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PAMSA HeartBeat
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Imprint
Editor in Chief Leonel Ayala, El Salvador Proofreading Helana Chapman, Dominican Republic Gnesis caas, El Salvador Laura Figueiredo, Brazil Design Leonel Ayala, El Salvador
Publisher
International Federation of Medical Students Associations General Secretariat: IFMSA c/o WMA B.P. 63 01212 Ferney-Voltaire, France Phone: +33 450 404 759 Fax: +33 450 405 937 Email: gs@ifmsa.org Homepage: www.ifmsa.org
Contacts
da.pubsmedia.pamsa@gmail.com
PAMSA HeartBeat
Contents
5 6 7 8 10 12 14 16 17 18
The ifmsa global health equity initiative Health determinants Advocating for a rational use of prescription
drugs through medical education
Sdh and reproductive health Rio political declaration on social determinants of health. What we plan!
PAMSA HeartBeat
Pamsa Team
Gabriela Noles
Regional Coordinator IFMSA - Per rcamericas@ifmsa.org DA for NMO Development IFMSA - Chile da.nmo.pamsa@gmail.com
Javiera Brierley
Alhel Caldern
Leonel Ayala
Mardelangel Zapata
Americas Regional Projects Assistant APEMH amregpa@gmail.com
Elas Ortega
Frdric Morin
Roberto Garca
Tessy Cerrn
Paola Aguirre
Erick Melndez
Ricardo Zules
Introduction
Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in My name is Roberto Leonel Ayala Minero, a 6th year human beings of whom they know nothing - Voltaire medical student, proud member of IFMSA - El Salvador and Im pleased to introduce myself as the new DA on Remember, we owe nothing more than to give the Publications and Media for the term 2011 2012. best attention as possible to our society, try not to be identified by one of the most accurate quotes that Im very honored to be able to continue the great work describe the patients opinion about doctors. We have that has been presented in the past HeartBeat numbers, to learn to give the best answers, practice to give the and with your help I know well keep this amazing line best solutions, but mostly know our patients to be the of communication active and letting all PAMSA know best doctors. about different regions and cultures, so we can find ways to improve our own. Leonel Ayala DA for Publications and Media Im truly excited to present this new edition of our magazine, being Social Determinants on health and infectious diseases the topic selected for it. This was selected for two main reasons, the first one honoring the PAMSA Regional Meeting 2012, product of the amazing work done by our fellow members from Peru, and the second due to the importance of being able to recognize the roots of the problems that are affecting health in our countries and getting to find solutions helping our society in a mayor scale. As medical students and doctors we acquire the responsibility to be aware of our patients environment and how it determines their health. As defined by the World Health Organization (WHO) The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices, making us clear that being a health provider is more than just taking care of our patients, but to have a more wider perspective and aside being physicians we should try to go deeper into the problem, so eventually we can improve the factors that have an influence in our health. You will find very interesting articles in this number, from which we can all learn about some of the most important determinants on health, including health systems, reproductive health and the importance of medical education. Dear PAMSA family!
This magazine is an IFMSA Publication. Portions if this magazine may be reproduced for non political, and non profit purposes mentioning the source provided. Notice: Every case has been taken in the preparation of this document. Nevertheless, errors cannot always be avoided. IFMSA cannot accept any responsability for any liability. The opinions expressed in this magazine are those of the authors and do not necessarily reflect the views of IFMSA.
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From our RC
Dear PAMSA friends, I am honored to write in this, the fourth RM special edition of the PAMSA Heartbeat Social Determinants of Health and Infectious diseases Why infectious diseases and social determinants of health? Mainly, for two reasons. First, it is the theme elected by our Regional Meeting 2012 OC as theme event for the RM and; Secondly, because even though non communicable diseases are nowadays one of the main health issue of our region, the infectious diseases are still important thus determinate future health but, most importantly, are the most affected by the social environment of the people. This is the reality that we see every day or must see. Before this, the big question is: what are we doing about it? Our members are sharing in these lines their thoughts, wishes and actions to tackle this topic. We cordially invite our readers to enjoy our publication and that every page encourage you to act. Yours, Gabriela Noles IFMSA Regional Coordinator for the Americas
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Laura A. Figueiredo In the midst of our dazed lives of academic medicine and in moments of crisis in my course, ive found in IFMSA an endless source of encouragement to continue this journey. Was in IFMSA that I realized how to fight for a cause is extremely rewarding, even when everything goes against you. The IFMSA welcomed me and showed me how our society needs actions for health prevention, care and an attention especially. Today we see brutalities that happen in the Public Health and we can contemplate the importantance that IFMSA has to act on significant gaps of the state to provide health care to all, even though we can not change in large proportions, they are aware that we try and at least one person affected by the action already characterizes the success of our work.
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Manuel Alejandro Rodrguez, MD. Belkis J. MenoniBlanco, MD (Alumni of FEVESOCEM, IFMSA Venezuela) The health system in Venezuela consists in clinics and hospitals, public and private, in rural and urban areas. That system is classified depending on the number of people in each community and the services in these health centers. The clinical system is developed to promote prevention, immunization and outpatient treatment of diseases. In contrast, the hospital system, which is classified into levels, is responsible for the assistance provided to patients with diseases that require rapid and short hospital stay (level I) and more specialized care that demands more technology (level IV). The public system have been made based also on preventive health programs, for example, breastfeeding, HIV and AIDS, Diabetes, Cardiovascular diseases, comprehensive care to children and adolescents, prevention of epidemics, tropical diseases... One of the most recent health campaigns is the No Tobacco National Program, which entered into effect on World No Tobacco Day (so decreed by the WHO) From the early stages of medical school, the student has contact with Public Health and Health Prevention, because these matters are included in the curriculum of all universities of this country. During their training, the medical student goes to remote communities to develop research projects and promotes prevention and care for diseases of these communities.
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One of the main shortcomings is the current intention of establishing a parallel public health system, which is not related to the traditional. This new system is far from solving the current problems, quite the opposite, actually increases the clutter and creates a battle between the two systems. But both strive for similar goals, since they seek equality and population health and who loses in this battle are the users, because the administrators of these systems end up diverting resources from one and neglecting the other. At the present time, Venezuela unfortunately has a long list of problems in the health system, many of which could be prevented or simply solved. Examples of that wear are manifested by the constant lack of supplies in
health centers, emergencies and sites of hospitalization, which are often evidenced by the deterioration of some buildings, lack of equipment, materials, drugs or beds to accommodate patients properly, as also not enough staff to handle the overwhelming number of people attending daily for health. In conclusion, the duty of health professionals and students worldwide, not only in Venezuela, should be promote health education, preventive campaigns and social assistance, based on medical ethics and morality. We found in IFMSA a preparation for entering this world of possibilities and take the reins, though young, of our careers, so that, in the future, we will use preventive policies and social actions in our communities.
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Illustration from: Dahlgren, G. and Whitehead, M. (1991). Policies and Strategies to Promote Social Equity in Health. Stockholm: Institute for Futures Studies. 10 PAMSA HeartBeat
Health Determinants:
Kevin Stephen Acosta Velsquez *, Martha Liliana Ospina Gutirrez ** *3rd year Medical Student, School of Medicine, University of Tolima. Ibagu -Tolima- Colombia **5th year Medical Student, School of Medicine, University of Tolima. IbaguTolima-Colombia As the youth represent agents of change, they have an important future role in developing countries. Although only a small percentage of Colombian youth have access to super education, they are the innovators that have united their voices toward a better society. Within this population, the medical students have created strength in their presence, where they have developed various opportunities for students in their early medical education to have direct contact with community members. These individuals represent decisive agents that will direct the focus on the principal health determinants in the rural and urban communities: Education. Due to the local and global activities promoted by the governments and different organizations, including the Association of Medical Students, education has been successful in many areas. In particular, the initiative of the International Week of Maternal Breastfeeding was founded by the World Alliance for Breastfeeding Action (WABA). By forming strategies for annual implementation between August 1-7, future physicians have become critical and active agent of change for this health topic.
This focus on the rights of this social and vulnerable group is an advantage for the remaining hospital functions, as a University Hospital and principal rotation site for the medical students at the Faculty of Health Sciences of Tolima. In promotion of this program, at the start of the latter half of this year, the Scientific Association of Medical Students of the University of Tolima (ACEMED UT) (Local Committee of ASCEMCOL) and the respective Hospital, created and implemented the First Week for Collaboration: The IAMI HFLLA and the ACEMED UT. The implemented strategy was to create a collective and equal work environment between the IAMI Hospital and the public university, where both would act as a social, education and health base of the relevant community, from an epidemiologic and geographic perspective. The hospital roles were defined and permitted the Tolima medical students to become involved in the planning, organization and development of education activities and promotion of maternal breastfeeding. In this manner, this educative center can combine the directed objectives of the maternal and infantile population with the group members and leaders of the project, where health determinants would be considered.
Considered by the World Health Organization (WHO) as a natural act and behavior to learn, maternal breastfeeding is an important topic, especially due to the offered benefits in the biopsychosocial environment of the individual. Currently, the Hospital Federico Lleras Acosta (HFLLA) is considered one of the most important Colombian institutions that offer health services, where an initiative (1992) between the WHO and UNICEF, established the Institution Amiga de la Mujer y la Holding life by Ramn Llorente, FEVESOCEM Venezuela Infancia (IAMI).
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Acting locally, Thinking Globally during the International Week of Maternal Breastfeeding in Colombia.
These strategies are proposed for a direct intervention between the community and public hospitals as a solution for the actual health problem. The timespace-communication triangle can be implemented in the search for the appropriate promotion of maternal breastfeeding with the media. It is important that all members of each association of medical students implement concrete actions for these initiatives, which would permit a strong collaboration between hospital and university as well as offer solutions for the public health problems that affect the local, national and global community. References: 1. Zambrano, A. Determinantes del estado de salud en Colombia y su impacto segn rea urbana y rural: Una comparacin entre 1997 y 2003. Available at: http://www.asivamosensalud.org/descargas/lecturas/ Zambrano_estado_de_salud.pdf. 2. Alvarez, L. (2009). Los determinantes sociales de la salud: Ms all de los factores de riesgo. (2009). Rev Gerenc Polit Salud, Bogot (Colombia), 8 (17): 69-79. 3. World Health Organization. (2011). Child and adolescent health and development: World breastfeeding week. Available at: http:// w w w. w h o. i n t / c h i l d _ a d o l e s c e n t _ h e a l t h / n ew s / archive/2011/03_08_2011/en/index.html. 4. Hospital Federico Lleras Acosta de Ibagu- Tolima E.S.E. (2011). Homepage. Available at: http://www. hflleras.gov.co/. 5. World Alliance for Breastfeeding Action. (2011). World Breastfeeding Week. Available at: http:// worldbreastfeedingweek.org/. 6. World Health Organization. (2004). Estrategia mundial: Lactancia materna, fundamental para la supervivencia infantil. Available at: http://www.who. int/mediacentre/news/releases/2004/pr19/es/.
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Elias Jesus Ortega Chahla. Universidad Nacional de Tucuman. San Miguel de Tucuman, Tucuman, Argentina. 2011. 14
prescription drugs. At the same time, just as not all disease For this reason, we are at the best moment to improve this conditions require prescription drugs, some medications educational process in early medical education, before produce deleterious effects in the human body. This may medical students become certified health professionals. constitute a frequent form of poor medical practice.3 As medical students, how can we advocate for a Rational Use of Prescription Drugs? We can: Common examples of Irrational Use of Prescription Demand that our professors and mentors base their Drugs2 drug prescribing practices on evidence-based medicine. Too many medications are prescribed per patient Participate in curriculum changes that improve the (polypharmacy). teaching of rational practice in medical education. Injections are used where oral formulations would be Participate and organize courses, workshops and other more appropriate. activities to promote the rational use of prescription Antimicrobial medications are prescribed in inadequate drugs. doses or duration or for non-bacterial infections, thereby Develop independent criteria when reviewing treatment contributing to the alarming problem of antimicrobial guidelines while following WHO standards in selection resistance. of the appropriate medication. Prescriptions do not follow clinical guidelines. Patients self-medicate inappropriately or do not As future healthcare professionals, it is our sacred duty adhere to prescribed treatment. and privilege to promote the best quality of attention to our patients. We have the responsibility to advocate for the rational use of prescription drugs. Within our reach, Across the world, there are countless examples of we have organizations (i.e. IFMSA) that offer the unique incorrect and unnecessary use of prescription drugs. and wonderful opportunity to work as one global team, Although the motive for these prescriptions may be gathering the appropriate resources and tools to fight based on many factors, the most important reason is for improved prescription practices. inadequate education on prescribing practices among medical students and health professionals. So the The power of a doctors pen is mightier than the deadliest question arises, why are medical students not taught disease how to use prescription drugs correctly? The answer is complicated, although one possibility is that medical References: school professors are not aware of the Rational Use of 1. National Therapeutic Form. (2011). Medical Prescription Drugs. Confederation of the Argentine Republic, 11th ed. Argentina. Why does it happen? Studies in Canada, Australia, Kuwait and the USA, as 2. De Vries, T.P.G.M, Henning, R.H., Hogerzeil, H.V., well as in middle-income countries, such as South Africa Fresle, D.A. (1994). Guide to the good prescribing: A and Thailand, have revealed that inappropriate use of practical manual. Geneva: World Health Organization, medications is widespread in teaching hospitals.3 Action Programme on Essential Drugs. The high cost of medications contributes to low adherence levels by patients. In some studies, an estimated 90% 3. Mordujovich, P., Buschiazzo, H. (2006). of consumers buy antibiotics for three or less days, Rationalized approach on therapeutics. Argentina: which makes compliance with the recommended dosage National University of La Plata. impossible.2 If we do not start to educate the healthcare professionals about the Rational Use of Prescription Drugs, how can we expect that they will be responsible prescribers?
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If youd like to read the whole article you can visit the following link: http://www.who.int/sdhconference/ declaration/Rio_political_declaration.pdf
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What we plan!
As a family, we wanted all PAMSA to know what each of us is planning on doing on this amazing journey waiting ahead for us! So here is a little message from all of us to our dearest PAMSA.
Dear PAMSA family, as you know my name is Gabriela Noles but almost all people call me Coti. I am glad and honored to be the IFMSA Regional Coordinator of the amazing Region of the Americas. This year as IFMSA RC Americas I will be focused mainly in supporting, updating and linking NMOs by being in close contact with each one of them. Also, I will organize the procedures in the region by updating/creating our Internal Operating Guidelines and all the attachments to it. Finally, I will assure a well organized and enjoyable RM2013 by working closely with the OC.
Hello IFMSA! As NMO DAs we want to improve the communication between NMOs, and ensure that the region develops to its fullest potential. We believe that PAMSA can take IFMSA very far, and we want to contribute to this by working with our beautiful RC, the PAMSA NMO Presidents and all PAMSA members. So, lets do this! Llama Hugs. Alheli and Javiera
Dear PAMSAeans, It is with great honor and satisfaction that I introduce myself as the person in charge of the projects of our beloved region. I am really motivated to make our region bigger than ever through our projects. Initially, we have to work on our data base and strengthen the Project Support Division (PSD) in each NMO, developing and supporting them. Getting an IFMSA official status for most of the projects of our region is one of my goals. I will work constantly with the national projects coordinators and each project coordinator in order to give them support to present their projects during the MM and AM. To summarize, the constant evaluation, communication and motivation of the people of our region will be important things to consider in my period. We are hardworking and full of energy. That is one of the reasons why I feel really proud of being PAMSAean. On the other hand, projects are connected with all the committees and the NMOs, we considered them as the heart of our federation. Im sure that with our hard work, everybody will get to know that PAMSA has the BIGGEST heart of the world! Do not hesitate to contact me if you have any doubt related to projects. Lots of hugs Mardelangel Zapata Ponze de Leon (Maggie ) Regional Projects Assistant 18 PAMSA HeartBeat
Hey my awesome SCOMEdians! It is with great pleasure that I write to you in the frame of the Regional Meeting of PAMSA! Since my appointment as Regional Assistant Ive been working really hard Integrating and developing SCOME in PAMSA. In this sense, I am working closely with the NOMEs of the region to improve communication and collaboration between NMOs in creating and maintaining Transnational regional Projects and SWGs that attend to PAMSAs needs and priorities. I deeply believe in the involvement of students in medical education, since we are the recipients I think it is only fair that we have input on it, and SCOME gives us a space for that purpose, making us one single voice in advocating for a better, modern and wholesome medical education. It is this very voice I want to see roar in the Americas! Lets Rock SCOME in PAMSA! Elias Ortega. SCOME RA
Hi Dear PAMSA members As SCORP Regional Assistant for PAMSA during these months I have experienced big positive feelings and I can`t find the exact words to describe them. I have used all of them to inspire myself and all PAMSA SCORPions to continue working as hard as we can for Human Rights and Peace all over the Americas and in each NMOs. But our work as SCORP can`t stop right there; we need to continue the improvement in our region to create a solid structure all over PAMSA. If we achieve this main goal, our regional communication and projects will develop in an efficient mode. Personally, as a motivated SCORP member I will put my best to give all my dear SCORPions the mechanisms and tools to increase the amazing job they are developing in their NMOs and also being an integral participant of all SCORP PAMSA projects; hopefully to accomplish a TRANSANATIONAL SCORP PAMSA PROJECT for all NMOs. Yeah! I wish everybody an amazing RM and remember that motivation is the best way to change the world positively. Ricardo Gabriel Zules Oa SCORP Regional Assistant for PAMSA 2011-2012
Hi! We are Paola and Erick, SCORA Regional Co-Assistants! During this term we are going to work towards ensuring that SCORA keeps its growth within the region, have a great team with all the NORAs in the region and encourage the PAMSA SCORAngels to develop more projects according to the reality of our region. To us, teamwork and mutual cooperation is a priority when developing and growing as a unit. We are sure it is the only way we can achieve the goals we have and make SCORA, the PAMSA region and its NMOs grow and develop.
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Hey PAMSA, my name is Roberto Garcia and Im the SCORE RA As RA this year, the first activity will be the RM and Pre-RM, where Ill meet all the NOREs of the assisting NMOs, and together we will work as close as possible. We have to analyze the actual situation of SCORE in PAMSA, seek which NMOs arent active and support them so they can achieve the activation of SCORE in their NMOs. I think SCORE is a highly important committee to the medical students, because it gives us the opportunity to involve ourselves deeper into the investigation field, and not only locally but internationally. Ill work as well with the Exchange Workshop along the SCOPE RA where we will give the National officers the tools to coordinate the committee that they represent. I wish as well, by this mean, to tell every NMO that they count with my total unconditional support for the development of SCORE in their country. We will be working as well, with collaboration of other committees, in seeking the common strengthen and the growth of PAMSA. I hope that at the end of this year, many of the NMOs that dont have SCORE active in them, will be able to do so, and that in our region IFMSA continues to grow so we can keep creating leaders for a society that needs them so much.
Hi my dear PAMSA family This year I want to improve the SCOPH exchange in PAMSA, because we have a lot of good projects that can be useful for this and we have a lot of people that have so many good ideas about this topic. Also I want to do online trainings about the topics youd like, helping this way to capacitate LPOs and NPOs in all the SCOPH related matters. For me, its important to do more online meetings, where we can talk about all the problems we have, as well as projects (already implemented or new ones). I want to motivate you to participate more in ifmsa-scoph@yahoogroups.com, IFMSA- SCOPH in facebook and ifmsa-pamsa@yahoogroups.com, there you can write all you want, share photos, videos, and any other thing youd like to share of a project. I would like to be your friend, someone that is near you when you need. Kisses and love GianinaTessyCerron Calderon RA SCOPH PAMSA
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Dear PAMSAmigos and SCOPEans, My name is Frdric Morin, I am a 3rd year medical medical student at University of Montreal and the SCOPE Regional Assistant (RA) within PAMSA. SCOPE, as you may know, is the oldest Standing Committee (SC). One of IFMSA main goals is to give medical students around the world a better understanding of what is global health and its influences. Regarding this specific goal, SCOPE is definitly reaching this goal by giving a practical example of how a health system can influence a populations health and by creating reflexions and discussions among medical students. We will have the chance during the following days, of what I already consider as a successful Regional Meeting (RM), to share our ideas and visions of SCOPE, to gather our energy and enthousiasm to show the rest of the world how proactive we can be in PAMSA and how fruitful our sessions can be. To me, this Regional Meeting rhymes with tools development. I truly believe that such meetings allow us to share our problems, our solutions, our ideas, through group discussions, activites, reflexions and projects. I really want all of us to leave this meeting with more IFMSA/SCOPE knowledge and concrete ideas on how to improve your standing committee in YOUR NMO. To make this possible, I would suggest all PAMSAmigos, not just SCOPEans, to write down a list of goals they want achieve during RM. It looks a bit childish but I promise you will not regret the outcomes of any meeting if you do so. I also invite you to see the potential in every activities. We have a very packed agenda but I also encourage you to take advantage of lunch times and other free time to learn more about IFMSAs potential and to NEVER stop sharing your ideas/problems/solutions with other delegates. I will be easily reachable during the whole RM so dont hesitate to talk to me at any moment during sessions, lunch, free time or on the dancefloor, why not? ;) Your questions, ideas and comments are always welcome. After 3 RMs, I can assure that: We are a family! Frederic alias Fico/Fede/Fred
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