12, 1996, the2nd International MedicalStudents Workshop on the Futureof Medical Education was held inBelo Horizonte, Brazil. One of itsmajor topics was the role of publichealth and primary health care inmedical education.

This working group was the first tobe held on this topic. Last year inMaastricht this subject was not at-

tended. The working group consisted ofeleven delegates from different countriesi.e. Brazil, Finland, South Africa, Yugo-slavia, The Netherlands, Sweden, Greece,Germany and Argentina. Primary HealthCare (PHC) is an important subject at thismoment with the year 2000 getting closer,all those who want to make health for allreality are working harder. The Project of

Uma Nova Integração (UNI) is an exam-ple of this. This working group was set upto compare the different systems in thedifferent countries, to define the problemsand try to find solutions. The objective ofthese exercise was to define the deficien-cies that we have in medical education thatmakes it difficult for doctors to participatein Public Health Sector. Medical Educa-tion is very important because the two im-portant variables that influence the futurecareer in Public Health Sector are theteachers and curriculum.

Objectives

1. To clearly define Public Health2. To describe the different experi-ences in the different countries3. To identify the deficiencies inmedical education4. To find solutions5. Results

The implementation

What is public health?The public health sector is that a govern-

ment provides for all citizens. It includes,among others, public clinics, public hospitals,health awareness, school health andenviromental health, as opposed to the Pri-vate Health Sector which is provided by pri-vate health care professionals not contractedto the government and private companies forall those who can afford to pay. This includesamong others individual practice, group prac-tice, private hospitals.

Since health, according to the WHO defi-nition, means the complete well-being of anindividual on the mental, physical and sociallevel, Public Health should strive for the com-plete well-being of all citizens.

Who is responsible for public health?The first that comes to mind is the govern-

ment. They have the money and the power.But it is the responsibility of civil society tomake a government aware of their needs.Where civil society does not exist, it is the dutyof non-governmental organizations to makethe government aware of the needs of thecommunity and also try to build civil society.The medical students should be a catalyst inthis process. They have to work together withother health agents in their health care sys-tem. This will include the medical schools,dental schools, nursing schools, physiotherapyschools, education schools, local committees,town councils. The community is the majorrole player in public health. After all they arethe ones that have to receive it, so they arethe ones that have to tell to the governmentwhich help is needed and where.

Different experiences from different countries:Public Health has different aspects in dif-

ferent countries. We found that the problemsin the poor countries are closely related tosocial problems. The problems begin with theproviding of sanitation and it goes all the wayto a lack of doctors in the rural areas.

For instance, in the Amazonas State thedoctors do not want to serve in small commu-nities in the rain forest because of culturalhandicaps, lack of schools, lack of communi-cation networks and lack of roads. The com-munities are very poor. This is not unique tothe Amazonas. All delegates reported thatthey have similar situations in their countries.Lack of incentives in the rural areas results inshortage of doctors. There is an overcrowd-ing of doctors in urban areas because of bet-ter life style. There is also a shortage of doc-tors in the Public Sector because of lack ofgood salaries, long working hours, bad work-ing conditions, shortage of medicine and lackof consulting rooms.

The differences in the public and privatesector in Brazil and South Africa are similar.The health care problems in Brazil and SouthAfrica seem identical. The private sector pro-

Medical Education Workshops series

By Jolijn Bronwer, The Netherlands

Public Health and Primary HealthCare in Medical Education

IFMSA

Prof. Chaves, the great Latin American expert on Public Health and Medical Education at a lecture.


May 1996

work and in which way they can be involvedin it. They will also know how to handleproblems that may occur in this area.

Ad 5: Lack of multidisciplinary system.All over the world it looks like different dis-

ciplines in the health care system are affraidto work together. It seems like they feel threat-ened to lose their own identity. We think thatis the other way round and that is essential towork together with other disciplines in orderto get the best results. We should be taught towork together as a team and not as individualdisciplines. This isn’t only true for "educated"disciplines but for example also for traditionalhealers. In areas where the traditional healerstill has great power and connection with thecommunity it is smarter to work together withhim than telling your patients that he is nogood. If you do that, your patients will prob-ably never listen to you again.

There should also be an intersectorial con-nection between health education and civilassociations.

Ad 6: Lack of tutor training.In both the university and the community,

the tutors should be educated about teachingmedical students. There should be a properteaching training for each specific topic.

Final thought

We must think about the future. If we con-tinue like this, then we’ll end up not havingmoney for PHC, because we invest too muchmoney in specialised areas. When the PHCsystem is healthy and well conserved it willsave us a lot of money. The patients will gothrough hierarchical medical attention. Firstpatients will be seen by PHC workers. Theywill decide if the patients need to go to a hos-pital or if they can help the patient themselves.In this way the amount of people attending ahospital will be much smaller. The care for allpatient will be a lot better in this way.

vides health care for a small rich populationwhereas the public sector provides for a largepoor population. There are strong lobbygroups in parliament that favour the privatesector because they have investments in theprivate companies.

In the developed countries provision ofbasic necessities is a reality. The problems thatthe developed world has are mostly environ-mental, e.g. skin cancer. The Public Health isdirected towards informing the public aboutdangers of sun exposure. Depression is also amajor problem in Finland and The Nether-lands. There is a shortage of doctors in ruralareas in Finland. It is compulsory to work in arural area for a year. There are financial in-centives for those willing to work in rural ar-eas. The problem of this approach is that thereis a high turnover of doctors, leading to poorquality care. In Finland, the public and theprivate sector’s quality of care is the same.However, for tertiary care, cues are longer inthe public sector. The salaries are okay in thepublic sector - doctors don’t make a fortunebut they can live well. In The Netherlandsthere is no private sector. In Yugoslavia thereis a small private sector because people stillhave trust in the public sector.

Deficiencies in medical education:After discussion we have identified that

there are some problems that are just the samein all countries. We decided to work on thesetopics.

1. Everywhere in the world we can see thatthere is a lack of connection between medi-cal education and community needs.2. There is a lack of social aspects and mo-tivation for PHC in medical education.3. Students are only trained in an artificialenvironment.4. In all the countries there is a differ-ent health system; the students have alack of knowledge about their own sys-tem, its managment and its administra-tion.5. There is a lack of connection betweenthe different disciplines, such as doctors,nurses, physiotherapists etc.6. Lack of tutor training in PHC.Possible solutions and results:Ad 1: Lack of connection between medi-

cal students and community.In Brazil, the Kellogg Foundation started

the UNI project. This is a great project thatmakes the students work closely togetherwith the community. Also the communitygets more power. Within the communitythere will be leaders appointed to repre-sent the community and make demands forthe things that are needed within the com-munity. In this way it will always be clearwhat is needed where.

It is of great importance that this idea isbeing incorporated in the society in order toavoid that it fades away. The community itselfmust make the project strong and the com-

IFMSA

Workshop participants together with staff of a rural health care center.munity must also continue the process.

Ad 2: Lack of social aspects and motivationfor PHC in medical education.

For this problem, we think that there is alot of work to do for the professors both con-cerning universities’/medical schools’ structureand curriculum contents. Education is thekeyword in this case. It is very important thatthe students are involved in PHC from thebeginning of the curriculum. The best way isprobably to make involvement with PHC com-pulsory from the start. In the courses PHCshould be involved. The teachers should beconvinced about the importance of PHC. Onlyif the students are involved in PHC on a regu-lar basis will it be possible to make them awareof the importance and make it more prob-able that they will continue working withinPHC for the rest of their lives.

Ad 3: Students are only trained in an artifi-cial environment.

This topic follows the prior one perfectly.The only solution here is of course to get thestudents out in the community and involvethem in PHC. What shouldn’t be forgotten isthe fact that the students need a theoreticalbackground in order to benefit from their pres-ence. What also is of great importance is thatstudents should go to the same communityregularly. When they go to different commu-nities all the time they will not be able to seecontinuity and they will never really get in-volved in the system.

Ad 4: Students’ lack of knowledge abouttheir own health system.

Each country has its own health system.We think that it is very important for thefuture doctors of a country to know theirown health system. The students shouldknow how it works and they should betaught about the management and admin-istration of it. When students know all thisthey will get a better view on how things



I t is unacceptable that individuals andsocieties with the fewest resources -the poor, the unemployed, the weak

and the vulnerable»-should have to bear«the greatest burden of the economic andsocial transformation of our world.»

-Secretary-General Boutros Boutros-Ghali

The Official Summit at theBella Center

The WSSD was held at the Bella Center inCopenhagen. In there, final deliberations forthe final Summit Declaration were held inCommittees, while a General Exchange ofviews was held at the Plenary. Finally, theSummit Declaration was approved and rati-fied by UN at a Ceremony attended by 118Heads of State and/or Government.

The main body of the Declaration had al-ready been approved in the Preparatory Com-mittees in New York. Only some of the most

compromising points had been left in brack-ets for further negotiation at the Committeesduring the Summit.

A legal advisor of one of the Spanish NGOscommented she was surprised of the manydifficulties and negotiations under the finalresolution: the Summit document was in-tended to express only a declaration of Inten-tions, and not constitute a legal committmentfor the signing States; however, every wordhad been carefully scrutinized as if it wasreally going to mean really more thanintentions...The Caucuses

NGOs and many other civil actors had hadthe opportunity to express their opinionsabout the different issues of the documentduring the PrepComs. In there they consti-tuted lobby groups known as «caucuses».There was for example, a Health Caucus, aYouth Caucus, a Latin American Caucus, butmost of all, a Women’s Caucus.

Results of the SummitThe simple fact of having been held can be

considered a success itself,since there weremany States trying it not to happen. It is thefirst time in History that heads of State admitthe reality of Social Development and sign acompromise to tackle poverty.

Among old forgotten concepts re-taken wasthe 0.7% theory, launched by UN in the 70’s,which means that rich countries should at leastdedicate 0.7% of their Gross National Prod-uct in aid to developing countries.

A new theory was that of the 20/20. This isexplained by dedicating at least 20% of richcountries’ aid to developing ones in SocialDevelopment programs, and DevelopingCountries dedicating at least 20% of their to-tal budgets to Social Development as well.However, this concept is not well received,neither in many rich countries (which some-times hide commercial interests under theshape of «aid»), nor in the poorer.

There was also a firm condemn to childrenwork, however, many among the poor com-plained that just a condemn is not enough: achildren work is in many cases essential for afamiliy to survive, therefore, a different soci-ety pattern must be introduced in order toallow children go on an educational processinstead of being forced to work.

Finally, it was also aknowledged the impor-tant role of women in Third World Countrieseconomies and their contribution to SocialDevelopment.

From the points of view that most concernus: Health, Education and Youth, results werealso satisfactory.

Youth was specially active at the Summittoo. Besides the regular meetings of the YouthCaucus, there was a Youth Consultation for

World Summit forSocial Development

United Nations Inter-Governmental Organisations (IGOs)had a frenetic activity, each one showing their contributiontowards Social Development, and the main issues accordingto their basic fields, i.e. Health for WHO, Nutrition for FAO,Education for UNESCO, and so on; no doubt, one of the mainIGOs was UNDP, the United Nations Development program,which was basically concerned at the preparations of the Sum-mit.

A variety of documents and reports were available, but wewould just mention now a heading of a newspaper, briefingWHO’s Director General, Dr. Hiroshi Nakajima, address tothe Plenary: «Poverty makes you sick».

In a briefing with some of the WHO staff at the Summit,they said they were defending Health Parameters as a keyparameters of Social Development, and the necessity ofenough nutritional resources and basic Primary Health Careto achieve this Development. WHO was satisfied with the waythis concepts had been stated in the final Summit declaration.

UNESCO Director General, Federico Mayor, said in aninformal press briefing on corridors never trust those who al-ways give a pesimistic approach to the results of these meet-ings, «never trust the pesimistic; our problem is that many

Federico Mayor Zaragoza, Director General of UNESCO.IFMSA

United Nations Agencies at the Summit

times NGOs do a good criticism of reality, but are pesimistic, onthe other hand Governments are very optimistic, but never docriticism; I’d suggest you to adopt a reasonably optimistic attitude,an optimism a la Catalana».

By Luis-Alberto Ramos Neira, External Relations Officer.


May 1996

the World Summit, held during the previousdays. WAY, the Way Assembly of Youth, gavetheir yearly international Youth Awards«Prime Minister of Malaysia» at a grandiousgala. A special connection was kept betweenthe Secretary General of the InternationalConference on Human Settlements (HabitatII), the last UN Summit of the Century, andseveral Youth Organisations, in order to ar-range the organisation of a Youth Day duringthat Summit, to be held in Istanbul, Turkey,next June 1996.

The NGO Forum �95 at Holmen

Parallel to the Official Summit, there wasan NGO forum, held at Holmen, a formerDanish Navy Base. This was a kind of a greatfair event, with over 2500 (two thousand andfive hundred) Non-Governmental Organ-isations present. There was a Global Villageon the site, where many of the NGOs heldstands to present themselves to the thousandsof visitiors that passed by every day.

But the real value of the Forum came fromthe hundreds of conferences that NGOs of-fered there. Everyone there contributed to thethree main topics of the Summit (atackingpoverty, creating jobs, building solidarity) fromtheir perspective and practical approach:Women, Health, Children, Agriculture, Ecol-ogy, Religion, political denounce, Business,

Slums, Jungle, Desert, Indigenous Peoples...Some of the ideas called our attention, for

example, when hearing about the problemsof the indigenous peoples in Paraguay: Whatdoes the Summit mean by Social Integration?:Usually, by «socially integrating» the indigenousmeans disintegrating their own society and forc-edly integrating the whites’...

However, the final feeling about the Forumwas that of a little disaster. Too many of theconferences were delayed, postponed or evencancelled withouth giving enough notice aboutit, some of the NGOs seemed to be moreworried about self-promoting, or letting theworld know clear that they were against theofficial summit, and claiming more legitimitythan governments to represent the People.Finally, several «alternative documents» weremade to the Official Declaration in BellaCenter; procedures to create the redactioncommittee, and the way they included sug-gestions from participants in several open ses-sions remained obscure to us.

Another negative point we could all agreewas the unfortunate location of the NGOForum, both for the country and the site inCopenhagen. Denmark is not a cheap coun-try at all, and over 70,000 people were ex-pected to attend it, many of them from devel-oping countries, who could live a whole weekat home with the money of a hot dog atHolmen; this, however, must be excused for

the fact that Denmark is probably the Statethat has a clearer compromise on Social is-sues, both internally and in co-operation forDevelopment. Secondly, Holmen was discon-nected from the Bella Center for those NGOsthat were not accredited at the official Sum-mit; this created a rare atmosphere betweenNGOs themselves, differentiating them. Thiswe could especially clearly see on several meet-ings of the Spanish and Latin AmericanNGOs, who especially complained that Gov-ernments had ignored or showed little dia-logue attitude towards NGOs from the respec-tive countries during the Summit.

IFMSA involvement and futureperspectives

IFMSA can involve itself as an active actorat any UN event in a similar level level to thatof WHO, and we could therefore allign withWHO’s policies or elaborate our own.

But IFMSA’s main strenght does not comeby speaking, but by doing. So it’s through ourprojects that our main committment mustshow. Relating with the WSSD, it’s obviousthat we are definitely contributing to its goals:we help those socially displaced by our refu-gee projects, we create community awarenessand actions in the Health field through theVillage Concept; our international vocationin our exchange programs builds World Citi-zenship, which is one of the main tools to cre-ate a New World Order, our concern aboutMedical Education, when done together withother IMISO Partners, becomes a seriousconcern about the Education for the 21stCentury as an imprescindible tool to createjobs...

The Summit is not an end stop, a seriousfollow-up is planned. States have signed a for-mal declaration that must turn out now intoconcrete plans of action. IFMSA Can still con-tribute with our points of view and projects atall levels: International, national and local.

Finally, during our stay in Copenhagen weparticipated in the preparations for the Youthevents at the Second International Confer-ence on Human Settlements (Habitat II), al-ready nicknamed «the city Summit». We per-sonally consider this is an unfortunate givenname for this conference, if we consider thatfocusing on city issues we leave apart most ofthe world population nowadays, and especiallyregarding Health Care issues, those most un-attended and yet needed.

However, such an event is a good tool toguide IFMSA. Since preparations for thisevents need mid-term planning and involve-ment, they undoubtedly serve as tool to makeus consider its whole direction, and a goodtraining and learning experience to develop,implement and evaluate IFMSA projects.

It is the best opportunity to face IFMSAtowards Society and see ourselves through theeyes of the World.A view of the WSSD main hall in Bella Center.

IFMSA



Peter Kubica, IFMSA Director of Marketing.

I t was only few years ago, when we started to use computerinstead of typewriter and now computers are pushing outalso phones, faxes and regular mail. Many of these applications

are dependent on the world’s biggest computer network - Internet.

History:

IFMSA entered this computer world in the year 1995, when wasestablished first mail-server in Greece, that allowed international stu-dent organizations to communicate via E-mail. Hypertext home pagein Slovakia followed only few months later. Thus was established uni-versal source of information about IFMSA and its international activi-ties, that is accessible from all over the world 24 hours daily. At thevery beginning IFMSA home page contained only brief information,which has been raising till today up to 9 Mbytes of texts, pictures anddownloadable files.

Current situation

IFMSA mail serverIt is a standard mailserver run by program listproc. It is a forum for

discussions and means of communication for all the IFMSA officersand member countries. I would recommend to everybody interestedin IFMSA to subscribe by sending a message SUBSCRIBE <your e-mail> to [email protected] or via IFMSA home page.

IFMSA home pageIt contains still more and more material. You can find there all the

official documents, addresses, IFMSA history, newsletters, important

IFMSA on theInternet

meetings, pictures etc. Each IFMSA working area has the separatepage with all the news from exchanges, electives, public health, medi-cal education, AIDS and refugees. Very new is IFMSA download di-rectory, which contains important files. Their format allows you toprint them (MS WORD, PM5) or use them by different programs(IFMSA addresses for Eudora Light).

Electives databaseIt was established in Greece and is linked to IFMSA home

page. It gives the opportunity for every student interested in goingabroad to overview all the electives offered by IFMSA. Data-base is well structured and easy to operate.

Member organizationsThay have also started to build their pages by which they in-

form the others about their national activities and local condi-tions for foreign students. Nowadays Canada, Croatia, Finland,Greece, Hungary, Malta, Slovakia, Spain and Sweden have homepages and other countries are building them.

Future plans:

Computers as the means of communication can save a lot oftime and money, so they will probably be in use more and more.As soon as all the IFMSA people get full Internet access, we canstop sending all the documents by regular mail and start to sendthem by e-mail. Second step may be just to place all the informa-tion on the WWW pages and leave e-mail just for private corre-spondence and mailserver for discussions, which is much moreflexible.

The World at a mouse click: by visiting IFMSA Home Page (top image), you can access all information available, suscribe IFMSA Mail Server (right) orconsult elective courses throughout the World (left).


May 1996

I think the best start for this articlewill be with a question and theanswer to it. So :

What is Public Health?

The modern Public Health movementis little more than a century old. Duringthat time tremendous improvements havebeen made in the life chances of much ofthe world’s population. Vaccines and an-tibiotics have all but eliminated many dis-eases; drugs and medical procedures haveadded years to life expectancy; and edu-cational programs have improved thehealthy behaviour of individuals. Never-theless, the discovery of new health prob-lems and the stubborn persistence of oldones remind us of how precarious ourexistence is and how vigilant we must be.

Developing policies to improve health(and Public Health) requires a clear andworkable definition of what health (andPublic Health) are. A definition that ac-knowledges the aspect of health we areable to measure is the following : «Healthis a state characterised by anatomic integ-rity, ability to perform personally valuedfamily, work and community roles; abilityto deal with physical, biologic, and socialstress; a feeling of well-being; and free-dom from the risk of disease and untimelyhealth».

For the concept of Public Health I willuse the definition written by Winslow in“Science in 1920” which was true than andI think it is true now as well : “PublicHealth is the science and art of prevent-ing disease, prolonging life and promot-ing physical health and efficiency throughorganised community efforts for the sani-tation of the environment, the educationof the individual in principles of personalhygiene, the organisation of medical andnursing service for the early diagnosis and

preventive treatment of the disease, andthe development of the social machinerywhich will ensure to every individual in thecommunity a standard of living adequatefor the maintenance of health.”

There should be a clear distinction be-tween Public Health and health, but thisisn’t so obvious always, therefore I’d liketo make this distinction : “Public Healthis the art and science of preventing dis-ease and injury, and promoting health andefficiency of populations through organ-ised community effort, while health careis the diagnosis, treat-ment or rehabilitation ofa patient under care, ac-complished on a one-to-one basis”.

Public Health is vastlysuperior to the healthcare and essential fromthe viewpoint of enhanc-ing the health status andquality of life and envi-ronment of the people.Public Health activitieschange with changingtechnology and socialvalues, but the goals re-main the same - to re-duce the amount of dis-ease, premature death,and disease-produceddiscomfort and disabilityin the population.

The range of workwhich needs to be donein the field of PublicHealth is very extensive,from monitoring thehealth of the populationand developing healthstrategies and the alli-ances with which to im-plement them to produc-ing an informed partici-

Are we really capable to solve the main basic problems?. Just by havingclean water supplies most infectious diseases would be tackled.

WHO PHOTO BY PH. MERCHEZ

pating public and ensuring that adequateand appropriate services for preventiontreatment and care are in place in an eq-uitable fashion.

The problems:

I have to admit that in the beginning ofmy career within IFMSA (in the autumnof '93) the concept of Public Health wasthe same as the Village Concept Projectin my mind (and I dare to affirm that thisis true for most of us active in SCOPH ).

Close to the Year 2000

Nicholas Brodszki, IFMSA Director of Public Health



PUBLIC HEALTH: CLOSE TO THE YEAR 2000PUBLIC HEALTH: CLOSE TO THE YEAR 2000

Only after my second IFMSA meeting Irealised that Public Health is much-muchmore than just VCP.

I will try to ask some of the questionsfor which I have no answer and I don’texpect you to have answers -my intentionis to try to make you aware of them andto make you reflect about them (they arenot ranked in their order of importance,it is simply as come up in my mind).

—how can we craft humane and afford-able health care delivery systems out of thefragmented tangle of privileges and self in-terests that no regulator or politician has yetfound the levers to control? Yes, it seems al-most impossible - but only almost. And ifWE don’t do anything about it,who will?

—how will we findthe courage, the vo-cabulary to facethe choices wec a n n o t

avoid, at theedges of life?Can we makethose choices and

preserve our humanity? Modern technologyhas put us into a corner where we are al-ready selecting who will live and who willdie. We have come to the time when our as-pirations have overstepped our resources.

—homelessness, or infant mortality, or thegrowing impoverishment of large number ofinner cities and rural women and children inmany places of the world. Have we become asociety willing simply to ignore worseningsymptoms of the dangerous and debilitating“-isms” - racism, classism, sexism, ageism?

—can we save the endangered earth, canwe stop modern industry from making somemore devastating mistakes? How can we beeffective close to home, what impact can wehave locally when the global pressures seemso enormous, when population continues toexpand at the astounding rate of 90 million

each year?—AIDS: how can we galvanise the in-

tensity of social response that this threatclearly demands,without igniting adangerous back-

fire of fear, repression and hate? It isheartbreaking to see the callousness with

which the public seems ready to accept thedecimation of whole segments of the worldpopulation. And it is confusing to try to sort

Education and training at all levels, in order to build the capacity among the communities themselves to be self-responsible for their own health.

PHOTO: WHO/PAHO/ C. CAGGERO

out how to strike an optimal balance ofopenness about sex ( in hopes of making itsafer), without seeming to condone the verybehaviours that are the source of the prob-lem.

—in developing countries, where the per-sistent question intensifies: how can we domore (and more) with less (and less)? Age-ing populations in the Third World are bur-dened increasingly with acute infections andchronic disease. Communities there are con-taminated with the old, microbial PublicHealth threats and the new, chemical ones.

I could go on enumerating questions,but there is one, that I want to ask as thelast one, because it’s fundamental, anddifficult.

—It is this question of the appropriatebalance between the individual and the so-cial - the private and the public sides of Pub-lic Health. How can we find a workable bal-ance in our professional practice, and howcan we find a healthy balance in our per-sonal lives?

The root causes of poor health are, forthe most part, not addressed by healthcare. To address them, it is first of all nec-essary to know what they are and how theyaffect society. We therefore need to col-lect and analyse information about thestate of public’s health. We then need toplan the activities necessary to maintainand improve the public’s health. Theseactivities would include social policies suchas those to ensure adequate food and shel-ter and to reduce environmental hazards;community-based preventive services suchas outreach and community educationprograms; and personal preventive serv-ices such as immunisations. The planningfunction would involve analysing the prob-lems, determining the solutions, and ar-ranging to implement them. The solutionswould involve co-ordination or integrationof personal and Public Health services andof public and private sector functions. Fi-nally, we must review the effectiveness ofthese solutions.

We have occasionally followed thismodel on a small scale. However, we havenever done so as a general plan of actionbecause of inadequate funding, insuffi-cient knowledge, and the opposition ofthose who prefer the unplanned -or lessplanned- society.

The goals

1. Changing patterns of Public HealthReview the concept and practice of Pub-

lic Health in the context of changing healthsituations in countries in order to betterintegrate health with, and contribute to,economic development.


May 1996

2. Education and training of health per-sonnel

Plan for improved Public Health edu-cation for the 21st century and enhancehealth knowledge, skills and values at alllevels. Promote closer partnership withother sectors, stressing multidisciplinaryapproaches in management, communitydevelopment and global health develop-ment action.3. Enhance immunity : immunise to pro-tect both individuals and communities

Altogether we have effective immunis-ing agents against 20 to 30 formerly com-mon infections. Increased immunisationwhich should definitely be on our agenda,means reduced risk of epidemic spread ina population, reducing the number of “un-healthy individuals”.4. Sensible behaviour: encourage healthyhabits and discourage the harmful ones

Some conspicuous modern PublicHealth problems are a result of the waypeople behave, these are sometimes calledthe diseases of lifestyle. To mention someof them: conditions attributable to tobaccoaddiction, abuse of alcohol, drugs, inju-ries and death from traffic crashes, vio-lence against others and self, dental car-ies, coronary heart disease, obesity and thelist can made longer and longer.

It ought to be a simple matter to reducethe impact of this conditions on the Pub-lic Health, but it has proved very difficultto alter behaviour, mainly because factorsinfluencing behaviour are so poorly un-derstood.

Emphasis has moved increasingly to-ward influencing health-related behaviourin a positive direction, that is encourag-ing individuals and populations to behavein healthful ways; this approach may getbetter results than attempts to discouragehabits and behaviours that are unhealthy.5. Safe environment: to control physical,chemical and biological hazards

The environmental threats like:—atmospheric pollution due to combus-

tion of fossil fuels that produce oxides ofcarbon, sulphur, and nitrogen may directlyaffect health, contributing to respiratorydamage, but perhaps has even moreserious indirect effect consequent uponacid production and build-up of carbondioxide in the atmosphere.

More obvious and as serious are:—contamination of water, air, and es-

sential ecosystems with toxic by-productsof the petrochemical industry and pesti-cides. Some of these new environmentalhealth hazards are imperfectly under-stood, but some appear to damage humanchromosomes -they may be mutagenic,teratogenic, or carcinogenic.6. Good nutrition: well balanced diet,

neither too much nor too little to eatNutritional deficit reduces resistance to

infection, and infection increases meta-bolic demands for nutriment, so a viciouscircle exists. In the affluent industrial na-tions, we see the opposite problem of over-nutrition and the diseases causes or con-tributes to, for example, diabetes, coro-nary heart disease, obesity. There aremany studies that support recommenda-tions for health-promoting diets, so thisshould be a part of the Public Healthpolicy.7. Role of the women

Provide appropriate education, infor-mation and support in order to strengthentheir capacities and enhance their role inrelation to health and development.8. Well-born children : every child awanted child, every mother fit and healthy

Unlike other living creatures, we cancontrol our reproductive rate. As threatsto survival in infancy and childhood re-ceded, limits on reproductive rates havebecome greater. As birth rates fall, it be-comes desirable to ensure that those whoare born are the best possible additionsto the human race. This requires knowl-edge and application of factors leading to

Project Piaxtla in Mexico. A community-based experience inspired by WHO Health for All policy.WHO PHOTO

birth of infants in optimum health. Goodprenatal care and attention to maternalhealth and nutritional status go far achiev-ing this. Avoiding exposure of the devel-oping fetus to toxic substances, includingprescribed and other drugs, tobacco andalcohol, is an important part of prenatalcare.9. The challenge represented by the dis-advantaged

The avoidance of unnecessary andavoidable disease and suffering which pre-dominantly borne by the disadvantaged -which points to policies which addressthese questions and the challenge of em-powering the disadvantaged.10. The challenge of caring for the elderly

—a most common problem in devel-oped countries— in a human and accept-able ways which indicates the need forlocally based, strong, primary medicalcare.11. Research on health, environment andeconomic development

Encourage the ideas for starting andsupport research on critical issues in-volved in the interaction of health, en-vironment and economical develop-ment, including macro-economic analy-





sis and promote research on priorityissues in such fields as epidemiology,demography, health systems develop-ment and financing, appropriate tech-nology for health, and pharmaceuticals,to support the implementation of healthfor all strategies.12. We have not only inherited the earthfrom our ancestors, we have it in trust forour descendants.

The recognition that ultimately the fateof humans is bound up with that of theirhabitat and that policies for developmentwhich ignore the ecology of that habitatwill compromise our well-being.

As for me, I consider that the highestpriorities for the immediate future are toinitiate changes in social values relatingto human aggression and violence, and toalter our reproductive behaviour in orderto improve the delicate balance betweenmankind and other living creatures on ourplanet.

Achievements

-So farThe WHO’s Strategy of Health for All

by the year 2000 was adopted 1981. 15years later its influence has been feltaround the world. The Health for All(which as an action is the same, in myview as Public Health) emphasises theneed to re-orientate health systems toones based on primary health care, toincrease public participation in healthand to develop intersectorial, partner-ship approaches which recognise andmobilise the contributions of govern-ments, the voluntary and private sectorsof health.

The strategy also stresses the impor-tance of having health outcome objec-tives and targets rather planning healthservices on the basis of norms for pro-viding and staffing services which aredetached from any impact they mayhave.

However, in my view, the task in handwill take 5 to 10 years to complete andof course in one sense with the speedof change of today it will never be com-pleted. The current uncertain global po-litical and economic environments have

brought about a certain pessimism re-garding the WHO strategy. And I feelthat innovative approaches towardshealth and development are required inorder that humanity may enter the thirdmillennium with health and wealth.

Too often, health and economical de-velopment are regarded as a mutualtrade-off. In other words, health hasbeen regarded as an unnecessary ex-pense which consumes the resourcesrequired for economic development;hence very low priority in investmenthas been granted to the health com-pared with the industrial sector. Lessoften health has been seen as a passiveoutcome of economic development.

What to do?

It seems to me there are a set of prin-cipal issues on the basis of which we candiscuss an agenda for the actions to-ward the 21st century:

First, is the recognition of the needfor the optimal use of resources, bothfinancial and human and technological.These resources wil l become con-straints if not used wisely, but if usedoptimally may turn out to be an oppor-tunity for us to achieve broader policyobjectives of efficiency and effective-ness with minimum compromise in eq-uity.

Second is our conviction of the needfor solidarity to help each other on thisplanet. It is simply not acceptable thatthe majority of people remain poor andunhealthy. The international commu-nity should therefore be further mobi-lised to help those in need.

Third, this whole process may requiresome guiding principles and focalpoints. For us now is IFMSA. For later,as physicians working in the field ofPublic Health, it is WHO. Both have animportant role since they both serve theinternational community in providingguiding principles and a forum for dis-cussions and the WHO even as the co-ordinating body of international healthas mandated by its Constitution.

Nicholas BrodszkiSCOPH - Director '95-'96

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May 1996

A CO-OPERATION FORDEVELOPMENTIMPROVING HEALTH CARECONDITIONS INMANGLARALTO (ECUADOR)

As a part of the activities of thefirst Intersectorial Meeting ofInternational Students’ Organi-

zations (IMISO), a Leadership Train-ing Program was held in Geneva, at theWorld Health Organization Head Quar-ters, in 1986.

During those sessions, students of theareas of Medicine, Pharmacy, Veteri-nary, Law, Physiotherapy, Dentistryand Agriculture studied the role ofYouth for the achievement of “Healthfor All”, a goal fixed by WHO at theInternational Conference of Alma-Atain 1978.

As a consequence of it, “The VillageConcept” was born; a concrete actionof Young students towards Human Sus-tainable Development aiming toachieve self-sustainable improvement ofhealth conditions and general develop-ment parameters in a Human Settle-ment with the following key features:

1.- Community Action: Local stu-dents, together with villagers, help eachother to establish general and specificobjectives to improve living conditionsin the area. Participation of local lead-ers and villagers is necessary to estab-lish a Village Concept Project (VCP).

2.- International Co-operation: Stu-dents from all over the world partici-pate on 3-month rotational basis, work-ing on the specific objectives plannedfor each rotation, together with localstudents and villagers. This adds VCPsan educational role, since internationalparticipation introduces students fromall over the world to a real approach ofdeveloping countries and areas, andbecome young ambassadors of develop-ment concepts within their own socie-

ties when they return. Student partici-pation is planned for a limited period(3 to 6 years), after which the villagerswill remain responsible of their ownprogress.

3.- Intersectorial approach: Healthfor All achievement is not understoodonly from the medical aspects, sinceWHO defines Health not only as theabsence of disease. Real developmentmust work out through a multi-discipli-nary approach. Therefore, whenever anew VCP is presented, the IMISOgroup guarantees the participation ofstudents from different areas.

A first Village Concept Pilot Projectwas run in Ojobi, Ghana, from 1986 to1992, with a relative success, especiallyon the medical objectives.

Currently, there are 2 Village Con-cept Projects running (second VCP inGhana and Sudan VCP), and 3 otheron different preparatory stages (Tanza-nia-Neema Project, I tal ian CalcuttaProject and Ecuador Project).

General Structure of VillageConcept Projects

General functioning of VCPs was regu-lated through the experience of the firstPilot Project and recently revised by theIMISO VC-Group at a meeting held inLeuven (Belgium), last may 1995. Thisregulations are written down at the “Vil-lage Concept Document”.The Local Group:

A group of local students from differ-ent faculties nearby the area is of outmostimportance for the correct implementa-tion of the project, and assure the conti-nuity throughout the specified period.

The main tasks of the local group are:1.- Contact local villagers, specially rel-

evant people, like local leaders, group ofelders, traditional healers, birth attendants.

2.- Identify a group of professors at theirlocal University to act as project supervi-sors.

3.- Develop all together General andSpecific objectives for the VCP, and es-tablish a system of periodic evaluation and

Primary Health Care building, built by the community themselves.WHO PHOTO BY R. ELISA


IFMSA-AIEME Village Concept Group; Spain.

The IMISO Village Concept




progress report.4.- Guarantee a specific part of funds

raised at the target country for the project.5.- Provide students participating from

different countries and disciplines with aspecific training upon arrival, as well asaccomodation facilities during their wholeperiod staying at the country.The International Coordinating Group (ICG):

Once students from a developing coun-try bring out a project proposal to estab-lish a VCP, it is studied at the differentstudent organizations, and students froma developed country will adopt the project.Ideally, different IMISO partners at thesame developed country will adopt theproject and will act as “foster country”,with some specific tasks, among others:

1.- Obtain international recognition forthe VCP, to facilitate donations andfundraising.

2.- Establish requirements needed fromforeign students participating at the coun-try, in co-ordination with the local group:language, level of studies, disciplines re-quired at each concrete step of the project,etc.

3.- Provide a well-established financialsupport for the whole duration of theproject.

4.- Co-operate with the local group atthe different evaluations and progress re-ports; reinforce the local group of super-visors with another group of experts at thefoster country.The IMISO VC-Group:

The IMISO VC-Group is formed by thefive permanent members of IMISO, spe-cific experts in the development field fromAIESEC (business and economics stu-dents), ELSA (law students), IAAS (agri-cultural students), IFMSA (medical stu-dents) and IPSF (pharmaceutical stu-dents). Some other student organizationsco-operating on VCPs and attending theIMISO VC-Group are, for example, IFSA(forestry students).

The IMISO VC-Group has a generaloverviewing function, with no specific rela-tion to a concrete project, but a generalsupervising role of all of them. In order toachieve this, some of its general tasks are:

1.- Regular meetings (2-3 times a year)to know about progress achieved in all

projects.2.- Presentation and adoption of new

projects at those meetings.3.- Look for prospective foster countries

at initial steps of new VCPs.4.- Regularly publish “Project News”, a

specific newsletter to know the latestabout VCPs.

IMISO VCP in Manglaralto,Ecuador

This has been the first VCP initiated byAIESEC, presented to the other IMISOpartners at the General Meeting inWütgenbach, Belgium, on February 1995,and adopted as a VCP at the VC-Groupmeeting in Leuven, in May 1995.

Although the project has been initi-ated in a different way compared toother VCPs, still complies with the mainconditions required at the VC Docu-ment.

Manglaralto is the area where a lo-cal foundation, “Fundación Ecua-toriana Nuestra Señora del Fiat”, isworking on a general development andeducational project. Basic and profes-sional schools are already working, lo-cal villagers participate in the founda-tion’s management and activities, pro-duce handicrafts for export to have afixed source of income. However thereare st i l l problems to be solved:Manglaralto does not have proper wa-ter supply, a lot of health problems areworsened due to the non-existance of ahealth post in the area, and food sup-plies are still very dependent on exter-nal donations.

The European University of Brussels(EUB, Belgium) has been co-operatingand facilitating financial support to thefoundation’s activities in Manglaralto forseveral years. Recently, AIESEC-EUBwas given the opportunity to send one oftheir members to the area, and see on thesite some of the main problems that stillremain to be solved.

IFMSA-AIEME , representing IFMSAin Spain, has adopted the correspondingpart of this VCP for the Health Care ob-jectives part. IAAS-Spain, on their side,Training on hygienic measures Traditional Birth Attendants in Senegal.

UNICEF/WHO PHOTO BY J. LING


May 1996


are working out the objectives to be im-plemented there by agricultural studentsalso participating in the project.

In any case, our tasks as ICG will be mucheasier than in other countries, since wecount with several advantages for its estab-lishment, not the least that we share a com-mon language in both parts of the Ocean.

Calendar of Action:July 1995: Presentation of the Project

to Ecuadorian Medical Students at theIFMSA Regional Congress in Argentina.Result: Ecuadorian Medical Studentsshowed their interest to participate in theproject and have contacted AIESEC-Guayaquil to assist on the Health Carepart of the project as local group.

August 1995: Presentation to IFMSAgroup on Public Health. Result: IFMSAwill adopt the project next year as the com-plete project is presented, includingbudget proposal and calendar of action.

September 1995: Presentation to IMISOpartners in Spain; IAAS Spain has alsojoined the project.

Progress report to the IMISO VC-Group in Leuven (Belgium).

- From now on, we detail only the specifichealth care part -

October 1995: Constitution of the Boardof Advisors for the project (to be con-firmed):

·Dr. Angel Gil, M.D., UniversidadComplutense de Madrid

·Dra. Antonia López, M.D.,Universidad de Extremadura

·Dr. José Eiros, M.D., Universidad deValladolid

·Dr. Ignacio Garrote, M.D., IFMSA-AIEME

November 1995: Confirm our counter-parts in Ecuador are establishing the lo-cal coordinating group.

First funds raising finished.March 1996: Dr. Ignacio Garrote visits

Manglaralto for one year. This job will beconsidered as his mandatory civil service(substitutory to military service in Spain),and will be developed for a duration of 12months. His main task in the area will becreating and applying surveys on generalhealth care standards in the area, in or-der to contribute to set up the VCP health

care general and specific objectives. Re-sult: so far, two progress reports have beensubmitted by Dr. Garrote, which have al-lowed the Group of support in Spain do-ing the first presentations for fudraisingand to the supervisors.

March 1996: Progress report to IFMSAExchange Officers’ Meeting.

April 1994: IFMSA-AIEME mid-yearmeeting; result: six local committees divide theseveral tasks of the project, a general co-ordinator is elected for the whole duration ofthe project. A previous meeting in Brusselsdefines the overall goals for the coming moths.

May 1996: A home page is set on theinternet with information about the project:http://www.gui.uva.es/~aieme/ecuador

July 1996: Expected date of first rota-tion for medical students. Goals: PrimaryHealth Care and finalizing health surveys.Minimum stay: 3 months.

August 1996: Progress report to IFMSAGeneral Assembly in Prague, includinggeneral and specific (first 12 months) ob-jectives for the project, expected totalduration of the project and overall budget.Adoption of the project by IFMSA.

October 1996: Second rotation of stu-dents, evaluation of first rotation.

December 1996: Dr. Garrote leavesManglaralto, evaluation and S.W.O.T.analysis of the first year.Setting up main objectives for theManglaralto VCP:

AIESEC: Educational and capacitybuilding goals over local villagers and lead-ers, small business creation.

IPSF and IFMSA: Contact traditionalhealers and herborists. Research and sup-port their techniques.

IPSF and IAAS: Study and support tra-ditional healing herbs.

IFMSA and IAAS: Research on nutri-tional supplies on the community.

IPSF and IFMSA: Establishment of aHealth Care Center

IAAS: Research and support on localcrop production, assuring sufficient andvaried nutritional resources.Main research to develop health survey:

·Research water supply, waste manage-ment and latrines facilities.

·Research main health statistics: birth

WHO PHOTO BY D. HENRIOUD

A traditional healer in Ecuador.

rate, death rate, child death rate, immu-nization rate, and so on.

·Presence/absence of a health post, lo-cal pharmacy, traditional healers,herborists, traditional birth attendants,study ways of integration and support lo-cal healers within a local health commit-tee formed by volunteers and local lead-ers.First specific Health Care objectives inManglaralto

1.- Epidemiological study in the area.Maximum possible co-ordination with theEcuadorian Health Authorities

2.- Primary Health Care. Dr. Garroteis a non-clinical Parasitologist, so he won’tbe so much personally devoted to it, butrather set up goals for the participationof the Villagers and medical students.

3.- Set up objectives for the rotation ofmedical students.

Selection criteria:3.1 Fluent knowledge in Spanish.3.2 3rd or 4th year medical students

(preferably 3rd)3.3 Having studied and passed: Micro-

biology, Parasitology, Pharmacology andPhysiopathology.

3.4 Special requirements:a) Candidates must fulfill all the pro-

gram prevention rules, and have a certifi-cate of all vaccinations required.

b) Candidates must have read and ap-proved the project description.

c) Candidates must withdraw all responsi-bilities from IFMSA-AIEME, and are respon-sible of their personal security and insurance.

4.- Create prevention programs andHealth Care Workshops within the com-munity according to WHO guidelines. Thecommunity will decide on the topics anddevelop the work, together with students,with the medical advice.




Life in a refugee campBy José Ignacio Garrote, IFMSA-AIEME Valladolid, Spain.

«Nacho» Garrote first went toCroatia to participate inIFMSA Refugee Project. Thenhe went back on his ownseveral times and with otherNGOs. He has also set up theGroup of Support for«Médecins Sans Frontières» inValladolid. Currently, he isnow doing the baseline surveyin Manglaralto (Ecuador) toestablish there a VillageConcept Project.

Obonjan is only 4 km. far fromSibenik by sea, where a cold,silent war was held, and the

worse enemy was passiv i ty. Peopledwelled in 11 barrack houses, whereup to six people could live in 12-15m2 rooms, and in «provisional» (forat least 2 years) mi l i tary tents , inwhich there was even more peopleand worse sanitation, since there wasno floor and were flooded in raintime.

Initially, that island hosted summercamps, with a capacity of 400 adoles-cents; it has come to lodge about 2000refugees, with the subsequent prob-lems of water and food supplies, aswell as all sanitaries (I insist, plannedfor 400 kids in 4 months periods), thatwere all broken.

Our daily duty

They woke us up at 7 a.m., a little« to i le t te» (co ld shower in best o fcases) and breakfast: a cup of tea anda piece of bread. After, refugees dedi-cated to let the time «pass by». Lunchwas a highly spiced soup (to fake therotten taste) and if you were lucky,you’d get a piece of meat or fish in-side; single course. Dinner was samesoup wi th some more water and

Bunker Hospital (8m. deep in the ground). J. I. GARROTE

«It’s easy for«It’s easy for«It’s easy for«It’s easy for«It’s easy foryou; you onlyyou; you onlyyou; you onlyyou; you onlyyou; you onlyspend somespend somespend somespend somespend somemonths inmonths inmonths inmonths inmonths in

here... the mosthere... the mosthere... the mosthere... the mosthere... the mostyou can loseyou can loseyou can loseyou can loseyou can losehere is yourhere is yourhere is yourhere is yourhere is your

own life»own life»own life»own life»own life»

tain position and respect among the oth-ers. Sad to see what some ladies had todo in order to get milk for their babies...

Those among the dariest, fished on theseaside, to sell most of it in order to getcoffee, cigarrettes and wine. Alcoholismin such a small place, full of people andloneliness, was a common thing. Some-body, I don’t know through which favours,managed to open some time later a bar (Imissed that period in there, and I couldnotice a «before» and «after» the baropened, and its consequences on the re-

boiled potatoes.My work there as a medical student

was done together with other foreignmedica l s tudents and two loca lnurses, no doctor around. We dealtday- to-day cases and most ser iousones were evacuated to Sibenik. Manyrefugees faked illness to get out (al-ways with our company and a soldier),and buy some things at the black mar-ket in Sibenik.

We were surprised at the enormouspass iv i ty o f re fugees, jus t s i t t ing ,watching the time go by. We also triedto st imulate them to some act iv i ty,l ike in other camps, to occupy theirt ime in that «transitional» situation.We had to hide packs of clothes fromhumanitarian aid, to avoid from grow-ing the «dirty clothes cemetary», theywouldn ’ t even wash the i r c lo thes.Anyway, we learnt their great abilityto laugh by crying, «njema problema»,they’d still say.

The toughest plague we had to fight waslocal «maffia», through which, on ex-change of some favours, some familiescould get extra packs of food and a cer-


May 1996


lations among Croat and MuslimBosnians).

I will never forget the fear on the faceof raped women... what everybody fearedmost was Future. I will never forget ei-ther those eyes of Muslim youngsters, onlydreaming of the day the arms embargo willbe lifted... War is a part of their lives, butunfortunately, is a part of their educationtoo: chocolates wrapped up incamoufflage papers, lolly pops with a sol-dier as stick, drawing books where theyhave to color soldiers killing each otherand red is their favourite color...

«It's easy for you...»

I surprised myself how fast I got usedto war, listening all nights the never end-ing mortar drumming, having a coffee ata bunker while grenades were falling. Iforgot who I was, what I did and was hap-pening to me. Telling bad jokes hiddenunder a cellar, you easily forgot everythingduring the overnight in Sibenik with a boatof sick people. Many of them had a drugaddiction to benzodiazepines, createdduring their stay in other camps (Tomis-laudrad and Heliodrame), most of themhad given away their documents andmoney to somebody who was arranging«a job in Europe» for them.

One friend I soon lost claimed to me:«It’s easy for you; you only spend somemonths in here, enrich yourself, have afantastic experience, relief yourremorsement a bit, while all your family,friends and belongings are safe in Spain,while the most you can lose here is yourown life». As you quickly learn in there,human lives are very cheap, specially yourown; it wouldn’t surprise you after havingseen how they killed someone in Sibenikfor eight pints of milk.

Most remarkable thing is the psycho-logical trauma of refugees; they were peo-ple like us, who have experienced and suf-fered an enormous falldown (not compa-rable with poverty in the Third World,though I don’t mean to establish a com-parison at all) and its consequent psychi-atric disorders (all secondary). It was norrare, neither difficult there to communi-cate in English with a former Lawyer orEngineer; everybody there was the same.

One may think, while reading theselines, that I placed myself on the «Muslimside» and critisized only the others. It isnot my task to judge or put the blames onsomeone. These people used to live to-gether in peace, it has been war that hascreated the differences and cruelties. Endthis war and I´m sure they’ll live togetherin peace one day again.

Eight people living in a tent.

A note fromCroMSIC

We would like to give you somesta t is t ic in format ion aboutre fugees s i tuat ion in Croat ia :Croat ia has been host ing about250,000 f rom Croat ian andBosnian territories up till now. Inthe per iod you have jus t readabout in this article we had about450,000 refugees.

Croatia is a small country witha population of 4.8 million. It isnot poss ib le to p lace a l l thosepoor peop le in appropr ia teaccomodation in hotels or touristcamps. Of course, we know theirsituation is very hard and that wehave to improve it, but it is alsot rue that r ich count r ies shouldhelp us to deal with this problem.

We th ink our Government istrying their best, especially if wecons ider that the EuropeanUnion, w i th 100 t imes ourpopulation, is only hosting about50,000 refugees.

Goran HauserCroatian Medical Students'

International Committee

J. I. GARROTE




David Werner is the famousauthor, among other books, of«Where there is no Doctor», abasic text we have been using foryears as pre-reading material forour VCPs. This text is aconvocation address, at JohnsHopkins Schoolof Public Health, 1985

Those of you receiving a degree inpublic health are faced with anunusual -and in some ways para-

doxical- challenge. For as we all know, intoday’s world the biggest obstacles to«Health for All» are not technical, butrather social and political. Widespread

rather the quest to stay in power.We are all aware of the health-related

inequities that result in millions of prema-ture deaths every year. One in two of theworld’s people never in their lives see atrained health worker. One in three arewithout clean water to drink. One in fourof the world’s children are malnourished.And so on.

It has been estimated that to provideadequate primary health care for all theworld’s people would cost an extra $50billion a year -an amount equal to worldmilitary spending every three weeks.

So we can see that the underlying ob-stacle to primary health care are not re-ally economic, but political.

The politics of health and health careare fraught with contradictions. Just as anexample, look at smoking. The govern-ments of overdeveloped countries nowwarn their people that «cigarette smok-ing is dangerous to your health». Yet thesesame governments, while cutting back onhealth benefits to the poor, continue tosubsidize the tobacco industry with mil-lions of dollars. And since fewer peoplein the rich countries now smoke, the bigtobacco companies have bolstered theirsales campaigns in the Third World, wherethe growing epidemic of smoking nowcontributes to more deaths than do mosttropical diseases.

The subsidizing of the tobacco industryis but one of many, many ways in whichattempts at public health are dissipated bygovernments that try to stay in power bycatering to the interests of the powerful.The United States of America, as one ofthe world’s wealthiest and strongest na-tions, has consistently made internationaldecisions which favor the rich and power-ful at the expense of the health and well-being of the poor majority. Its oppositionto the United Nations’ mandate againstthe unethical promotion of infant milkproducts is a good example. It is interest-ing to note that in the long run, the grass-roots, popular boycott of Nestlé and othermulti-nationals, did more to bring the milkcompanies into line than did all mandatesfrom the United Nations.

An equally blatant example of how U.S.foreign policy is prepared to obstruct apoor nation’s health in order to protectpowerful economic interests is seen by itsreaction to the Bangladesh Health Minis-try’s new drug policy. As we all know,overuse and misuse of medications in theworld today has reached epidemic propor-tions. In poor countries, up to 50% of thehealth budgets are spent on importeddrugs. Of the 25,000 different medicationsnow being promoted, only about 250 areranked as essential by the World HealthOrganization. Yet the drug companies

Public Health, Poverty andEmpowerment: a challenge

By David Werner, Health Rights, California.

IFMSA

hunger and poor health do not result fromtotal scarcity of resources, or from over-population, as was once thought. Rather,they result from unfair distribution: ofland, resources, knowledge, and power -too much in the hands of too few. Or, asMahatma Gandhi put it: There is enoughfor everyone’s need but not for everyone’sgreed.

It is often argued that the major obsta-cles to health are economic. And true, formost of the world’s people, the underly-ing cause of poor health is poverty -pov-erty and their powerlessness to do any-thing about it. Yet, the economic resourcesto do something about it do exist. Unfor-tunately, control over those resources isin the hands of local, national and worldleaders whose first priority, too often, isnot the well-being of all the people, but

David Werner with IFMSA representatives at the NGO Forum during the WSSD in Copenhagen.


May 1996


promote their products in the poor coun-tries with a vengeance. The informationthey publish about their products in thesecountries is often dangerously falsified. Inmany poor countries, the drug companiesspend more on brainwashing and mislead-ing the doctors than the medical schoolsspend on educating them. The companiesrepeatedly and illegally pay Ministers ofHealth under the table to keep on utiliz-ing pharmaceuticals that have beenbanned in developed countries anddumped on the Third World. All in all, theabuses and false promotion of needless,costly, and irrationally combined medica-tions have reached alarming and health-threatening proportions, particularly inthe Third World. When the Bangladeshigovernment, recognizing serious short-ages in 150 essential drugs, passed a de-cree that banned the import of 1,700 non-essential preparations, the multi-nationaldrug companies did everything in theirpower to make the Bangladeshi govern-ment annul the decree. After all, if a poor

country like Bangladesh can take a standagainst the multi-nationals in favor of itspeople’s health, might not other nationsfollow the example? So these companiesbegan to make threats. Factories wouldbe closed. Foreign companies would pullout. Workers would be fired. Acute short-ages of essential drugs would result. Thefuture of foreign investment in Bangladeshwould be in jeopardy. Representativesfrom the U.S. Government not only re-fused to support Bangladesh’s new drugpolicy, they threatened to reduce or dis-continue foreign aid if it were upheld.

As has been demostrated in China,Cuba, Nicaragua, Kerala State of India,and elsewhere, the health of a nation’speople has more to do with fair distribu-tion of resources than with total wealth.Fair distribution, in turn, depends uponegalitarian governmment. What it comesdown to is that the health of the poor inthe world today is abysmal because toomany governments are in the hands ofpowerful, elite groups or military juntas,

that do not fairly representtheir people. Clearly, what isneeded is radical change, ofgovernmments and socialstructures. Those who rulethe world today will not bringabout the changes that areneeded for the well-being ofthe people. They have toomuch self-interest in main-taining the status quo. Thechanges can only come aboutthrough organized action ofthe people themselves. Inmost countries today, pri-mary health care implies avery fundamental, socialevolution -if not revolution.

In several countries today,popular revolutions have re-cently taken place or are inprocess. New governmentswith wide popular supporthave gone about redistribut-ing resources and extendingprimary health services fairlyto all the people. However,the powerful nations of theworld, for the same reasons

they oppose the UN decree on infant milkproducts, or the Bangladeshi govern-ment’s new drug policy, consistently vio-late international and humanitarian codesin order to try to destroy the revolution-ary governments that have dared to sidewith the people.

Yet the peoples of the world, little bylittle, are beginning to awaken, to jointogether to protest the exploits of thepowerful and the injustice which damagestheir health.

We are on the edge of a worldwidemovement, led by the poor and oppressed,in defense of their rights to a fair share ofwhat the world provides. Health for all canonly be achieved through a struggle forsocial equity -a struggle led, not by thoseon the top, but by those on the bottom, bythe people themselves.

Given the fundamentally political na-ture of health, what are those of yougraduating today going to do with yourshining new degrees in public health?

If what you are looking for is simply awell-paid, respectable job, with a degreefrom Johns Hopkins in your pocket youshould have no problem. But if you hon-estly want to help those in greatest needgain the strength and ability to improvetheir health and their lives in a lasting way,then your future is less certain, and -de-pending on which country you go to- per-haps unsafe.

You may try to stay out of politics, towork within the realm of public health inthe narrower, more conventional sense.Baby weighing, latrines, dark green leafyvegetables, MCH, ORT, GOBI, and allthat.

But be careful. Even with the best in-tentions, you can easily end up doing moreharm than good. Health work is neverapolitical. Either it is done in ways thathelp empower people so that they can takegreater control over the factors that de-termine their health Or it is done in waysthat try to keep people under control, or-ganizationally disabled, overly dependenton centralized, institutionalized,overprofessionalized yet inadequate serv-ices.

Thus, health care can be either people

Poster describing measures to prevent cholera.WHO PHOTO BY PH MERCHEZ

«There is«There is«There is«There is«There isenough forenough forenough forenough forenough foreveryone'severyone'severyone'severyone'severyone's

need, but notneed, but notneed, but notneed, but notneed, but notfor everyone'sfor everyone'sfor everyone'sfor everyone'sfor everyone's

greed».greed».greed».greed».greed».



empowering, in the sense that it gives peo-ple greater control over the factors that in-fluence their health and their lives, as wellas greater leverage over public institutionsand leaders. Or it can be peopledisempowering, insofar as it is used by theauthorities as an instrument of social con-trol. People empowering health care uti-lizes health education, not to change peo-ple’s attitudes and behavior, but rather tohelp people to change their situation. Or,as Paulo Freire would say to change theirworld.

I could talk for a long time about peo-ple-supportive and people-oppressive ap-proaches to health care. But a graduationspeech is appreciated mostly for its brevity.Therefore I would like to look with you atjust one issue in public health, which willperhaps make you reflect on the politicalimplications even in areas that at first glanceseem non-political.

The area I refer to is ORT, OralRehydration Therapy. (Personally, I pre-fer to call it RLL or Return-of-Liquid-Lost.This is because most of the world’s peoplehave limited schooling and may not under-stand words like oral, or rehydration, ortherapy. I think the first step toward puttinghealth into people’s hands is to simplify ourlanguage. Besides, RLL -The Return ofLiquids Lost- sounds friendlier and morepoetic).

I am sure that, in your public health pro-gram, you have studied the various alter-native approaches to oral rehydration indepth, weighing their comparative advan-tages and disadvantages. I wonder, how-ever, how much you have looked at thepolitical implications of the different alter-natives: which are people empowering, andwhich are dependency-creating. For surelythe «empowerment factor» should alwaysbe a key consideration when evaluating thelong-term implications of any health carealternatives.

As we all know, when a child hasdiarrhea, the Return-of-Liquid-Lost can belifesaving. In so far as diarrhea is thenumber one cause of death in children inthe world today, oral rehydration is one ofthe most important health measures thatmothers, fathers, children, school teachers,and health professionals can learn. Its po-tential impact on people’s health -and onpeople’s confidence to cope for themselveswith one of the world’s biggest killers- istremendous. It is safe to say that if schoolchildren could learn how to prepare andgive the «special drink» to their youngerbrothers and sisters with diarrhea, then theworld’s children could have a bigger impacton lowering child mortality than do all thedoctors and nurses on earth.

As you are well aware, there are two

main approaches to oral rehydrationtherapy: «packets» and «home-mix».

Packets -or «sachets» as they werecalled by the experts until somebody dis-covered that not even college graduatesunderstood that word- are prepackagedenvelopes of sugar and salts for mixingwith a liter of water. Packets are mostlyproduced in millions by multi-nationalcompanies under contract to organiza-tions like WHO, UNICEF, and USAID.They are usually distributed through re-gional offices to health ministries, clinics,ORT centers, and -finally- to motherswhen their children get diarrhea.

The home-mix, on the other hand, isprepared completely in the home, usinglocal ingredients and traditional measur-ing methods in order to mix water withthe indicated amounts of sugar and salt.Or it can also be made building on localcustoms, by using rice water, soups, ormild herbal teas.

The relative advantages and dis-advantages of packets versus home-mixhave been much debated. Studies showthat their safety and effectiveness isroughly the same -provided that the pack-ets are available when needed, which

often they are not.Politically, however, the two methods

are diametrically opposed. The use ofpackets keeps the control of diarrheamedicalized, institutionalizcd, mystified,and dependency-increasing. In order torehydrate a baby with diarrhea, the fam-ily has to depend on a magical, often im-ported, «medicine» that involves a wholechain of commercial, international, gov-ernmental, bureaucratic, professional anddistributional links. If any link of the chainfails, the supply of packets stops. Or ifpeople in the countryside begin to standup for their rights, the supply of packetsstops. Thus, control of the most common,most fatal, most easily treated, healthproblem is taken out of the people’shands. Poor families are made to look tothe government for help, and be gratefulfor small lifesaving handouts.

The use of the home-mix has just theopposite effect of the packet. It is a de-mystified and de-mystifying approach thatis independent of outside resources, ex-cept for an initial educational component.It helps people realize that with a littleknowledge and no magic medicine what-soever, they can save their children from


Empowering people: Villagers building a «Blair latrine».WHO PHOTO BY L. TAYLOR


May 1996

a powerful enemy, without being beholdento anyone. Thus the home-mix helps toliberate people from unnecessary depend-ency and to build people’s self-confidencein their own ability to solve the problemsthat limit their well-being.

It is no surprise then, that around theworld small community-directed pro-grams committed to basic rights consist-ently choose the home-mix. Nor is it asurprise that WHO, most health Minis-tries, and other large national and inter-national agencies are «packeteers.»

At this point, I want to put in a goodword for UNICEF, which in many waysseems to be more in touch with the realneeds of the people and more aware oftheir potential than is for example, theWorld Health Organization. AlthoughUNICEF started with a strong promotionof the packets, over the last two or threeyears, it has moved progressively towardpomotion of the home-mix approach tooral rehydration. In some countries, infact, UNICEF is now promoting prima-rily the home-mix. I think that UNICEFis to be applauded for this, and that WHOneeds to be taken to ask for the wide gapbetween its people-empowering rhetoricand its people-belittling policies at the fieldlevel.

Oral rehydration is but one of manyhotly debated health issues, which willconcern you in the practice of publichealth. When you are faced with makingdecisions or giving advice as to alterna-tive approaches, always remember look atthe political implications. Approacheswhich are people-empowering, even ifthey seem to take longer or to involve agreater element of risk or uncertainty, inthe long run may do more to-wards bringing about ahealthier, more eq-uitable society,than other meth-ods which ap-

pear to be safer,more predictable,more measurable,or more easily admin-

istered.One thing is clear: That health for all

will only come about through a restruc-turing of our social order so that there isa fairer distribution of wealth, resources,and power -a society where people canlearn to live together in peace, where pro-fessionals and laborers and farmworkerscan embrace each other as equals, withthe same standard of living and the samewages, and where people watch out thatno one takes more than his share, at some-one else’s expense.

But, as I have already mentioned, sucha restructuring for a healthier social or-der is not likely to come about from thoseat the top. It can only come through theorganized, united action of those at thebottom.

As health professionals we are amongthe fat and fortunate few, the elite of so-ciety, the one percent of the world’s popu-lation with university degrees. Whether welike it or not, we are in some ways part ofthe problem -part of the inner circle of asocial order that perpetrates poor health.Our challenge, then, is not to try to changethe people, or to try to make them morehealthy according to our mandates. It israther to allow the people to change us,to make us less greedy, more humble,more able to serve people on their terms.Our challenge is to help those on the bot-tom create a new economic and socialorder in which everyone can afford to behealthy.

I would like to close with a quote fromZafrullah Chowdhury, a doctor who wasa freedom fighter in the liberation ofBangladesh, and who subsequentlyfounded Gonoshasthaya Kendra, a com-munity-based health program that hastaken many courageous and innovative

steps to help empower farmworkers,women, and others who have long

been treated unjustly. Zafrullah,incidentally, was offered the post

of Minister ofHealth ofBangladesh,

but turned it down, saying thatworking within the government, his

hands would be tied. He felt he coulddo more to change policy from the


outside, working directly for and with thepeople. And in fact, the creation of theGonoshasthaya People’s PharmaceuticalCompany to produce low cost, essentialdrugs, was a key factor in influencing theBangladeshi Government to establish thedaring drug policy that I mentioned ear-lier. The following, then, is a quote fromZafrullah Chowdhury.

Primary health care is generally onlylacking when other rights are also beingdenied. Usually it is only lacking wherethe greed of some goes unchecked andurecognized (or unacknowledged) as be-ing thc cause. Once primary health is ac-cepted as a human right, then the primaryhealth worker (and, we might say, thepublic health worker) becomes, first andforemost, a political figure, involved in thelife of the community and its integrity.With a sensitivity to the villagers and thecommunity as a whole, he will be betterable to diagnose and prescribe. Basically,though, he will bring about the health thatis the birthright of the community by fac-ing the more comprehensive politicalproblems of oppression and injustice, ...apathy, and misguided goodwill.

On the road that lies ahead, each of yougraduating today will be involved in thestruggle for a healthier society. Whetherwe like to admit it or not, conflicts of in-terest do exist between those on the topof the social pyramid and those on thebottom. I hope that each of you finds thecourage and committment to side withthose on the bottom.

What I have tried to say to you thisevening with too many words has beensummed up far more eloquently by theschoolboys of Barbiana, Italy, poorfarmboys who are expelled from schooland then helped by a priest to teach eachother. This quote is from their book, Let-ter to a Teacher, which might as fittinglybe entitled, Letter To a Public HealthWorker. They say:

Whoever is fond of the comfortable andfortunate stays out of politics, he does notwant anything to change.

But these schoolboys add that:To get to know the children of the poor

and to love politics, are one and the samething. You cannot love human beings whoare marked by unjust laws, and not workfor other laws.

The choice is yours. Good luck.

David WernerHealthRights964 Hamilton Ave.Palo Alto, CA 94301-2212USAe-mail: [email protected]



Workshop on Public Health:Close to the Year 2000

During the last decade, we have beenhearing all around “Public Health”.But what we actually mean for Pub-

lic Health is still unstandardized not onlyamong medical students but also amonghealth professionals. Most think that PublicHealth is a part of Medicine, this disciplinethey teach us in the universities. This work-shop is intended to throw some light on thesedefinitions and treat public health as a wholeby defining it as the health of the populationall over the world.

But let’s stop here to talk about health. Whatdo we mean by health. Should we use WHOdefinition or discuss it and search for otherswhich may better fit our objectives.

Once we have this idea of health, let’s thinkof what in a man’s life is going to determinehis health status. Environment, genetics, life-style and health assistance have been definedas the four major determinants of health, butwhat do we mean by each one of them, andwhat weigh does each one of them have indetermining health of a population.

So taking Public Health as something uni-versal, WHO guidelines, goals and strategieshad to be present in such an event. A map-ping of diseases all over the world, which ofthem are the most frequent, the most severe,and the hypothetical solutions for them is whatwe intend to offer in the first sessions.

As IFMSA has been concerned from thebeginning about developing countries, warcatastrophies and refugees, a whole day willbe dedicated to such issues. We will try to over-view the real situation in developing countries,and which would be the strategies for coop-eration. We’re going to have with it a clearexample of the global concept of health, andits main determinants.

Migration is also becoming a relevant issuein health in most European countries. Howare immigrants going to affect health situa-tion in Europe will be discussed.

Health systems have also been related to

health status, and still is not clear its role inproducing health. Somehow, they are consid-ered in most European countries as a right,while in some other parts of the world theyare considered as a privilege. Our aim is todescribe in general terms the main health caresystems existing nowadays and their advan-tages and disadvantages in terms of econom-ics, ethics, and health status.

Dealing with such relevant issues in threedays may seem quite an ambitious purpose.But the real goals of this workshop is to offera general view and give some points to opendiscussion among stu-dents.

For this purpose wecounted on the sup-port from Health Stud-ies Institute from Cata-lonia, both Barcelonaand Autonomous Uni-versities and other rel-evant personalities.Public Health profes-sionals from all overthe world had alreadykindly answered to ourrequest to take part inthis event.

Dr. Oriol Vall, chiefof the paediatrics unitin Hospital del Mar(Barcelona) and co-operant in Rwandawith Medécins SansFrontiers is contactingwith some of the localdelegations of NGOsto arrange an interest-ing workshop on coop-eration.

Migration problemswill be approached byDr. Tom Shulpe (Hol-land), member of the

Social Paediatrics Society.Members of the Medical Technology As-

sessment Agency from Catalonia will intro-duce us in Health Systems, Sources Manage-ment and bioethics.

At the time, about 40 students have al-ready registered for the workshop. Theyare willing to learn and share his experi-ences and ideas.

Roser VivesWorkshop Organising Committee



May 1996

Dr. Val lbona pointed out thatpublic health models are get-ting more and more complex

(“the web of causality”). One shouldemphasise less on life expectancy andfavour the quality of l i fe aspects inthese models. Reform of the healthcare system, the larger util isation ofmedica l in format ics technology aswell as changes in the curriculum forhealth professionals and, last but notleast, modifications of the health be-haviour of the population appear tobe the future four great revolut ionsof the heal th system in the Uni tedStates.

Dr Moreno exposed several strate-gies of malaria vaccine developmentand the i r conceptual problems. Hethen made an in t roduct ion to theSpf66, pro tec t ing 30-60% of thevaccined people.

Dr. Oliveras started with a defini-tion of the third world and of devel-oping countries. He tried to show thatthe v iew o f the wor ld depends onwhere you live. Then he pointed outfactors associated with under devel-opment. There are many reasons likelack of minerals, lack of money, lackof infrastructure and internal prob-lems, but the main problem seems tobe based on the relationships betweenindustr ial ised and developing coun-tries. Secondly there are commercialproblems because ofthe low prices forraw materials, i.e. tea, and coffee, themain products of Afr ica. Third areindustrial problems.

Having no money and yet invest-ments from industr ial ised countr iesare prof i t geared mainly. The solu-t ions o f fered by Dr . O l ivares aresouth-south cooperat ions and to re-verse the relationships between northand south.

Dr. Shulpen. First of all pointed outthat the Southamericans and Asiansare not in a arrears with medical sup-ply. But Africa needs doctors, basicknowledge and medical improvement.He pointed out that the aim shouldbe DALY(Daily Adjusted Life Years).He favours NGOs because their workis non profit making.

Dr. Sancho. Pointed out that in thelast fifteen years not much happened.For th is reason, h is NGO main lystarted projects in Spain. He said thattraining and new ideas given to thethird world would be more effective.

Mr. Moragas. Showed the projectsrunning at his universi ty. They arethree. Placed in Mauritania (turningdesert to farmland), in El Salvador(Summer camps) and in Colombia(supporting a Colombian project).

Mrs. Marina Labra. Defined refu-gees and immigrants. Then, analysedThe origin of refugees in Africa, Iraqand Bosn ia-Herzegov ina.Sheatr ibuted th is to wars and nat ional

problems in these countries. 90% ofthe refugees go to African or Asiancountries and to the USA. It is diffi-cul t to div ide the refugees by eco-nomic, political and other reasons.

Dr. Oriol Vall. Showed the experi-ence of Rwanda. He star ted wi th ageographical and histor ical accountof the country and related then to thepresent problems. Then he had a slideshow on how to build a refugee campand care about the refugees.

Dr. Tom Shulpen and Dr. JuanCabezos. Outlined the special socio-cultural circumstances concerning im-migrants (specifically immigrants ofthe Islamic world). Dr. Cabezos gavean introductory lecture on importeddiseases.

L lu is Boh igas. Def in ing what ahea l th care sys tem shou ld be andemphasised the financing methods ofthe health care systems of the devel-oped world.

Dr. Albert Jovell. Evolution of theoutcomes of health care technology

DÉBORAH ORTIZ, IFMSA-AIEME

Jan Green (left), IFMSA Director of Public Health, explains the main objectives of the workshop.


Workshop on Public Health:the conclusions




is becoming much more common. Dr.Jovel l gave an in t roduct ion of themethods cur rent ly used in hea l thtechnology assessment and economyof heath. He then pointed out differ-ent ethical positions one could adoptgiving examples leading to the discus-sions in the auditorium.

Students presentations

The presentat ions on Wednesdaystarted with a study of landmines inEritrea by Norway. He showed factsabout the in jur ies caused bylandmines, fac ts about the heal thservice and the number of landmines

still being there. He wanted to pointout the medical and economical dam-age done by landmines. The Brazil-ian s tudents d iscussed threeprojects: increasing men’s fertil-i t y , assess ing eye d iseasesamong ch i ld ren in a daycare center and he lp ingthe indians overcome dis-ease as a rural project.

On Fr iday the Ger-

man students presentedthe Ghana Vi l lagePro jec t and showed afilm about the work donethere . I ta ly repor ted aproject on public health edu-cation together with UNICEF.Af ter that Uganda presented aproject done to provide clean waterby installing four water pipes in fourv i l lages in Uganda. Then Braz i lshowed three projects supported byHolos foundat ion. One deal t aboutnutrit ion, one about short term clin-ics and one about helping Indians sur-vive.

Definition of public health

This is essent ia l heal th care pro-v ided to the communi ty based onpractical, scientifically proved factsthrough research. I t should be so-cial ly acceptable, avai lable and af-fordable through use of local materi-als where applicable with complete in-volvement of the community in a l lstages of i ts implementation, to en-sure its sustainabil l i ty. The integra-tion of the existing national organi-sa t ions and NGOs is essent ia l fo rproper coordination. Coupled with anelement of cont inues evaluat ion to


Left to right: Eric (Uganda), Jean-Marc (Luxembourg) and Michael (Germany), during one of theworkshop presentations.


Time to work and time for fun....


May 1996

ensure the succes of PHC. The aim isto achieve empowerment of the com-

munity to be able to takecare o f the i r own

needs.PH manag-ers : i t i s an

in teg ra t i onof soc ia l ,

c u l t u r a la n d

p o -l i t i c a l

author i -t ies that

are bear ingon the com-muni ty . Thei n t e r s e c t i o nof theseforces shouldbe the gov-

erning body of PH services.

Conclusions

There was lot of frontside teaching atthe workshop,as aresult some participantsmentioned that the time devoted to stu-dent discussions was not enough. Maybe,there would have been more discussionsin workgroups but the OC was not able toorganise them because many peoplemissed the registration deadline. Somestudents did not fully attend the sessionsand were instead on holiday. Many pres-entations were made by Brazilian stu-dents, this serves as a challenge to othermember organisations to try and preparesome work and share their experience atthese workshops. Inspite of this, the PHworkshop was a tremendous success sincea proper and working definition of PH inIFMSA was obtained.

My view as a participant

IFMSA

Déborah Ortiz Sánchez, Vice-President Public Health,IFMSA-AIEME (Spain).

Since it was my first IFMSA Workshop, I cannot compare itto the previous. Anyway, the general outcome was positive; Ifound particularly interesting Kurt's presentation about the

landmine effects and the many Brazilian projects, whichshowed what we can do as medical students. That is why Iwould personally have liked more students presentations.

It has helped me to do my job as Public Health officer, sinceI met many people that also work in this area within

IFMSA, as well as several Public Health professionals. Itclarified many of the concepts we frequently use without

knowing their meaning.This workshop, together with all IFMSA meetings, have

made me change my idea on my future career as a Doctor,that probably will be now much more Public-Health-

oriented than I once thought.




The challenges in the health fieldtoday can be stated in terms ofthe principles which must now

guide our actions: (1) the need for healthinterventions to be relevant and of thehighest quality, to be based on priorities,and to achieve the highest cost-effectiveresults, and (2) the need for equitable ac-cess to health care for everyone.

Thanks to scientific and technologicalprogress, various medical interventionspromise to reduce suffering and prolonglife, but their increasing cost sets limits onthe choice of health care available and theway it is administered. At the same time,the users of health services are becomingbetter informed and more demanding.

To meet the challenges, in both affluentand developing countries, reforms to thehealth systems are under way or are be-ing planned, and all health professionalsmust prepare themselves to play a funda-mental role in applying these reforms. Letus examine the role of «frontline» profes-sionals, since they are the closest to theusers of health services.

Depending on the social, cultural andeconomic context and the state of the lo-cal health system, frontline health person-nel may be village health workers, nurses,or general practitioners (family doctors).In future the latter will probably be moreand more sought after, inasmuch as theyseem capable of finding an adequate so-lution to most patients’ health problemsin ways that satisfy them while provingcost-effective from the point of view of thehealth system. However, these family doc-tors will have to learn to evolve within thehealth services so as to respond better tothe challenges of the future.

Five roles

The frontline health professionals willhave five principal roles to play.

Care-givers. Besides giving individualtreatment, frontline doctors must take intoaccount the total (physical, mental andsocial) needs of the patient. They must

Frontline doctors of tomorrow

By Charles Boelen, World Health Organization, Geneva.


WHO/PAHO PHOTO BY J. VIZCARRA

A health education session in Peru. Doctors must be excellent communicators if they are to foster apartnership with families and communities.


May 1996

ensure that a full range of treatment -cura-tive, preventive or rehabilitative- will bedispensed in ways that are complemen-tary, integrated and continuous. And theymust ensure that the treatment is of thehighest quality.

Decision-makers. In a climate oftransparency the frontline doctor will haveto take the decisions that can be justifiedin terms of efficacy and cost. From all thepossible ways of treating a given healthcondition, the one that seems most appro-priate in the given situation must be cho-sen. As regards expenditure, the limitedresouces available for health must beshared out fairly to the benefit of everyindividual in the community.

Communicators. Lifestyle aspectssuch as a balanced diet, safety measuresat work, type of leisure pursuits, respectfor the environment and so on all have adetermining influence on health. The in-volvement of the individual in protectingand restoring his or her own health istherefore vital, since exposure to a healthrisk is largely determined by one’s behav-iour. The doctors of tomorrow must beexcellent communicators in order to per-

suade individuals, families and the com-munities in their charge to adopt healthylifestyles and become partners in thehealth effort.

Community leaders. The needsand problems of the whole community-in a suburb or a district- must not beforgotten. By understanding the deter-minants of health inherent in the physi-cal and social environement and by ap-preciating the breadth of each problemor health risk, the frontline doctor willnot simply be treating individuals whoseek help but will also take a positiveinterest in community health activitieswhich will benefit large numbers of peo-ple.

Managers. To carry out all thesefunctions, it will be essential for thefrontline doctors to acquire managerialskills. This will enable them to initiateexchanges of information in order tomake better decisions, and to workwithin a multidisciplinary team in closeassociat ion with other partners forhealth and social development. Bothold and new methods of dispensing carewill have to be integrated with the to-


Dr Charles Boelen is Chief of EducationalDevelopment of Human Resources for

Health; Division of Development of HumanResources for Health, World Health

Organization, 1211 Geneva 27, Switzerland(Article Published in "World Health", 4thyear, no 5, sept.-oct. 1994, reproduced

with the author's permission)

WHO PHOTO BY D. DERIAZ

When the whole community is actively involved in building for a health project, it stands the bestchances of being adopted and used. Villagers making bricks to build a health post in Mali.

The idealThe idealThe idealThe idealThe idealfrontline healthfrontline healthfrontline healthfrontline healthfrontline healthprofessional ofprofessional ofprofessional ofprofessional ofprofessional of

the future mightthe future mightthe future mightthe future mightthe future mightbe described asbe described asbe described asbe described asbe described as

«the five-star«the five-star«the five-star«the five-star«the five-stardoctor» -someonedoctor» -someonedoctor» -someonedoctor» -someonedoctor» -someonewho is equal inwho is equal inwho is equal inwho is equal inwho is equal inexcellence to aexcellence to aexcellence to aexcellence to aexcellence to a

five-star hotel orfive-star hotel orfive-star hotel orfive-star hotel orfive-star hotel orrestaurant, butrestaurant, butrestaurant, butrestaurant, butrestaurant, butis accessible tois accessible tois accessible tois accessible tois accessible toeveryone fromeveryone fromeveryone fromeveryone fromeveryone fromthe richest tothe richest tothe richest tothe richest tothe richest tothe poorest.the poorest.the poorest.the poorest.the poorest.

tal i ty of health and social services,whether destined for the individual orfor the community.

The ideal frontl ine health profes-sional of the future might be describedas «the five-star doctor» -someone whois equal in excellence to a five-star ho-tel or restaurant, but is accessible toeveryone from the richest to the poor-est. The skills of the doctors of tomor-row will serve the needs of all healthsystems and services; these abilities willbe desirable to a certain degree inhealth personnel at every level.

Far from being a dream, these goalsand skills must be seen as imperativefor our doctors of tomorrow.



August 1st - 4th 1996

Conflicts are springing up all overthe world, all the time. We haveall witnessed the disasterous re-

sults in places such as former Yugoslaviawhen these conflicts turn violent. World-wide figures for displaced people reach50 million, mass slaughters of men, womenand children, 800 maimed or killed everymonth by landmines. A humanitariancrisis that can not be ignored.

The consequences to health are vast. Thephysical effects are huge, but the psychologi-cal damage caused by horrors of war can lastindefinately. War also causes disruption ofsociety and displacement of people - health isseriously challenged in the environment of arefugee camp.

When these conflicts arise it is vital that thereare organisations well trained in relief workto deal with the consequences. This work issomething that is already occuring and hope-fully will continue to expand.

Less well established is the role of conflictprevention. With a knowledge of how devas-tating to health war can be, we must questionwhether we have a responsibility to try andprevent it. This is an issue which should beexplored and as future advocates of health,medical students mayhave an importantrole to play.

In August 1996there will be a work-shop organised byIFMSA in HradecKralove, Czech Re-public with the theme‘Medicine and War -conflict prevention’.Without wishing to ig-nore the importanceof relief work, thisparticular workshopwill focus more on

exploring conflict prevention.The workshop will be aimed at informing

and discussing the medical effects of war andthe physicians role in treating and preventingthese. There will be lectures and presentationscovering topics such as ‘why do conflicts turnviolent?’ by experts e.g. MSF, and presenta-tions by medical students working with refu-gees relief and violence prevention issues.

In smaller working groups we intend tobrainstorm for ideas and discuss work andstrategy in promoting peace, tolerance andpost-conflict peace building. No previousknowledge will be needed for these groups.It is hoped to be an interactive workshop -everyone from every background has experi-ence of conflict in some form which can bedrawn on.

To take part in what should be a reallyexciting and interesting workshop, pleasecontact:

Petr Vaculik,Phone: +42 49 5816376Fax: +42 49 24393e-mail: [email protected]/o ASMLFUKSimkova 870500 38 Hradec KraloveCzech Republic

Policy resolution onNuclear Weapons

DisarmamentThe International Federation of

Medical Students’ Associations:Considering the role of physicians

and medical students to promotehuman health and well-being;

Aware that the Peoples Republic ofChina still is testing nuclear weapons,and that France recently decided toresume such tests;

Conscious that the continuingexistence and development of nuclearweapons pose serious risks tohumanity;

Recognizing that a single nuclearbomb exploding in a city - whetherthrough accident, terrorism or war -could result in large scale loss of life;

Realizing that prevention is the onlyeffective approach, as there is no ef-fective medical response to a nuclearexplosion;

Noting that the UN General Assem-bly states that the complete elimina-tion of nuclear weapons is the onlyguarantee against the threat of nuclearwar;

Welcoming the progress of nucleardisarmament with the treaties INF,START I and START II;

Realizing that in 2003, when theSTART treaties are fully implementedthere will remain about 20 000 nuclearwarheads;

Bearing in mind the August 1982IFMSA resolution on Nuclear War andthe August 1994 IFMSA statement thatnuclear weapons should be illegalaccording to international law;

Recalling the commitment the nu-clear weapons states made towardstotal nuclear disarmament in 1968 andagain in May 1995, in the negotiationson the Non Proliferation Treaty,

1. Strongly opposes all testing ofnuclear weapons.

2. Calls on the Nuclear weaponsstates to negotiate a total nuclearweapons test ban by 1996.

3. Supports the call for abolition ofall nuclear weapons.

(10th of August, 1995)

Conflict prevention

Workshop onMedicine and War

By Wigs Bateman, United Kingdom

IGNACIO GARROTEHospital at an old disco hall.


May 1996

Mum for a dayThe elder is luslim, the baby isnot. However, they had a lot of

things in common: both of themhad lost all their relatives, friends,belongings, etc., due to war; bothof them used to live in Bosnia.

They met on a bus on their way toa refugee camp. Since then, they

decided to adopt each other. Don'tever tell the lady that girl is not her

daughter; don't ever tell the girlthat lady is not her mum.

Photonews: Ignacio Garrote

I s a nuclear weapons free world a dis-tant dream, that only Nobel PeacePrize winners, and other radicals can be

deceived to believe in? Convinced that the onlylasting solution to the danger of nuclear weap-ons being used again, the International Phy-sicians for the Prevention of Nuclear War(IPPNW) works for the slow but firm aboli-tion of nuclear weapons. Military leaders haveover the last years weakened the cold wardogmas of the military and political value ofnuclear weapons.The World Health organi-zation has repeatedly stated that nuclearweapons constitute the greatest threat to hu-man kind. Based on the special responsibilitydoctors have for human health and well-be-ing IPPNW have initiated a new project whichambitious goal is: There shall, by the year 2000,be a binding global agreement signed by theworld’s governments to abolish all nuclearweapons within a set timetable.

To reach their goal IPPNW mobilizes it’snetwork of approximately 80 national affili-ates with about 170,000 members. The cam-paign will work at many levels.

Information campaign

An important challenge in the campaign isto make people actually believe that nuclearweapons can be put away. This will be doneby spreading information in coordinated me-dia campaigns, through TV-films currentlybeing produced, through seminars andcourses for physicians and the public. IPPNWhas since its start in 1980 disseminated infor-mation, and its information campaign on themedical effects of nuclear war won it the NobelPeace Prize in 1985.

The main part of the campaign, however,is focused on dialogue. Research done byOxford Research Group have found that onlyabout 700 persons in the world have any ma-jor influence in decisions regarding nuclearweapons. Only 5 of these are women. Politi-cians rarely have any influence in nuclearpolicy making. The decisions are mainly takenby weapons designers, security officials,defense contractors, military strategists, bu-reaucrats and researchers in the nuclear weap-

ons laboratories. By arranging meetings withthe real decision makers, getting to know themand express medical concerns and establish adialogue with them, IPPNW hopes to sowseeds of change among locked mindsets inthe nuclear weapons states. There are no tech-nical or financial problems tied to a nuclearweapons free world. The barrier is exclusivelya mental one. The good thing is that opinionscan change, though it takes time.

IFMSA

Networking with other non governmen-tal organizations is another important legin the campaign. IFMSA have endorsedIPPNWs Call to Abolition, signed now byseveral hundred NGOs. IFMSA havetaken a firm position on this issue with itsPolicy declaration on nuclear weapons dis-armament at the GA in August 95. Let-ters have been sent to the French andChinese governments expressing our con-cerns on their continued nuclear testing.

Illegal weapons?

In 1993 WHO directed a question to theWorld Court in Hague to consider the legal-ity of nuclear weapons use. The UN GeneralAssembly followed with a similar statementin 1994. At the GA 94 IFMSA expressed itsview that nuclear weapons should be illegalaccording to international laws. The WorldCourt oral hearings have been held this au-tumn and a decision from the Court is ex-pected in early 1996. Attending the hearingsand a NGO conference in Hague were IljaMooji and IFMSA president LennertVeerman. They participated in the discussionsabout the creation of “Abolition 2000 - A Glo-bal Network to Eliminate Nuclear Weapons”.

Medical associations

There is a growing awareness in medicalassociations around the world that abolitionof nuclear weapons is the only remedy againstthe nuclear threat. Only this way we can besure that Nagasaki was the last place a nu-clear bomb was used. Large and mainstreammedical organizations are joining IFMSA’sand IPPNW’s efforts to rid the world of nu-clear weapons. Lately the German, Malaysian,Bangladeshi and Norwegian medical associa-tions have expressed their support for a nu-clear weapons free world. So has the Ameri-can Public Health Association (APHA) hope.While Chirac underlines the importance ofdeterring crabs and plankton at Mururoa, wecan find hope in the words of the late Frenchpoet, Victor Hugo: There is only one thing thatis stronger than all the armies in the world, andthat is an idea, whose time has come.

By Kurt Hanevik IPPNW Liaison Officer

IFMSA joins ambitious projectto abolish nuclear weapons



The grave deterioration of livingconditions the world over hasprompted governments to call

upon the United Nations to hold the sec-ond UN Conference on Human Settle-ments: HABITAT II , called «THE CITYSUMMIT» by the United Nations Secre-tary-General, Dr. Boutros Boutros-Ghali.The overall goal of the Conferenceis to make the world’s cities, towns andvillages healthy, safe, equitable and sus-tainable. The two overall themes of theConference are:

- adequate shelter for all- sustainable human settlements develop-

ment in an urbanizing worldHABITAT II will be held in Istanbul, Tur-

key, in June 1996, twenty years after the firstConference on Human Settlements, HABI-TAT I, was held in Vancouver, Canada. HABI-TAT I drew international attention to prob-lems in settlements of all kinds, rural as wellas urban.

HABITAT II will build on this effort andfocus on the urbanization process, as citiesand towns accomodate a growing majority ofthe world’s population in the coming century.

For centuries, cities and towns have beenthe source of prosperity and progress for anever increasing proportion of humanity. Thediversity of the skills and cultures in cities hasopened new frontiers by generating economicgrowth, social cohesion and opportunity.

But in the midst of all this promise, moreand more cities are faced with growing un-employment, crime, disease and pollution.Cities of hope are becoming cities of despair.Main issues to discuss

-Shelter and Affordable Housing-Governance, Leadership and Participation-Urban Poverty Reduction and Job Creation-Environmental Management and the«Brown Agenda» for Cities-Disaster Mitigation, Relief and Re-Construc-tion-Gender-Awareness

The City Summits' ChallengeThe overall task of the Conference is to

generate worldwide action to improve peo-

ple’s living environments. The Conference,together with international agencies and gov-ernments, will initiate and debate a GlobalPlan of Action for human settlements devel-opment, addressing the issues facing us dur-ing the next two decades but focusing on im-mediate action in the first five years (1996-2000).IFMSA challenge towards Istanbul

During the WSSD, several Youth Organi-sations had the opportunity to meet Mr. WallyN’Dow, Secretary General of Habitat II.

At those evening meetings were present,among others, representatives from ELSA,AIESEC, Global 2000, World Assembly ofYouth, UN Youth volunteers, World StudentChristian Federation, IFMSA, as well as sev-eral representatives from UN: ambassadorsin Geneva and New York, representatives ofUNDP and from the Habitat II Secretariat inNairobi.

What UN is doing today is aiming at us, theCitizens of tomorrow, that is why it is so im-portant to give at this Summit our visions forour own Century.

We will be given a big track to collaboratewith UN in the organization. We tried to cre-ate an action plan for these coming months.

The link between the WSSDand Habitat II:

UN major issues in Copenhagen -employ-ment, social exclusion, poverty- are the samethemes that will determine livingness or notof the next century.

Habitat II establishes the Global SocialAgenda for the 21st Century: housing, shel-ter, living solidarity, gainful employment, self-esteem in the community, religious dimen-sions, security in lives and possibility of liveli-hoods... You cannot build a new social agendawithout housing and shelter. No outcome ofthe WSSD is fulfilled as long as no shelter isprovided for the jobless/homeless.

Social peace is under attack, society is dis-integrating. Social and political peace of thenext decades will depend on how we deal withthe social agenda: house, food, employment...

The Second United Nations Conference on Human Settlements

Habitat II: «The City Summit»

Human environment does not take place inUN papers, but in the people.

Youth will have a complete day at HabitatII, and it will be up to us to decide what willhappen there. Since Youth organisations areusually lacking continuity in leadership, UNwill provide with the support we request fromthem.

«Our Global Home: Youth forHabitat II»

This is the name we gave to Youth activitiesfor the Habitat II Conference... Now it is upto all of us to give contents to this name.

A focal point (i.e., a contact group) will co-ordinate preparations, the conference, and itsfollow-up. A youth co-ordinator will central-ize information at the UN office.

The Habitat I declaration will be reviewed.A database on projects will be established inco-operation with the Turkish Liaison-Officer.Finally, a new policy statement will be ap-proved. In conjunction with the Conference,it will be held a Trade Fair on sustainable tech-nologies.

Habitat II Secretariat is based in Nairobi(Kenya), and a Liaison Officer is establishedat UNDP in New York UN Headquarters.

A Youth liaison officer is provided by theSecretariat in Nairobi, as well as the YouthFocal point in New York.

Perhaps for the first time in History Youthis given such a preponderant role at a UNSummit, the «Youth Sunday».

Now it is our turn, to find out which ourconcern as Youth and medical students shouldbe.

And put words into action.

By Luis-Alberto Ramos Neira, Spain.

IFMSA

UN will keep lit the light searching for social justice atHabitat II in Istanbul after Copenhagen and Beijing.


May 1996

EMSA, FELSOCEM and IFMSAevents

◆ ◆ ◆ ◆ ◆ June 1996Congress of medical students of therepublic of Bosnia and HerzegovinaTuzla, Bosnia and HerzegovinaContact:Mirza Muminovic, [email protected]◆ ◆ ◆ ◆ ◆ 24. - 30.6.1996English Eurotalk MoscowMoscow, RussiaContact:Inna Zolnikova, fax #7-095-2053187Larisa Vydrich, fax #7-095-4000847◆ ◆ ◆ ◆ ◆ 13. - 20.7. 1996German EurotalkKiel, GermanyContact:Martina Schubert, Holtenauerstrasse 171 a,24118 Kiel, GermanyTel. #49 431 [email protected]: March 31st◆ ◆ ◆ ◆ ◆ 15.7 - 1.8.1996Croatian refugee project:Bosnian and Croatian refugees, Rijeka, CroatiaContact:Enver [email protected]◆ ◆ ◆ ◆ ◆ 20. - 30.7.1996International Medical Students’ CampMoscow, RussiaContact:Inna Zolnikova, fax #7-095-2053187Larisa Vydrich, fax #7-095-4000847◆ ◆ ◆ ◆ ◆ 20.7. - 4.8.1996International Summer School Stop Aids:“Do the action, but use protection”Belgrade-Kopaonik, Yugoslaviaalso supplementary SCOAS meetingContact:[email protected]@osmeh.fon.bg.ac.yu◆ ◆ ◆ ◆ ◆ 20.7.-27.7.199611th Medical Students InternationalScientific Congressand FELSOCEM General AssemblyCusco, PeruContact:Silvia Mayorga Zá[email protected]◆ ◆ ◆ ◆ ◆ 1. - 4.8.1996IFMSA Workshop on Medicine and WarHradec Kralove, Czech RepublicContact:[email protected]◆ ◆ ◆ ◆ ◆ 6. - 11.8.199645th IFMSA General AssemblyPrague, Czech Republic

Contact:OC;ASM-GA OC, c/o LF UK, Simkova 870, 50038 Hradec KraloveCzech RepublicFax #42 (0)49 [email protected]: May 17th (early registration)◆ ◆ ◆ ◆ ◆ 2. - 7.10.19966th EMSA General AssemblyCrete, GreeceContact:EMSA 6th GA, Medical School, P.O. BOX1393, Heraklion 71110 Crete, Greece.Tel: # 30 94 44 0005Fax # 30 81 [email protected]: early registration, August 9th

Other events

◆ ◆ ◆ ◆ ◆ 20. - 25.5.1996World Health AssemblyGeneva, SwitzerlandContact:WHO liaison officer Clemens [email protected]◆ ◆ ◆ ◆ ◆ 3. - 14.6.1996Second UN Conference on HumanSettlements - Habitat IIIstanbul, TurkeyContact:[email protected]◆ ◆ ◆ ◆ ◆ 25. - 28.6.1996The 7th Ottawa International Conferenceon Medical Education and AssessmentMaastricht, the NetherlandsContact;[email protected]: //www.educ.rulimburg.nl◆ ◆ ◆ ◆ ◆ 7. - 12.7.199611th international conference on AIDSVancouver, CanadaContact:[email protected]@osmeh.fon.bg.ac.yu◆ ◆ ◆ ◆ ◆ 23. - 26.7.1996International Physicians for the Preventionof Nuclear War (IPPNW)World student meetingBoston, USAContact:[email protected]

◆ ◆ ◆ ◆ ◆ 3. - 7.9.1996Association of medical schools in Europe(AMSE), annual deans’ meetingGranada, SpainContact:Prof. Curtoni, president of AMSE, Universityof Torino, Italy, Faculty of

medicine◆ ◆ ◆ ◆ ◆ 4. - 8.11.19961st. International Meeting of MedicalStudents’ Scientific MagazinesXII Scientific forum of Cuban MedicalStudentsCamaguey Higher Medicine Institute, Cuba.Contact:Abel García Valdés, Revista “16 de Abril”,Calle G s/n e/ 25 y 27.Vedado,C.Habana.C.Postal 10400.CubaFax # 53 7 333063,336257,[email protected], [email protected]

Summer Schools

◆ ◆ ◆ ◆ ◆ Tropical MedicineAlexandria, Egypt1. - 21.6.1996/1. - 21.7.1996/1. - 21.8.1996Contact:Mohamed Magdy, Alexandria ExchangeOfficer,Bl. “B” Apt.502 El-Madina El-Tibia,Mostfa Kamel, Alexandria, EgyptTel: # 203 800 609/547 4993Fax # 203 5861471/5451924Deadline: one month before◆ ◆ ◆ ◆ ◆ Summer School on Tropical medicineAin Shams Student Scientific Society (ASSS)Cairo, Egypt1. - 20.6.199671. - 20.8.1996Contact:Prof. Ali Khalifa Office, Oncology DiagnosticUnit, Ain Shams UniversityFaculty of medicine, Abbassia , Cairo, Egypt.Tel/fax # 20 2 [email protected]◆ ◆ ◆ ◆ ◆ Pediatric diseases in the third worldZagazig, Benha, Egypt1. - 21.6.1996/3. - 24.8.1996Contact:Ehab El Menshawy, Abo El Ela Str,El Tokky House Flat 4, Menia El Kameh,Sharkia, EgyptTel: # 2 005 661630Fax # 2 055 325000 #2 055 328655Deadline: one month before◆ ◆ ◆ ◆ ◆ Diving MedicineRijeka, Croatia13. - 27.7.1996/20.7. - 3.8.1996Contact:Rijeka Faculty of Medicine, Summer School '96Branchetta 22, 51000, Rijeka, CroatiaTel: # 385 51 227 444Fax # 385 51 514 [email protected]://mamed.medri.hrDeadline: June 15th

PLEASE REPORT CHANGESAND NEW EVENTS TO:

EMSA GENERAL TASK FORCEDIRECTOR

EVA SCHMIDTKEBROUWERSWEG 100, K 484,

6216 EG MAASTRICHTTHE NETHERLANDS

E-MAIL:[email protected]

FAX (ATT. SIMONE JANS)# 31 (0)43 3881177



International Development Group

International Development Partner

The EuropeanCommission

General Secretariat Support

Leadership Training Program

Communications Partner

Medical Education Workshop

Village Concept in Sudan

GA '96 Official Carrier

IFMSA is the world's largest student organisation committed to the Peoples' Health, Education andDevelopment. We work in over fifty countries promoting international understanding through students

exchange, and facilitating progress in our profession through a multicultural experience. Thousandsof medical students have joined our compromise, working on voluntary basis, away from profit-

making purposes, with no political filiation or any other kind of discrimination.

University of Amsterdam

S I DAThe SwedishInternational

Development Agency

The KelloggFoundation


May 1996

WE GIVE MEDICAL STUDENTSINTERNATIONAL EXPERIENCE

From Nepal to Brazil; from Finland to South Africa...Medical students all over the world have common needs and face common problems

towards their professional careers.

Having the best possiblemedical training is not always

enough, it is alsonecessary to be

prepared for acoming multi

cultural society,and contributefrom our future

position asphysicians tointernational

understanding.

IFMSAInternationalProfessionalExchange

Program istherefore a

unique tool to prepare us for such future. Since 1951, long before otherstudent mobility schemes such as the ERASMUS were conceived, IFMSA has

been providing medical students with the opportunity to undergo medical

internships abroad.And we still do, over five thousand studentswithin our fifty member countries every year.

IFMSA General Secretariat;Faculteit der GeneeskundeAMC - Meibergdreef 15

NL-1105 AZ Amsterdam (The Netherlands)internet: [email protected]://crick.fmed.uniba.sk



Addvert.Student

BMJ(Films)

Public Health - Ibiblio

Documents

Transcript of Public Health - Ibiblio