JDN_24NL_Oct2021

JUNIOR DOCTORS
NETWORK
empowering young physicians to work together towards a healthier
world through advocacy, education, and international collaboration
Published by the Junior Doctors Network of the World Medical Association
The information, perspectives, and opinions expressed in this publication do not
necessarily reflect those of the World Medical Association or the Junior Doctors
Network. WMA and WMA-JDN do not assume any legal liability or responsibility
for the accuracy, completeness or usefulness of any information presented.
Junior Doctors Network Newsletter
Issue 24
October 2021
ISSN (print) 2415-1122
ISSN (online) 2312-220X
Junior Doctors Leadership 2020-2021
Junior Doctors Network Newsletter
Issue 24
October 2021
CHAIRPERSON
DEPUTY
CHAIRPERSON
SECRETARY
SOCIO-MEDICAL
AFFAIRS OFFICER
EDUCATION
DIRECTOR
MEDICAL ETHICS
OFFICER
MEMBERSHIP
DIRECTOR
PUBLICATIONS
DIRECTOR
COMMUNICATIONS
DIRECTOR
IMMEDIATE PAST
CHAIRPERSON
Dr Yassen Tcholakov
Canada
Dr Julie Bacqué
France
Dr Wunna Tun
Myanmar
Dr Manon Pigeolet
Belgium
Dr Helena Chapman
Dominican Republic
Dr Lyndah Kemunto
Kenya
Dr Lwando Maki
South Africa
Dr Uchechukwu Arum
Nigeria/United Kingdom
Dr Maki Okamoto
Japan
Dr Chukwuma
Oraegbunam
Nigeria
Page 2
Editorial Team 2020−2021
Junior Doctors Network Newsletter
Issue 24
October 2021
Dr Victor Animasahun
Nigeria
Dr Nishwa Azeem
Pakistan
Dr Sejin Choi
Republic of Korea
Dr Ricardo Correa
Panama/United States
Dr Giacomo Crotti
Italy
Dr Mashkur Isa
Nigeria/United Kingdom
Dr Jooyoung Moon
Republic of Korea
Dr Jeazul Ponce H.
Mexico
Dr Parth Patel
Malawi
Dr Vandrome Nakundi
Kakonga
Dem. Rep. of Congo
Dr Mellany Murgor
Kenya
Dr Suleiman A. Idris
Nigeria
Page 3
Table of Contents
TEAM OF OFFICIALS’ CONTRIBUTIONS
07 Words from the JDN Management Team
By JDN Management Team
08 Words from the Communications Director
By Dr Maki OKAMOTO (Japan)
09 Words from the Publications Director
By Dr Helena CHAPMAN (Dominican Republic)
JDN REFLECTIONS
10 Reflections by the JDN Management Team (2020−2021)
By JDN Management Team
15 Reflections by Former JDN Officers
By Dr Lawrence LOH (Canada), Dr Mike Kalmus ELIASZ (United Kingdom),
Dr Ian PEREIRA (Canada), Dr Kostas RODITIS (Greece), and Dr Anthony
UDE (Nigeria)
18 Reflections by JDN Publications Team (2020−2021)
By JDN Publications Team
22 Reflections by JDN Members (2020−2021)
By Dr Yakubu AHMADU (Nigeria), Dr Dabota Yvonne BUOWARI (Nigeria), Dr
Maymona CHOUDRY (Philippines), Dr Leonard Goh Zhong NING (Malaysia),
Dr Imtiaz HAFIZ (Bangladesh), Dr Christopher MATHEW (India), Dr Merlinda
SHAZELLENNE (Malaysia), Dr Rabindra Prasad YADAV (Nepal), Dr Frank
RODRÍGUEZ YEPEZ (PANAMA), and Dr Marie-Claire WANGARI (Kenya)
Junior Doctors Network Newsletter
Issue 24
October 2021
Page 4
Table of Contents
WORKING GROUP UPDATES
26 Climate Change Working Group
By Dr Yassen TCHOLAKOV (Canada)
27 Medical Ethics Working Group
By Dr Lwando MAKI (South Africa)
28 Medical Exchange, Education, and International Mobility Working
Group
By Dr Uchechukwu ARUM (Nigeria/United Kingdom)
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES
30 Ethical Dilemmas in Post-graduate Training during the COVID-19
Pandemic
By Dr Rui Lourenço TEIXEIRA (Portugal)
33 Public Health Ethics during the COVID-19 Pandemic
By Dr Frank RODRÍGUEZ YEPEZ (Panama)
36 Junior Doctors Lead a Global Call to Action to Promote
Multidisciplinary Collaborations
By Dr Helena CHAPMAN (Dominican Republic)
40 Digitization of Healthcare Service Delivery in Low- and Middle-income
Countries
By Dr Parth PATEL (Malawi) and Dr Sahiba MANIAR (India)
43 Social Accountability: One Step at a Time
By Dr Nishwa AZEEM (Pakistan)
46 Health Workforce Training in Organ and Tissue Donation in Mexico
By Dr Cinthya LUCIO (Mexico)
Junior Doctors Network Newsletter
Issue 24
October 2021
Page 5
Table of Contents
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS
49 Who Can Heal My Pain?
By Dr Dabota Yvonne BUOWARI (Nigeria)
50 The Impact of the COVID-19 Pandemic on Junior Doctors:
Perspectives from a Nigerian Physician
By Dr Dabota Yvonne BUOWARI (Nigeria)
53 The Impact of the COVID-19 Pandemic on Surgical Care in Italy
By Dr Teresa PERRA (Italy)
56 Life during the COVID-19 Pandemic: A Malaysian Junior Doctor’s
Observations
By Dr Merlinda SHAZELLENNE (Malaysia)
59 Myanmar Junior Doctors Risk Personal Safety during Military Coup
By Dr Wunna TUN (Myanmar)
JUNIOR DOCTORS’ ACTIVITIES
62 The Fight for Better Working Conditions for Resident Doctors in
Belgium
By Dr Manon PIGEOLET (Belgium)
65 2021 KMA Young Doctors Network Pre-conference: Career
Development and Entrepreneurship
By Dr Marie-Claire WANGARI (Kenya) and Dr Lyndah KEMUNTO (Kenya)
Junior Doctors Network Newsletter
Issue 24
October 2021
Page 6
Dear colleagues,
As we approach the end of another term of Junior Doctors Network (JDN) activities, we
remember our virtual interactions that have supported valuable contributions on relevant
global health discussions. As junior doctors, managing an international organisation
throughout this pandemic − with increasing clinical and public health responsibilities during
our training − has certainly been an exciting learning experience for all of us! This 11th year
of JDN collaborations has nevertheless been a memorable one.
At the end of this term, we must reflect on the existing and emerging health risks affecting
the world and identify innovative solutions to mitigate risks across populations. These risks
include: inequities that countries have faced during the pandemic, political conflicts across
countries where JDN members live and work, conditions that exacerbate the existing social
and environmental justice issues, and impacts of natural disasters in light of climate
change. Throughout the year, our monthly teleconferences, introductory session for
newcomers, webinars, biannual meetings, and numerous Working Group events have
allowed us to identify risks, foster JDN dialogue, publish findings in the JDN Newsletter,
World Medical Journal, and other scientific journals, and present calls to action for
decision-makers and other stakeholders as forward steps.
Junior Doctors Network Newsletter
Issue 24
October 2021
Words from the Management Team
TEAM OF OFFICIALS’ CONTRIBUTIONS Page 7
Photo 1. WMA leadership and JDN
Management Team at the Biannual
Meeting 2021. Credit: Dr Maki Okamoto.
As we celebrate our accomplishments for the 2020-2021
term, we look forward to building off of these milestones
for the 2021-2022 term. We hope that all JDN members
will be energized to identify pressing tasks, establish our
collective action plan to contribute to ongoing global
health efforts, and advocate for sustainable actions to
prioritize population health.
Please enjoy reading the following pages, as they
crystallise the reflections of JDN members at this time of
the year and bring forward the thoughts of fellow junior
doctors from all over the world on the most pressing
global health challenges.
Sincerely,
The JDN Management Team
Junior Doctors Network Newsletter
Issue 24
October 2021
Words from the Communications Director
TEAM OF OFFICIALS’ CONTRIBUTIONS Page 8
It is my pleasure to welcome you to the 24th edition of the Junior Doctors Network (JDN)
Newsletter. As I am finishing my JDN term as Communications Director, I would like to
express my appreciation for the opportunity to work with incredibly outstanding and highly
motivated junior doctors from all over the world.
In addition to their daily clinical and public health practice, junior doctors have a leadership
role to promote the future of medicine to tackle global health issues. We contribute to the
development of our future world! Before I started working with the JDN, I was relatively
overwhelmed with my hospital duties, and I had little capacity to think about global health,
medical colleagues, and the future of medicine. Through my work with JDN members, I
gained a holistic vision and broadened my horizons to feel more connected to the world.
Despite the physical distancing during the pandemic, we can still have close connections
with other JDN members and be open-minded about emerging challenges. If you feel tired
or overwhelmed, take time to cherish yourself, relax, and take time to talk with family and
friends. Your patients’ health will be secured when you focus on your health and well-being.
Remember that you are not alone and that your family, friends, and colleagues are by your
side! The JDN supports your work, as you are an important part of our future!
Maki Okamoto, MD
Communications Director (2020−2021)
Junior Doctors Network
World Medical Association
Dear colleagues,
To learn more information about
JDN activities and updates,
please visit the JDN media
accounts (Figure 1).
Sending love from Japan,
Maki Okamoto
Media Resource
Website https://www.wma.net/junior-doctors/
Mailing List https://goo.gl/forms/jCP774K1fldLIoWj1
Twitter @WmaJdn
Facebook (Members) WMA-JDN
Facebook (Public) WMA JDN
Instagram wma_jdn
Figure 1. List of JDN media resources.
Junior Doctors Network Newsletter
Issue 24
October 2021
Words from the Publications Director
Dear JDN colleagues,
On behalf of the Publications Team (2020−2021) of the Junior Doctors Network (JDN), we
are honored to share the 24th issue of the JDN Newsletter with junior doctors across the
world.
Since the start of the coronavirus disease 2019 (COVID-19) pandemic, junior doctors have
contributed significantly to advancing local and national response efforts to curb disease
transmission across health systems. Their leadership in clinical and public health practice,
capacity building, and research has helped close the gap in scientific knowledge, which has
highlighted emerging One Health challenges, including environmental and social justice
issues.
The JDN Newsletter provides an international platform where junior doctors offer valuable
insight about their clinical and community health leadership in local and national health
initiatives. This 24th issue includes articles from junior doctors from Belgium, Brazil,
Canada, Dominican Republic, India, Italy, Kenya, Malawi, Malaysia, Mexico, Myanmar,
Nigeria, Pakistan, Panama, South Africa, United Kingdom, and the United States. These
reports share updates on JDN Working Group activities, scientific perspectives on key local
and national challenges, and reflections on global health inequities. Their leadership can be
described by Henry Ford – “Coming together is a beginning, staying together is progress,
and working together is success” – and can empower their colleagues to develop timely
health initiatives and strengthen communication between World Medical Association
(WMA) and JDN members.
We acknowledge the leadership of all editors of the JDN Publications Team 2020-2021 as
we finalized this 24th issue. We recognize and appreciate the continued support of the JDN
Management Team and WMA leadership as we share this high-quality resource for junior
doctors across the globe. We hope that you enjoy reading about pressing global health
issues and activities of junior doctors in this 24th issue!
Together in health,
Helena Chapman
Helena Chapman, MD MPH PhD
Publications Director (2020−2021)
Junior Doctors Network
World Medical Association
TEAM OF OFFICIALS’ CONTRIBUTIONS Page 9
Junior Doctors Network Newsletter
Issue 24
October 2021
Reflections about Global Health Challenges
by the JDN Management Team (2020−2021)
TEAM OF OFFICIALS’ CONTRIBUTIONS
Dr Yassen Tcholakov (Chairperson, 2020−2021)
Dr Julie Bacqué (Deputy Chairperson, 2020−2021)
Page 10
Junior Doctors Network Newsletter
Issue 24
October 2021
TEAM OF OFFICIALS’ CONTRIBUTIONS
Dr Wunna Tun (Secretary, 2020−2021)
Dr Manon Pigeolet (Socio-Medical Affairs Officer, 2020−2021)
Page 11
Junior Doctors Network Newsletter
Issue 24
October 2021
TEAM OF OFFICIALS’ CONTRIBUTIONS
Dr Uchechukwu Arum (Education Director, 2020−2021)
Page 12
Dr Lwando Maki (Medical Ethics Officer, 2020−2021)
Junior Doctors Network Newsletter
Issue 24
October 2021
TEAM OF OFFICIALS’ CONTRIBUTIONS Page 13
Dr Helena Chapman (Publications Director, 2020−2021)
Dr Lyndah Kemunto (Membership Director, 2020−2021)
Junior Doctors Network Newsletter
Issue 24
October 2021
TEAM OF OFFICIALS’ CONTRIBUTIONS
Dr Maki Okamoto (Communications Director, 2020−2021)
Page 14
Dr Chukwuma Oraegbunam (Immediate Past Chairperson, 2020−2021)
Junior Doctors Network Newsletter
Issue 24
October 2021
Reflections about Global Health Challenges
by Former JDN Officers
FORMER TEAM OF OFFICIALS’ CONTRIBUTIONS
Dr Lawrence Loh (Co-founder/Inaugural Deputy Chair, 2011−2012)
Page 15
Dr Mike Kalmus Eliasz (Socio-Medical Affairs Officer, 2018−2019)
Junior Doctors Network Newsletter
Issue 24
October 2021
FORMER TEAM OF OFFICIALS’ CONTRIBUTIONS
Dr Ian Pereira (Education Officer, 2013−2015)
Page 16
Dr Kostas Roditis (Secretary, 2015−2018; Publications Director, 2012−2013)
Junior Doctors Network Newsletter
Issue 24
October 2021
FORMER TEAM OF OFFICIALS’ CONTRIBUTIONS
Dr Anthony Ude (Communications Director, 2018−2019)
Page 17
Acknowledgments: Special thanks to Dr Maki Okamoto (Communications
Director, 2021−2022) for her dedicated efforts to showcase our JDN
leadership in these captivating images!
Junior Doctors Network Newsletter
Issue 24
October 2021
Reflections about Global Health Challenges
by the JDN Publications Team (2020−2021)
PUBLICATION TEAM’S CONTRIBUTIONS
Dr Helena Chapman (Dominican Republic)
Dr Victor Animasahun (Nigeria)
Page 18
Junior Doctors Network Newsletter
Issue 24
October 2021
PUBLICATION TEAM’S CONTRIBUTIONS
Dr Ricardo Correa (Panama/United States).
Dr Suleiman Ahmad Idris (Nigeria)
Page 19
Junior Doctors Network Newsletter
Issue 24
October 2021
PUBLICATION TEAM’S CONTRIBUTIONS
Dr Mashkur Abdulhamid Isa (Nigeria/United Kingdom)
Dr Jooyoung Moon (Republic of Korea)
Page 20
Junior Doctors Network Newsletter
Issue 24
October 2021
PUBLICATION TEAM’S CONTRIBUTIONS
Dr Parth Patel (Malawi)
Dr Jeazul Ponce Hernández (Mexico)
Page 21
Junior Doctors Network Newsletter
Issue 24
October 2021
JDN MEMBERS’ CONTRIBUTIONS
Dr Yakubu Ahmadu (Nigeria)
For me, the most significant global health challenge is the
uncertainty of public health surveillance related to the incidence
and prevalence of infectious and chronic diseases across
communities. Junior doctors should always be prepared to identify
at-risk populations and develop innovative approaches to address
these pressing issues in their clinical and community health
practice.
Dr Dabota Yvonne Buowari (Nigeria)
The most significant global health challenge includes emerging and
re-emerging infectious diseases worldwide. The COVID-19
pandemic has driven society to adapt infectious control practices –
like social distancing, mask protection, handwashing, and vaccines
– to reduce community spread of this novel coronavirus. As health
care leaders, junior doctors should seek opportunities to strengthen
their knowledge and skills in order to be prepared for future health
challenges.
Dr Maymona Choudry (Philippines)
The most significant global health challenge is the resurgence of
the third wave of the COVID-19 pandemic with the delta variant.
The urgency of this resurgence has affected junior doctors in their
workplace across the globe, often leading to illness and burnout.
Junior doctors should seek opportunities to gain confidence with
their patients and inform them about the importance of vaccinations
as well as possible side effects.
Page 22
Reflections about Global Health Challenges
by JDN Members
Junior Doctors Network Newsletter
Issue 24
October 2021
JDN MEMBERS’ CONTRIBUTIONS
Dr Leonard Goh Zhong Ning (Malaysia)
The most significant global health challenge is the widening chasm
of income disparity across the world, which has been further
exacerbated by the COVID-19 pandemic. Income is strongly
associated with access to quality care, morbidity, mortality, and
quality of life. Junior doctors can better advocate for their patients
by being well-informed on local and global economic affairs and
becoming involved in policy-making!
Dr Imtiaz Hafiz (Bangladesh)
The COVID-19 pandemic at the forefront in our clinical workplace is
the most significant global health challenge to date. To address this
burden, national health systems must revitalise essential healthcare
services and prioritise infection control practices. Junior doctors
play a significant role in these tasks, which will ensure the
continuum of life-saving services amidst the pandemic.
Dr Christopher Mathew (India)
Poverty, illiteracy, and corruption leading to the inability of providing
“basic health for all” remains a primary challenge in low-income
countries. As junior doctors with crimson hearts and snowy white
souls, we should take active roles with local and national leadership
to identify solutions that can minimize the burden of these
challenges!
Page 23
Junior Doctors Network Newsletter
Issue 24
October 2021
JDN MEMBERS’ CONTRIBUTIONS
Dr Merlinda Shazellenne (Malaysia)
The most significant challenge is fostering unity across nations,
hierarchies, countries, regions, religions, races, and languages.
When we are united, we work best and without prejudice, for the
betterment of our world. Junior doctors must take the call to be
united, lead, and make our voice heard across the world!
Dr Rabindra Prasad Yadav (Nepal)
One primary global health challenge is that doctor-patient rapport
and trust have been hindered by misinformation spread by the
internet or news sources. To address this challenge, junior doctors
must incorporate novel approaches to best inform patients about
updated health information in their clinical responsibilities.
Dr Frank Rodríguez Yepez (Panama)
Inequities represent a major global health challenge, which was
clearly observed during the COVID-19 pandemic. As junior doctors,
we should recognize inequities in our countries, work closely with
our communities, and actively advocate for impactful changes.
Page 24
Junior Doctors Network Newsletter
Issue 24
October 2021
JDN MEMBERS’ CONTRIBUTIONS
Dr Marie-Claire Wangari (Kenya)
The quest for vaccine equity still plagues our world today, especially
in low- and middle-income countries. Junior doctors are an
invaluable human resource towards attaining vaccine equity
globally. They can advocate and push their leaders and
governments to do better and push for vaccination of all global
citizens. Indeed it is, “Nothing about us, without us.”
Page 25
In 2015, the Junior Doctors Network (JDN) Climate Change Working Group was formed to
organize JDN work and increase the World Medical Association (WMA)’s capacity to
engage in international climate change policy. It initially brought together JDN members
who, after participating in past experiences in the field of climate change and health, were
motivated by the desire to ensure that the voices of doctors were heard in the climate
negotiations at the time. In this early history of the group, many of the activities consisted of
planning, organizing, and coordinating advocacy related to negotiations of what would later
become the Paris Agreement (Photo 1). At this time, the JDN was one of the few health
groups which assiduously followed these negotiations.
The working group served as a platform where JDN members joined forces to
collaboratively write articles, conduct advocacy relevant research, and contribute to WMA
Policy. It recognized the unique position of health professionals in developing a positive
narrative capable of influencing climate change policy as well as the unique experiences of
JDN members in the field of climate change.
Junior Doctors Network Newsletter
Issue 24
October 2021
Climate Change Working Group Update
WORKING GROUPS
Yassen Tcholakov, MD MScPH MIH
Chairperson (2020−2021)
Climate Change Working Group Lead (2020−2021)
Junior Doctors Network
World Medical Association
Page 26
Photo 1. Meeting of Climate and Health advocates
during COP21 in Paris, France in December 2015.
Credit: JDN.
The Climate Change Working Group is
currently functioning in an ad-hoc mode and
only taking on tasks when opportunities arise.
Nevertheless, the working group welcomes
new project ideas from JDN members who
would like to take on leadership roles in
topics related to climate and health.
Medical Ethics form the foundation of the medical profession and comprise an integral part
of global health. Over the past decade, health professionals have encouraged and
stimulated discussions on diverse topics related to Medical Ethics, including clinical
competencies and responsibilities, human and animal research, patient confidentiality, and
end-of-life care. As such, junior doctors should be engaged as active leaders, encouraging
continued dialogue amongst the global health workforce on these diverse themes.
In June 2019, the Junior Doctors Network (JDN) formed the Medical Ethics Working Group
as a global network where junior doctors can share essential information, resources, and
activities on Medical Ethics topics. This working group aims to increase awareness about
Medical Ethics amongst junior doctors through innovative and scholarly activities. It has
had activities on Medical Ethics topics and encourages the active participation of junior
doctors in policy analysis, policy review, and research collaboration related to Medical
Ethics topics. The team has successfully completed many activities during 2021 (Figure 1).
Junior Doctors Network Newsletter
Issue 24
October 2021
Medical Ethics Working Group Update
WORKING GROUP UPDATES
Lwando Maki, MBCHB DiPEC AHM MRSSAf
Medical Ethics Officer (2020−2021)
Chair, Medical Ethics Working Group (2020−2021)
Junior Doctors Network
World Medical Association
Page 27
❑ Medical Ethics Alive: Coordinated the Grand Round
Webinar Series with Médecins Sans
Frontières/Doctors Without Borders on “Vaccine
Equity”. Prepared logistics for first (Spanish) bilingual
JDN webinar scheduled for February 2022.
❑ Medical Ethics Collaboration: Submitted the draft
proposal of the first JDN Working Group focusing on
LGBTQIA awareness.
❑ Medical Ethics Papers: Submitted three scientific
manuscripts to the World Medical Journal. Completed
a second collaboration (Medical Ethics Special Edition
of the JDN Newsletter) with the Publications Team.
If you are interested in Medical
Ethics and would like to participate
with other JDN colleagues in
collaborative activities, please
contact Dr Lwando Maki (Chair,
JDN Medical Ethics Working Group:
dr.lwando.maki@gmail.com).
Stay connected, and let your voice
reach the world!
Sincerely,
Lwando Maki
Figure 1. Medical Ethics Working Group activities during 2021.
Founded in last quarter of 2020, the Medical Exchange, Education, and International
Mobility Working Group is comprised of energetic, highly motivated, and dedicated Junior
Doctors Network (JDN) members who are interested in the advancement of medical
education. Education is one of the vital mission statements of the JDN, since the adequate
education of healthcare workers ultimately translates into optimal patient care.
Over the past few months, our Working Group has coordinated several activities for
continued learning and networking (Figure 1).
Junior Doctors Network Newsletter
Issue 24
October 2021
Medical Exchange, Education, and International Mobility
Working Group Update
WORKING GROUP UPDATES
Uchechukwu Arum, MD
Education Director (2020−2021)
Chair, Medical Exchange, Education, and International Mobility
Working Group (2020−2021)
Junior Doctors Network
World Medical Association
Page 28
❑ January 2021: JDN members connected on the first quarterly Working Group telecon.
❑ February 2021: The Working Group participated in the Accreditation Council for Graduate
Medical Education (ACGME) annual conference, which was held virtually from February
24-26, 2021. Using the theme, “Meaning in Medicine: Mastering the Moment”, JDN
members attended various conference sessions and expanded their networks within the
graduate medical community.
❑ March 2021: The Working Group Lead (Dr Uchechukwu Arum) coordinated the “Doctors’
Well-being” webinar on March 20, 2021. The keynote speakers included Dr Stuart Slavin,
a renowned ACGME Senior Scholar on Doctors’ Well-being, and Dr Elizabeth Gitau, Chief
Executive Officer of the Kenya Medical Association.
❑ April 2021: The Working Group Lead (Dr Uchechukwu Arum) coordinated the Working
Group sessions at the JDN biannual meeting.
❑ May 2021: The Working Group participated in the UNESCO World Conference on
Education for Sustainable Development.
❑ February-June 2021: The Working Group collaborated with the JDN Publications Team to
publish the Doctors’ Well-being Special Edition of the JDN Newsletter.
❑ June 2021: JDN members connected on the second quarterly Working Group telecon.
❑ August 2021: The Working Group Lead (Dr Uchechukwu Arum) represented the JDN in
the revision of World Federation for Medical Education Post-graduate Standards.
Figure 1. Coordinated Medical Exchange, Education, and International Mobility Working Group
activities for January-August 2021.
The Working Group will continue to explore avenues to partner with health institutions that
encourage medical exchange and international mobility. With the increased mobility of the
medical workforce across countries and continents, interdependence of nations in
combating disease, and globalisation, there is need for continued exchange of innovative
ideas and expertise.
The Working Group welcomes JDN members to contribute ideas and participate in
activities that will help advance medical education. These efforts will ultimately advance the
delivery of high-quality medical care and positively impact population health. If you are
interested in medical education and would like to participate with other JDN colleagues on
our virtual meetings and collaborative activities, please contact Dr Uchechukwu Arum
(Chair, JDN Medical Exchange, Education, and International Mobility Working Group:
arumaco@gmail.com).
Sincerely,
Uchechukwu Arum
Junior Doctors Network Newsletter
Issue 24
October 2021
WORKING GROUP UPDATES Page 29
As JDN members, we are leaders at the forefront of health
advocacy and can empower other physicians to learn more
about pressing health topics associated with medical
exchange and international mobility.
Since 2020, society has been managing the coronavirus disease 2019 (COVID-19)
pandemic that has completely shifted our daily clinical work. As the first specialty areas to
become involved, the departments of internal medicine and intensive care units have
continued to demonstrate resilience throughout the pandemic response efforts.
Over the past year, we have seen increased rates of COVID-19 incidence and
hospitalization, forcing hospitals to shift most of their clinical work to care for COVID-19
patients (1). This process has not only changed the physical configuration of our
departments, but it has also increased the allocation of health care workers to COVID-19
units (2). Doctors and nurses with training in critical care, infectious diseases, and
respiratory medicine were mobilized to newly created intensive care units. Then,
dermatologists, rheumatologists, and clinical oncologists were assigned to COVID-19
inpatient departments and emergency rooms.
Although serving our population during such crisis is a noble action, a few questions
remain:
Junior Doctors Network Newsletter
Issue 24
October 2021
Ethical Dilemmas in Post-graduate Training
during the COVID-19 Pandemic
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES
Rui Lourenço Teixeira, MD PhDc
Faculty of Medicine, University of Lisbon
Centro Hospitalar e Universitário de Lisboa Norte
Lisbon Academic Medical Center
Lisbon, Portugal
Page 30
❑ How many resources are needed?
❑ Between senior and junior doctors, who should be the first clinician to care for
COVID-19 patients?
❑ What criteria should be used in assigning doctors to COVID-19 units?
❑ Since many junior doctors are fully engaged in COVID-19 units, how long should
post-graduate training be postponed?
Like a long-standing war, many health professionals, namely doctors
and nurses, have been mobilized like soldiers to the battlefront.
Dilemma 1: Fulfilling Training Requirements
With several months assigned to COVID-19 health services – outside of their primary
medical training – junior doctors have been unable to fulfill their internship or training
requirements. Hence, they do not believe that they will be able to finish their post-graduate
trainings on their anticipated timeline. However, the question remains: How long will the
post-graduate medical training be postponed before trainees can complete the
requirements? Although many countries have developed different solutions, no strategy
has been publicly discussed (3).
Dilemma 2: Pursuing Doctoral Research Training
Like junior doctors in medical residency programs, similar challenges were faced by junior
doctors pursuing doctoral research training. Since hospitals focused on COVID-19 clinical
management, many research laboratories were closed or repurposed for COVID-19
diagnostic efforts. Although some clinical research programs were halted, clinical and non-
clinical researchers were encouraged to adapt their research on COVID-19-related topics.
Unfortunately, compensation or additional research grants were not frequently awarded.
Dilemma 3: Receiving Professional Recognition
Health care professionals – who have been involved with the clinical management for
COVID-19 and non-COVID-19 patients alike – have been honored by public and civil
authorities as heroes across the world. Some health systems have recognized this global
workforce with financial compensation or awards. However, we must reflect on the best
approach to acknowledge this global workforce: Is a symbolic financial amount sufficient,
especially as we consider this high-risk workplace setting? How should society award this
gratitude? Which ethical values should be considered when awarding such valuable
professionals?
Junior Doctors Network Newsletter
Issue 24
October 2021
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 31
By reflecting on these questions, three ethical dilemmas have
arisen in clinical practice.
We are living a fundamental opportunity to look again for our
ethical values framework and to take choices accordingly.
References
1) Kokudo N, Sugiyama H. Hospital capacity during the COVID-19 pandemic. Glob Health Med. 2021;3:56-
59.
2) McCabe R, Schmit N, Christen P, et al. Adapting hospital capacity to meet changing demands during the
COVID-19 pandemic. BMC Med. 2020;18:329.
3) Byrne LM, Holmboe ES, Combes JR, Nasca TJ. From medical school to residency: transitions during the
COVID-19 pandemic. J Grad Med Educ. 2020;12:507-511.
4) Padala PR, Jendro AM, Padala KP. Conducting clinical research during the COVID-19 pandemic:
investigator and participant perspectives. JMIR Public Health Surveill. 2020;6:e18887.
Junior Doctors Network Newsletter
Issue 24
October 2021
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 32
Critical times, such as the COVID-19 pandemic, tend to
expose the weaknesses of our national and global health
systems. However, they also offer an opportunity for
reflections on lessons learned, where health leaders can
identify strengths, achieved milestones, and areas for
improvement. At the same time, medical post-graduate
training is a precious window of time for trainees (Photo 1).
Difficult decisions must be made in relation to the training of
junior doctors.
Photo 1. Dr Rui Lourenço
Teixeira working in the hospital
in Portugal. Credit: Dr Rui
Lourenço Teixeira.
Through public health interventions, health workers can ensure societal conditions under
which people can lead healthier lives. Given this population-based focus, public health
often faces ethical dilemmas related to the extent of its reach and at what point the
interventions can infringe on individual liberties. This may differ from the ethical dilemmas
faced by medical interventions, which are based on individual interactions between
physicians and patients (1,2).
Medical ethics is based on four main principles – beneficence, non-maleficence, autonomy,
and justice – that can help identify moral dilemmas related to healthcare and biomedical
research. Some challenges are often related to the physician-patient relationship, including
abuses of power and shared decision-making about treatment. These principles are explicit
in describing physicians’ responsibilities toward patients and the wider community (1,2).
Even though public health concurs with the principles of medical ethics, it is difficult to fulfill
the expectations of the entire population.
Junior Doctors Network Newsletter
Issue 24
October 2021
Public Health Ethics during the COVID-19 Pandemic
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES
Frank Rodríguez Yepez, MD
Consultant, Pan American Health Organization
Panama Country Office
Panama City, Panama
Page 33
Public health is the science and art of protecting and improving
the health of the population as a whole.
An intervention that may be considered appropriate for one
population may not be appropriate for every individual within that
same population, and hence recognizing existing inequalities
within populations (1,2).
Over the past decades, public health ethics is an academic field that has been flourishing
extensively (3). Despite this growth, however, there is no current validated public health
ethics framework or code that can help provide a guideline in public health actions to
address ethical dilemmas at the global level (1,4). Some first steps have included three
scientific publications supported by the American Journal of Public Health, the American
Journal of Bioethics, and the American Public Health Association (1,3,4). In fact, the
APHA’s Public Health Code of Ethics offers a list of foundational ethical values of public
health: Professionalism and trust; Health and safety; Health justice and equity;
Interdependence and solidarity; Human rights and civil liberties; and Inclusivity and
engagement (4).
Using a public health lens, justice addresses the issue of fairness – in terms of the
distribution of intervention risks and benefits – ensuring that disparities related to health
conditions or outcomes among subgroups are minimized or eliminated (2). During the
COVID-19 pandemic, one clear example is vaccine equity, where the economic position of
countries has greatly influenced the vaccine distribution process. According to the World
Health Organization, as high-income countries were discussing booster shots, less than
Junior Doctors Network Newsletter
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October 2021
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 34
Figure 1. The COVID-19
pandemic has shown the
interconnectedness of our
global society. Credit: Pexels.
Each proposed intervention should seek to gain community
trust by relaying evidence-based information in a clear and
understandable form (Figure 1). Public health work should be
transparent and not be influenced by secondary interests.
Unfortunately, we have observed how opaque political
management and economical influences can jeopardize
community trust towards health authorities, including
widespread corruption and the promotion of unapproved
treatments.
Moving forward, the current COVID-19 pandemic represents an
opportunity to strengthen the process for documenting and sharing
best practices and success cases as useful resources that can
nurture future discussions.
one percent of populations in some low-income countries had received vaccines to date
(5). Since the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) knows no
borders, our global society needs solidarity and equitable distribution of vaccines to slow
down this pandemic, save lives, and achieve economic recovery (Figure 2).
References
1) Kass NE. An ethics framework for public health. Am J Public Health. 2001;91:1776-1782.
2) Swain GR, Burns KA, Etkind P. Preparedness: medical ethics versus public health ethics. J Public Health
Manag Pract. 2008;14:354-357.
3) Prah Ruger J. Positive public health ethics: toward flourishing and resilient communities and individuals.
Am J Bioeth. 2020;20:44-54.
4) American Public Health Association. Public health code of ethics. 2019 [cited 2021 Aug 30].
5) Georgieva K, Adhanom Ghebreyesus T, Malpass D, Okonjo-Iweala N. A new commitment for vaccine
equity and defeating the pandemic. 2021 [cited 2021 Aug 30].
Junior Doctors Network Newsletter
Issue 24
October 2021
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 35
Figure 2. Global access to COVID-19
vaccines offers the best hope for slowing
the COVID-19 pandemic. Credit: Pexels.
During the COVID-19 pandemic, we have witnessed the
rise of anti-vax and anti-mask movements. However, the
real question remains: To what extent can these
individual liberties be allowed if they will jeopardize the
health and well-being of an entire community?
Emerging environmental health risks can lead to an imbalance in the surrounding aquatic,
atmospheric, and terrestrial ecosystems, which can ultimately impact human and animal
health. The complex interplay of factors connecting human, animal, and environmental
health is recognized as the One Health concept (1).
Global health leaders will need to form multidisciplinary collaborations that can identify
vulnerable populations and develop prompt interventions that can mitigate risk to population
health and achieve the targets of the Sustainable Development Goals.
Junior Doctors Network Newsletter
Issue 24
October 2021
Junior Doctors Lead a Global Call to Action
to Promote Multidisciplinary Collaborations
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES
Helena Chapman, MD MPH PhD
Publications Director (2020−2021)
Junior Doctors Network
World Medical Association
“Look deep into nature, and then you will understand everything better”
− Albert Einstein
❑ Elevating health in the climate debate
❑ Delivering health in conflict and crisis
❑ Making health care fairer
❑ Expanding access to medicines
❑ Stopping infectious diseases
❑ Preparing for epidemics
❑ Protecting people from dangerous products
❑ Investing in the people who defend our health
❑ Keeping adolescents safe
❑ Earning public trust
❑ Harnessing new technologies
❑ Protecting the medicines that protect us
❑ Keeping health care clean
Figure 1. Urgent health challenges for the next decade.
Source: World Health Organization (2).
Page 36
In 2020, the World Health Organization
(WHO) recognized 13 global health
challenges to monitor over this “decade of
action” – including climate change, spread
of infectious diseases and antimicrobial
resistance, and unprepared health systems
during epidemics or crises – which will
require substantial global investment to
quantify risk, implement mitigation actions,
and build community and environmental
resiliency (2) (Figure 1).
Notably, the coronavirus disease 2019 (COVID-19) pandemic underscored the need to
better understand the One Health concept, including the impact of the lockdown restrictions
on Earth’s systems that exacerbated social and health disparities, including exposure to air
pollution (3). To connect global decision-makers and stakeholders, junior doctors are
uniquely trained to lead these dialogues that discuss innovative scientific approaches,
share relevant data and technologies, and stress the value of multidisciplinary
collaborations. These efforts will promote global solidarity and ultimately bridge the
scientific knowledge gap with forward steps to achieve national (e.g. Ministry of Health) and
international priorities (e.g. Sustainable Development Goals).
Identifying Novel Scientific Approaches and Data Sources
“To raise new questions, new possibilities, to regard old problems from a new angle,
requires creative imagination and marks real advance in science” (Albert Einstein). As
junior doctors complete their post-graduate training in medical and research specialties,
their training is typically focused on learning the principles of clinical medicine and
epidemiology as the foundation of public health. During the COVID-19 pandemic, however,
global leaders gained insight on the One Health concept and the benefit of multidisciplinary
collaborations, which incorporate diverse scientific approaches to advance scientific inquiry.
As a result, global experts from environmental sciences to economics – including junior
doctors – were widely involved in forming roundtables, developing data dashboards, and
presenting conference keynotes – all in efforts to better understand the spread of COVID-
19.
Four examples of innovative scientific approaches can offer junior doctors a holistic view of
the social determinants of health – including the social environment, physical infrastructure,
and access to health care services – that influence community health and well-being (4).
First, satellite data (e.g. National Aeronautics and Space Administration, NASA) can
complement traditional epidemiological approaches by offering real-time information of
public health importance about the natural and anthropogenic changes to surrounding
ecosystems. Second, data dashboards like the COVID-19 Earth Observation Dashboard,
supported by NASA, the European Space Agency, and the Japan Aerospace Exploration
Agency, present over 100 data indicators – economic, agriculture, water, air, and health –
to examine the effects of environmental and economic factors of the COVID-19 pandemic.
Junior Doctors Network Newsletter
Issue 24
October 2021
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 37
Junior doctors can continue to expand their knowledge toolbox
with complementary training that can advance their community
health and research activities.
Third, citizen science applications, defined as public participation in the research process of
data collection and analysis, can be instrumental to expand data collection coverage as
well as validate ground-based data with other data sources (e.g. satellite data). Finally,
qualitative research designs and analyses – such as case study, ethnography, grounded
theory, narrative, and phenomenology – can offer an instrumental lens to explore the social
dimensions of emerging environmental risks that influence individual and community health
and well-being.
Leveraging Scientific Knowledge through Multidisciplinary Collaborations
“Coming together is a beginning, staying together is progress, and working together is
success” (Henry Ford). Junior doctors, who are currently pursuing an array of clinical
disciplines across global settings, continue to collaborate on Junior Doctors Network (JDN)
working groups and provide commentary on World Medical Association (WMA) policy
statements. They have contributed their expertise through their participation in national and
international conferences and meetings as well as publications on original research,
reviews, and commentaries. These key activities provide insightful dialogue about existing
knowledge gaps and health inequities, propose critical policy analyses, and offer
recommendations to guide future community action in their countries. However, junior
doctors can expand their professional networks with other scientific communities –
including environmental and social scientists – where they share resources and build
innovative partnerships to advance scientific inquiry and discovery.
Two examples of multidisciplinary collaborations provide a unique platform for junior
doctors to impart their knowledge and skills and foster shared learning in global teams.
Junior Doctors Network Newsletter
Issue 24
October 2021
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 38
First, the Group on Earth Observations (GEO)
Health Community of Practice serves as a global
network of professionals who use satellite data to
improve health decision-making at local, national,
and international levels (Figure 2). Biweekly
community teleconferences, small work groups
(heat, infectious diseases, air quality, food
security and safety, health care infrastructure),
and symposia (e.g. GEO Virtual Symposium
2021, AmeriGEO Week 2021) present
opportunities for researchers and practitioners to
leverage their proficiencies, identify research and
practice gaps, and discuss next steps to advance
the scientific knowledge base.
Figure 2. GEO Health Community of Practice.
Credit: Dr Helena Chapman.
The WHO recognized the International Year of Health and Care Workers in 2021, and it is
time to highlight the key contributions of health care workers throughout the year –
including those frontline workers during the COVID-19 pandemic. As global leaders develop
management plans for emerging One Health risks – especially climate resilience for
sustainable development and pandemic preparedness – junior doctors can lead the call to
action that connects scientific disciplines in cross-cutting research applications to explore
community needs and develop solutions to safeguard population health. As they have
demonstrated their unique societal contributions in clinical and community health, health
education activities, and community advocacy during the COVID-19 pandemic, they are
strategically placed to guide national and global discourse that prioritizes the incorporation
of diverse scientific approaches in multidisciplinary collaborations and partnerships to
minimize community risk of endemic and epidemic health threats.
References
1) Centers for Disease Control and Prevention. One health. 2020 [cited 2021 Sep 1].
2) World Health Organization. Urgent health challenges for the next decade. 2020 [cited 2021 Sep 1].
3) Kerr GH, Goldberg DL, Anenberg SC. COVID-19 pandemic reveals persistent disparities in nitrogen
dioxide pollution. Proc Natl Acad Sci U.S.A. 2021;118:e2022409118.
4) Centers for Disease Control and Prevention. NCHHSTP social determinants of health. 2019 [cited 2021
Sep 1].
Junior Doctors Network Newsletter
Issue 24
October 2021
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 39
Figure 3. One Health Social Sciences Initiative of the
One Health Commission. Credit: OHSS.
Second, the One Health Social Sciences
Initiative of the One Health Commission offers a
network of social scientists that aims to identify
and address the root causes of disease and
determinants of community health through
social science methods and approaches
(Figure 3). Small work groups (climate change
and environmental justice, food security,
infectious diseases, pandemic control, policy)
provide a stage for in-depth dialogue about
current knowledge gaps and best approaches to
build global partnerships.
Together, junior doctors can lead discourse on key health
priorities that prioritize the One Health concept in national
and global health decision-making activities!
Globally, as we continue to suffer from exponentially rising health inequities, the
consequence of such situations leaves populations more vulnerable to degrading socio-
economic conditions. In contrast, healthcare delivery is experiencing growing technological
advancements with the use of telemedicine and other inventions. Many digital projects
aimed at improving both access to healthcare and the quality of healthcare delivery in low-
and middle-income countries (LMICs) have focused on healthcare challenges in LMICs.
These initiatives are now more clearly focused on the need for effective scaling and
integration to provide long-term benefit to healthcare systems, having progressed beyond
the initial phase of piloting and experimentation.
These inventions are capable of combining medical and the Internet of Things (IoT),
including mobile health (mHealth), antiretroviral therapy, blockchain technology, and
electronic medical records. Medical internet (IoMT) refers to the combination of medical
equipment and health information technology system applications that utilize networking
technology. The IoT uses cases of telemedicine to improve communication between
patients and physicians, reduce exposure potentials for contagious illnesses, and use
different intelligent sensor technologies capable of collecting data at the user level. For
instance, as a result of the coronavirus disease 2019 (COVID-19) pandemic, demand for
telehealth services increased, with more clinicians depending on technology to offer virtual
consultations for patient management.
Junior Doctors Network Newsletter
Issue 24
October 2021
Digitization of Healthcare Service Delivery
in Low- and Middle-income Countries
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 40
Parth Patel, MBBS
Atlas Medical Center
Blantyre, Malawi
Sahiba Maniar, MBBS
Grant Medical College and Sir Jamshedjee
Jeejeebhoy Group of Hospitals
Mumbai, India
Digital advancements in health are aimed to reduce time, increase
precision, and streamline efficiency through technological innovations.
Innovative IoT applications continue to be useful in the provision of healthcare services,
particularly in chronic disease management. For example, mHealth – including wearables,
applications, and mobile systems – can offer access to healthcare services and help
monitor some health conditions. The COVID-19 pandemic has led to a growing demand for
wearables for personal health surveillance, which directly connects medical and consumer
equipment. Wearable device suppliers have included cardiac variability features,
continuous glucose monitoring, electrocardiography, and pulse oximeters.
For example, several hospitals use AI-based patient surveillance tools to collect patient
information and provide real-time clinical management. The application of AI in medical
imaging can enhance protocol and reduce the number of steps required to execute a
specific task. Furthermore, a digital twin AI program can mimic medical devices and
patients as well as show how devices might function in real-life situations.
The implementation of telemedicine has helped close the health inequity gap, and there are
several benefits to consider in clinical practice.
❑ Consultation convenience. The challenge of time restrictions makes telemedicine a
more convenient healthcare service. The use of video calls, telephone calls, and web
chat allows clients to receive clinical evaluations and seek follow-up consultations on
prescriptions with doctors with their network.
❑ Less waiting time. Telemedicine can significantly reduce the waiting time at office
visits, since it only takes minutes to register health history on the online system.
❑ Cost-efficiency. A rising proportion of doctors charge less for teleconsultations when
compared to their face-to-face consultations. Since telemedicine can reduce travel costs,
families living in rural areas can benefit from increased access to healthcare services
from the comfort of their homes.
❑ Efficient transmission systems. These systems enhance how doctors communicate
and receive patients’ radiological and laboratory reports, as alternative measures to
personal visits and mail.
❑ Confidentiality. Telemedicine complies with Health Insurance Portability and
Accountability Act (HIPAA) standards aimed at preventing the leakage of personal health
information.
Junior Doctors Network Newsletter
Issue 24
October 2021
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 41
The use of artificial intelligence (AI) can enhance human decision-
making through automation and accelerate work-intensive jobs in
healthcare applications.
Despite data supporting telehealth provision in high-income countries, there is no current
evidence of its economic benefits for patients living in LMICs, where access and cost are
major impediments to healthcare services. Hence, telemedicine has a few limitations.
❑ Electronic glitches. As technology depends on the power supply, increased weather
and other disturbances may lead to power outages or interrupted internet access, which
can disrupt an online medical appointment.
❑ Physician resistance. Doctors, who struggle to use modern technology comfortably,
may resist use of this innovative technology.
❑ Inadequate assessment. Virtual interactions with primary healthcare providers or
dentists may fail to identify key non-verbal cues and lead to incomplete clinical
assessments.
Moving forward, there remains a pivotable need to improve public knowledge and
understanding of how digital healthcare systems work as well as overall awareness of the
benefits of telemedicine over traditional consultation approaches. The telemedicine design
process should involve community feedback at all steps, including procurement and
availability of uniformly distributed infrastructure, and consider four additional elements.
First, in order to identify societal demands, these efforts should entail efficient cooperation
with local leaders, healthcare experts, academic establishments and educators, healthcare
administrators, and local policymakers. Second, funding for healthcare-enhancing
innovations should focus on technology and social innovation. Third, telemedicine
programs that consider visual or hearing impairment, literacy levels, and learning
disabilities are essential to eliminate current health inequities and inequalities.
References
1) Labrique AB, Wadhwani C, Williams KA, et al. Best practices in scaling digital health in low and middle
income countries. Global Health. 2018;14:103.
2) Bernstein C. Digital health (digital healthcare). SearchHealthIT. 2021 [cited 2021 Aug 24].
3) Harper J. Pros and cons of telemedicine for today’s workers. US News. 2012 [cited 2021 Aug 24].
4) Babatunde AO, Abdulazeez AO, Adeyemo EA, Uche-Orji CI, Saliyu AA. Telemedicine in low and middle
income countries: closing or widening the health inequalities gap? European J Env Publi. 2021;5:em0075.
Junior Doctors Network Newsletter
Issue 24
October 2021
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 42
Although telemedicine can minimize health inequalities and allow
the achievement of universal health coverage in LMICs,
telemedicine applications should be more human-centered to
respond to real-time scenarios.
The World Health Organization (WHO) has defined social accountability as: “the obligation
to direct their education, research and service activities towards addressing the priority
health concerns of the community, the region, and/or the nation they have a mandate to
serve. The priority health concerns are to be identified jointly by governments, health care
organizations, health professionals and the public” (1). In this participatory process, citizens
are engaged to hold politicians, policymakers, and public officials accountable for the
provision of services (1). There is a growing body of research on the role of social
accountability in bringing about more accessible and high-quality healthcare, including the
World Development Report 2004: Making Services Work for Poor People (2,3).
In most democracies, the idea of accountability is embedded in the notion of electoral votes
for political parties or officials whose political mandates indicate specific policies (e.g.
healthcare) to pursue once elected. They often use generic, catchy slogans that promise
high-quality health services for all. These political mandates, however, show few details on
the exact policy reforms, feasibility studies, or any monitoring mechanisms to ensure
quality implementation of these so-called reforms.
Three primary stakeholders can be identified in the healthcare service system: the
government, healthcare providers, and the community. In a country like Pakistan, where
universal health coverage is still a farfetched dream, this article highlights existing
challenges and offers recommendations when implementing the framework of social
accountability.
Junior Doctors Network Newsletter
Issue 24
October 2021
Social Accountability: One Step at a Time
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES
Nishwa Azeem, MBBS
Research Assistant, Acute Stroke Center
Lahore General Hospital
Lahore, Pakistan
Page 43
These efforts call for the need for continuous civic engagement
in public service delivery.
Disseminating Information
Pakistan has an estimated 60% literacy rate and a low voter turnout, betokening little
political participation by the people. In a country like Pakistan, 70% of the national health
expenditures is paid out-of-pocket by citizens seeking private healthcare. This observation
shows the failure of government services. To address this burden, the first step to social
accountability is to inform the public of their right to health through high-quality and
accessible healthcare services.
Knowledge of Rights
Junior doctors are a product of the healthcare system, where welded professional
hierarchies and top-to-bottom health policy changes are a social norm. Oftentimes, they
are uninformed of their rights throughout their medical training. To increase their general
awareness, health authorities should ensure that they have the right to respectable pay,
appropriate workplace environments, and personal security.
Community Involvement
Civil society engagement means aligning healthcare priorities towards community needs by
meeting with community members and listening to their narratives. First, when policies are
made in closed offices by bureaucrats who are not always representative of the
communities, but rather come from a place of privilege, technocratic policies that are
quixotic and ineffective in the real world are bound to fail. Each union council (local
government) should make the annual budget accessible and open to community
discussion. Through public dialogue, the alignment of budget priorities will be truly reflective
of community needs and desires. For instance, the community may prefer more doctors or
an emergency doctor at the local hospital, instead of building a new primary healthcare
clinic. Hence, by considering the priorities of community members, healthcare workers can
support dialogue platforms between communities and their governing bodies, while
expanding coverage to marginalised groups.
Junior Doctors Network Newsletter
Issue 24
October 2021
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 44
To improve accessibility, a ‘bottom-up’ approach to policy
with customised communication plans is needed.
This step can encourage the development of health campaigns
that offer more clear and understandable public messaging on
pressing health issues.
Monitoring and Evaluation Methods
Once these reflective policies are developed, it is important to monitor and evaluate
healthcare provisions as well as existing challenges for healthcare and administrative
workers. It is equally critical to provide an open channel for them to be able to voice their
concerns over their well-being, satisfaction, and workplace stressors. For example, junior
doctors can experience significant levels of burnout or exhaustion that can impact their
attention and focus (4). Also, the Lady Health Workers went on strike for three months
when they were not paid their salaries, which led to a colossal impact on the polio
vaccination drive in Pakistan. To address these challenges, patient feedback, clinic exit
interviews, and community scorecards are essential to keep services effective and
encourage continuous problem-solving. Studies show that integrating patients’ perspectives
can potentially increase patient satisfaction with consultation as well as result in better
management decisions and optimal health outcomes (5,6).
Working as a junior doctor, I have witnessed how doctors and patients can become
frustrated. Patients are frustrated that they cannot access high-quality healthcare services
and have to resort to substandard private practices. Doctors are frustrated for having to
work inhumane hours in unhealthy and unsafe working environments, while having to deal
with patient complications due to seeking private healthcare services. The problem arises
when the needs of communities and healthcare providers are not addressed, which fosters
an environment of animosity and mistrust in the medical profession.
References
1) Boelen C, Heck JE; World Health Organization. Defining and measuring the social accountability of
medical schools. Geneva: WHO; 1995.
2) Boydell V, McMullen H, Cordero J, et al. Studying social accountability in the context of health system
strengthening: innovations and considerations for future work. Health Res Policy Sys. 2019;17:34.
3) World Bank. World Development Report 2004: making services work for poor people. Washington, DC:
World Bank; 2003.
4) Beyond Blue. National mental health survey of doctors and medical students. Melbourne, Australia:
Beyond Blue; 2013.
5) Frosch DL, Kaplan RM. Shared decision making in clinical medicine: past research and future directions.
Am J Prev Med. 1999;17:285-294.
6) de Ridder DTD, Theunissen NCM, van Dulmen SM. Does training general practitioners to elicit patients’
illness representations and action plans influence their communication as a whole? Patient Educ Couns.
2007;66:327-336.
Junior Doctors Network Newsletter
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October 2021
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These problems are not inherent to healthcare systems. They can be
solved through social accountability and collective action.
Transplants are one of the therapeutic and surgical alternatives to improve health and
quality of life. They have been successfully performed since the second half of the 20th
century. Although the world’s first successful kidney transplant was performed in 1954, the
first kidney transplant in Mexico occurred in 1963 (1). From a health systems perspective,
transplants correspond to the attention of high specialty services, focused on the individual
level.
This process begins with the identification of a potential organ or tissue donor. According to
Mexico’s General Health Law, hospitals that conduct these procedures must have a donor
coordinator (DC) (2). This health professional handles the evaluation and selection of
potential donors and promotes organ donation. This role is fundamental, principally
because the DC contributes to increasing the number of potential tissue and organ donors
within hospitals.
Some decision-makers argue that it is vital to focus efforts on increasing community
awareness and acceptance of organ donations, especially since relatives can refuse these
procedures. According to several surveys, however, a significant proportion of people have
expressed interest in becoming a donor (3,4). Therefore, since multiple health service
factors are involved – including the person’s willingness to donate, time required for the
delivery of the body, administrative procedures, and comprehensive knowledge about the
process – a DC should intervene efficiently.
Junior Doctors Network Newsletter
Issue 24
October 2021
Health Workforce Training in Organ and Tissue Donation
in Mexico
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES
Cinthya Lucio, MD MSc
Medical Coordinator, National Transplantation Centre
Ministry of Health
Mexico City, Mexico
Page 46
A series of regulatory, operational, organisational, economic, health,
and educational aspects are required to perform an organ transplant.
Training of the Donor Coordinator
In Mexico, the National Transplant Centre, a specialised agency of the Ministry of Health,
provides training through the Diploma for the Training of Coordinators for Organ and Tissue
Donation intended for Transplantation. With the inaugural session held in 2005, the Ministry
of Health has supported a total of 55 sessions until 2021. The syllabus consists of two
phases of theory (two weeks) and clinical practice (four weeks). Due to the coronavirus
disease 2019 (COVID-19) pandemic, the theoretical phase has been conducted online,
where participants have the opportunity to learn remotely from various experts on legal,
bioethical, clinical, and administrative topics related to donation and transplantation
processes. The clinical practice phase takes place in licensed hospitals under the guidance
of a senior DC.
In Mexico, the medical degree is awarded after successful completion of the 4-5 year
program of basic and clinical sciences, including one year of rotating internships and one
year of community service. Although most students are assigned to a primary health care
centre during the community service, alternatives include rotations in research, clinical care
in general hospitals, and the donation and transplantation program. Currently, 12
universities have implemented the donation and transplantation program, and 12 medical
school cohorts have graduated each year. Part of the training programme includes the
aforementioned diploma and a course in research methodology to conduct projects that
strengthen donation and transplantation activities.
Eleven years ago, I served as a Local Officer of Public Health of the International
Federation of Medical Students’ Associations (IFMSA). In this role, I commenced promoting
organ and tissue donations through community educational campaigns. Currently, as a
Medical Coordinator of the National Transplantation Centre, I am incredibly satisfied to
contribute to these training programmes as a professor and advisor to future generations of
health professionals. Undoubtedly, the health workforce – including DCs – are at the core
of health systems, and they must be sufficiently competent to implement these processes
with high standards of quality and efficiency.
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October 2021
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 47
The DC is a medical specialist or general practitioner with
experience and training in donation and transplantation.
After all, training and education strategies are essential to increase
organ and tissue donations for the benefit of people whose lives
depend on a transplant.
References
1) Hatzinger M, Stastny M, Grützmacher P, Sohn M. [The history of kidney transplantation]. Urologe A.
2016;55(10):1353-1359. German.
2) Diario Oficial de la Federación (Government of Mexico). Ley General de Salud. Mexico City, Mexico:
Government of Mexico; 2018. Spanish.
3) López-Falcony R, Ramírez-Orozco R, Ortiz-Aldana FI, et al. Attitudes toward organ donation and
transplantation in Guanajuato, Mexico. Transplant Proc. 2016;48(2):556-558.
4) Wakefield CE, Watts KJ, Homewood J, Meiser B, Siminoff LA. Attitudes toward organ donation and donor
behavior: a review of the international literature. Prog Transplant. 2010;20:380-391.
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October 2021
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 48
Junior Doctors Network Newsletter
Issue 24
October 2021
Who Can Heal My Pain?
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS
Dabota Yvonne Buowari, MD
Department of Accident and Emergency
University of Port Harcourt Teaching Hospital
Port Harcourt, Rivers State, Nigeria
Who can heal my pain
After I have been raped?
Who heals my pain
After my daughter has been raped?
Who can heal my pain
After I am sexually assaulted?
The pain is physical
The pain is emotional and psychological
The pain is deep in the heart
That it cannot be seen
The pain creates a hole in my heart
Where no medication can reach
No one can understand how I feel
Even the psychologist cannot provide healing
The pain which leaves scars beneath my flawless skin
Remains part of my soul
Page 49
Note: As a member of the Medical Women Association of Nigeria, Rivers State Branch,
the author dedicates this poem to the victims, survivors, and families of sexual assault.
During my undergraduate years in medical school at the University of Port Harcourt, in
Nigeria, I learned about economic, health, and social challenges experienced during
epidemics as well as pandemics throughout history. I was also encouraged to update my
medical knowledge about emerging diseases. After the World Medical Organization
declared the coronavirus disease 2019 (COVID-19) as a pandemic in March 2020, the
Nigerian Ministry of Health took several steps to train healthcare workers on best clinical
practices for clinical diagnosis, treatment, and use of personal protective equipment.
Lesson 1: Empathy
During the peak of the first wave of the COVID-19 pandemic, universal precautions were
observed, such as strict handwashing practices, physical distance between doctors and
patients during consultations, and use of personal protective equipment like facemasks and
face shields. During clinical interactions, active communication and empathy are essential
to maintain rapport with patients and encourage health and well-being. Junior doctors can
refine these valuable skills, which offer close connections with patients and families during
difficult conversations in clinical management, such as disease complications and end-of-
life decisions.
Junior Doctors Network Newsletter
Issue 24
October 2021
The Impact of the COVID-19 Pandemic on Junior Doctors:
Perspectives from a Nigerian Physician
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 50
Dabota Yvonne Buowari, MD
Department of Accident and Emergency
University of Port Harcourt Teaching Hospital
Port Harcourt, Rivers State, Nigeria
As a physician working in the emergency department in a
Nigerian teaching hospital, I share five lessons learned that
junior doctors can apply during their medical training – during
the COVID-19 pandemic and beyond.
Lesson 2: Comprehensive Medical History and Evaluation
Working in the emergency department requires rapid clinical decision-making to provide
timely disease management. However, accuracy, quality of care, and safety are important
elements to completing a comprehensive medical history and physical examination. Junior
doctors can apply their medical knowledge as well as understanding of ethical principles of
autonomy, beneficence, non-maleficence, and justice in clinical practice with patients and
families. Since the application of ethical principles in clinical practice can present unique
challenges, they can seek guidance and share best practices with colleagues and
supervisors.
Lesson 3: Continuous Medical Education and Professional Development
Emerging health challenges require healthcare workers to remain up-to-date on clinical
diagnosis, treatment, and prevention strategies. Junior doctors are responsible to take
appropriate continuous medical education and professional development courses to
prepare for the expected and unexpected clinical scenarios. They can also participate in
clinical case discussions and journal clubs to discuss novel diagnosis and treatment,
identify additional resources, and share lessons learned.
Lesson 4: Finding Work-Life Balance
Work-life balance is essential to maintain optimal health and well-being during medical
training. During the COVID-19 pandemic, junior doctors have experienced Zoom fatigue
and burnout, especially managing increased clinical responsibilities in the workplace. In
addition to their clinical practice, they were required to attend numerous virtual trainings,
workshops, and conferences in order to remain up-to-date with the rapid publications on
COVID-19. Hence, although managing the work-life balance has been challenging, it has
provided additional lessons learned during their medical training.
Lesson 5: Finding Creative Solutions for Mental Health
The ability to remain creative outside of the clinical environment is essential for all
healthcare workers. With the intense workload, junior doctors can seek opportunities to
share their experiences through creative writing and art. As frontline workers during the
pandemic, junior doctors can seek time for self-reflection as a way to reduce anxiety and
stress.
Junior Doctors Network Newsletter
Issue 24
October 2021
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 51
During the COVID-19 pandemic, I authored several poems,
including “My Face Mask” and “My COVID-19 Hero”.
Conclusion
The COVID-19 pandemic has significantly impacted our global society, and our lessons
learned will forever change clinical practice. All healthcare workers – including junior
doctors – should continue to strengthen their clinical knowledge and skills, practice
universal precautions at work and home, and apply best practices in doctor-patient
communication and clinical decision-making.
Junior Doctors Network Newsletter
Issue 24
October 2021
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 52
From its first appearance in the city of Wuhan to global concern, the coronavirus disease
2019 (COVID-19) has represented a major challenge for doctors and researchers around
the world. Following the recognition of COVID-19 as a public health emergency by the
World Health Organization (WHO), national governments recommended preventive and
protective measures (1). As of September 17, 2021, there have been 226,844,344
confirmed cases of COVID-19 reported to the WHO (2).
From the beginning of the COVID-19 pandemic, many elective surgical procedures have
either been cancelled or postponed. In 2020, with more than 600,000 surgical procedures
cancelled in Italy, the Italian healthcare system underwent major restructuring in order to
manage the impacts of the pandemic (3,4). Hospitals and clinical wards have been
dedicated to the care and treatment of COVID-19 patients. Many physicians and nurses
have been hired and transferred to work in infectious disease wards and intensive care
units.
Amid the pandemic, surgical patients have been facing two risks: the risk of the severe
acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the risk of not
having access to surgical care. Patients with perioperative SARS-CoV-2 infection have an
increased risk of postoperative pulmonary complications and mortality (5). Elective
surgeries were reduced due to the increased occupancy of critical care beds and demand
on anaesthesiologists in intensive care units. In light of current recommendations, various
Junior Doctors Network Newsletter
Issue 24
October 2021
The Impact of the COVID-19 Pandemic
on Surgical Care in Italy
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS
Teresa Perra, MD
Resident in General Surgery
University of Sassari
Sassari, Italy
Page 53
The pandemic, however, has directly affected health service
delivery, including significant impacts to surgical management.
measures were adopted for surgical practices. Wherever possible, separate environments
and pathways were set for patients with suspected or confirmed SARS-CoV-2 infection,
and personal protective equipment was required in clinical and surgical wards (6). Since
some surgical procedures cannot be postponed – especially patients with life-threatening
illnesses, malignancies that could progress, and active symptoms requiring urgent
treatment – careful attention should be given to patients diagnosed with cancer or end-of-
life illnesses.
In 2020, more than 50,000 surgical oncology procedures were cancelled in Italy (3,7).
Delays in cancer diagnosis and treatment can have negative consequences on morbidity
and mortality. The COVID-19 pandemic has delayed waiting lists for surgical procedures as
well as diagnosis and treatment for advanced cancer stages.
First, the best way to prevent virus spread is limiting exposure, applying recommended
preventive measures, and administering the vaccine. Second, collaborations between
global surgeons and researchers can offer shared knowledge about best practices and
lessons learned as well as potential solutions for surgical management of patients during
the pandemic. Finally, junior doctors should act locally by promoting the WHO
recommendations to stop COVID-19 community transmission. They can also act globally
by sharing clinical and community health experiences, highlighting challenges, and
proposing novel solutions to mitigate risk to community health.
Junior Doctors Network Newsletter
Issue 24
October 2021
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 54
Oncology patients need early diagnosis and prompt treatment, and
surgery plays a crucial role in their care.
Looking ahead, it is important for health systems to identify
sustainable solutions to minimize COVID-19 transmission and offer
support for rescheduled medical and surgical services.
References
1) World Health Organization. Coronavirus disease (COVID-19) advice for the public. 2021 [cited 2021 Aug
19].
2) World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard. 2021 [cited 2021 Sep
19].
3) Pierluigi M. Lettera al Ministro dal Presidente ACOI. 2021 [updated 2020 Nov 26; cited 2021 Aug 29].
Italian.
4) Camera dei deputati Servizio Studi XVIII Legislatura. Misure sanitarie per fronteggiare l’emergenza
coronavirus. 2021 [cited 2021 Aug 19]. Italian.
5) COVIDSurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with
perioperative SARS-CoV-2 infection: an international cohort study. Lancet. 2020;396:27-38.
6) Glasbey JC, Nepogodiev D, Simoes JFF, et al. Elective cancer surgery in COVID-19-free surgical
pathways during the SARS-CoV-2 pandemic: an international, multicenter, comparative cohort study. J
Clin Oncol. 2021;39:66-78.
7) Associazione Chirurghi Ospedalieri Italiani. Ripartenza COVID-19. Un sondaggio ACOI. 2021 [cited 2021
Sep 4]. Italian.
Junior Doctors Network Newsletter
Issue 24
October 2021
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 55
Since early 2020, the coronavirus disease 2019 (COVID-19) pandemic has represented an
upward battle in Malaysia. The Ministry of Health of Malaysia continues to lead national
efforts to reduce community transmission and vaccinate all citizens to better protect the
population against the disease. Since Malaysian junior doctors widely serve on the frontline
of these COVID-19 response efforts, I will share my clinical and community health
experiences working in clinical care and community health in Malaysia.
Clinical Experiences
During the COVID-19 pandemic, I was in charge of Orthopaedics at my tertiary-level
hospital. My team responsibilities included developing guidelines to reduce overcrowding
during clinic hours and reducing contact hours with patients at the outpatient clinic. We
followed Standard Operating Procedures, such as maintaining a one metre distance,
compulsory masking, and social distancing measures. In my hospital, elective and semi-
elective operations and cold case patient appointments were postponed. My colleagues
were assigned to serve as “frontliners” − a term used for doctors directly managing COVID-
19 care. These efforts included clinical care on COVID-19 wards, acute care in the
emergency department, and critical care in intensive care units.
Community Health Experiences
In Malaysia, our aim was to achieve herd immunity through mass vaccination. We also had
quarantine centres, mostly manned by junior doctors, to provide acute care for Category 1
(urgent) and 2 (semi-urgent) patients. Now, they also care for Category 3 (non-urgent)
patients in several centres.
Junior Doctors Network Newsletter
Issue 24
October 2021
Life during the COVID-19 Pandemic:
A Malaysian Junior Doctor’s Observations
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS
Merlinda Shazellenne, MBBS OHD
JDN Chairperson (2021−2022)
Malaysian Medical Association
Page 56
As vaccines became available, junior doctors were assigned to a
new job scope − vaccination and quarantine centres − especially in
communities with high rates of COVID-19 transmission.
As I reported for duty within my assigned community, I understood that it was the worst hit
district in the country. Together with the district health officers and public health doctors, we
conducted sampling and swabbing, data management and analysis, and field visits to
identify errant COVID-19 positive patients. We also completed factory visits to evaluate
operations, assist with sampling for disease surveillance, and issue quarantine restrictions
or closure based on the reported infection rates.
After returning from intense community work, I started helping with the vaccination centre
to expedite the number of people with completed vaccination doses (Photos 1-2). Other
colleagues were conducting sampling, data management and analysis, providing general
medical practice in healthcare facilities, caring for ventilated and critically ill patients in
intensive care units, serving in quarantine centres, and participating in COVID-19
surveillance activities. Sadly, we do not envision a rapid end to this pandemic in the near
future. Morale is low and tends to wax and wane with the epidemiological surveillance of
community transmission rates each week.
Junior Doctors Network Newsletter
Issue 24
October 2021
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 57
Photo 1. Dr Merlinda Shazellenne
contributes to the vaccination drive.
Credit: Dr Merlinda Shazellenne.
Photo 2. Dr Merlinda Shazellenne requests informed
consent from patients seeking vaccinations.
Credit: Dr Merlinda Shazellenne.
Through my clinical and community experiences, I have observed that
there are significant barriers in health service delivery.
Observed Challenges
First, I noticed the important role of our public health colleagues who contribute valuable
expertise to epidemiological surveillance and other field applications. As I have worked
hand-in-hand with health professions of this leadership hierarchy during the COVID-19
pandemic, I have learned numerous career lessons that will complement my medical
training. Second, there is a lack of unity between national authorities with local community
officials and professionals who execute orders. In handling any major disasters, community
leaders should be united and encourage open conversations and brainstorming sessions
without red tapes.
Conclusion
The COVID-19 pandemic has highlighted the need to prioritize prevention and control
efforts that reduce risk of infectious disease transmission. Healthcare workers must stay
strong during these difficult times and work together for better times ahead. As junior
doctors, we should take these clinical and community health experiences as a learning
curve and build upon these experiences throughout our required medical training.
Junior Doctors Network Newsletter
Issue 24
October 2021
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 58
In summary, learning is an ongoing process, and we should
always strive to learn from our colleagues and mentors as
well as be prepared to adapt to these new norms.
I applaud the actions of the Ministry of Health of Malaysia –
such as reassigning doctors to hard-hit areas and focusing on
herd immunity through mass vaccination efforts – in order to
prioritize population health.
Myanmar junior doctors stood in solidarity with millions of Myanmar people in defiance of
the military takeover. One civilian started protesting each night in front of the at the United
Nations (UN) headquarters in Myanmar with the sign, “How Many Dead Bodies UN Need
To Take Action?” After one month of these nocturnal protests, he became one of the first
casualties in Yangon, the former capital city of Myanmar, on February 28, 2021. These
daily protests against the military demanded the release of democratically elected leaders,
such as State Councilor Aung San Suu Kyi, President Win Myint, and other government
officials. The UN replied that they were “deeply concerned about Myanmar”, but took no
action against Myanmar’s military or security forces to end the coup (1).
Following the coup, junior doctors and other health care professionals went underground,
abandoning their jobs at government hospitals and health centers to protest the military
coup. However, in line with the Geneva Declaration or Modern-day Physician Pledge, they
continued to treat patients covertly through teleconsultation and underground clinics in
order to save lives (2). However, the World Medical Association (WMA) Council Resolution
in support of Myanmar medical personnel and citizens, which was issued at the WMA
Council Meeting in Seoul (April 2021), remained in effect, albeit continued attacks on health
care workers and doctors in prison (3).
Junior Doctors Network Newsletter
Issue 24
October 2021
Myanmar Junior Doctors Risk Personal Safety
during Military Coup
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS
Wunna Tun, MBBS MD
Secretary (2020−2021)
Junior Doctors Network
World Medical Association
Page 59
This disintegrated health system in Myanmar has reported a
rise in mortality rates of physicians and patients as well as
limited medication and equipment.
The Myanmar health care system is on the verge of collapsing as
the military pursues desperately needed physicians and medical
personnel for their resistance to the coup on February 1, 2021.
In recent months, Myanmar has experienced the third wave of the coronavirus disease
2019 (COVID-19), including the spread of the delta variant, with significant morbidity and
mortality among medical personnel and civilians. Notably, the Myanmar military junta
intentionally targeted junior doctors and health care workers who first resisted the coup. In
fact, over 200 Myanmar doctors were physically assaulted and either spent time in prison
or had arrest warrants (4). This reality resulted in the lack of available medical care for the
population, which contradicts their protection by international laws (4). Social media
platforms have facilitated communication to share requests (e.g. oxygen supplies) and
news of local funeral services for health care professionals and their families in Myanmar
and throughout the world..
Last year, we observed stark differences in how global communities have reacted to social
injustice issues throughout the world. For example, communities protested in the streets to
echo George Floyd’s “I can’t breathe” remarks, yet quietly neglect the voices from
Myanmar that fight for freedom from political coup (5). Notably, global leaders have taken
no action to prevent the military takeover, political instability, and COVID-19 pandemic in
Myanmar.
Duwa Lashi La, Myanmar’s interim president from the National Unity Government, declared
war on the military on September 7, 2021. His response was in part due to the failed
actions of the UN and the Association of Southeast Asian Nations (ASEAN) to act
accordingly and declare the military coup as a crime against humanity. The Myanmar
people are no longer confident in global leaders and believe that these UN organizations
have no power to fight against terrorist attacks. For this reason, the Myanmar people plan
to join forces to fight the military in efforts to restore democracy in their country (6). Even
some junior doctors have abandoned the stethoscope – in favor of a rifle – to join these
national efforts against the junta in Myanmar.
Junior Doctors Network Newsletter
Issue 24
October 2021
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 60
Now, seven months of the military coup, thousands of
Myanmar citizens – including junior doctors – have been
killed, and tens of thousands of health care workers and their
families have been arrested.
References
1) Reuters. ‘How many dead bodies?’ asked Myanmar protester killed on bloodiest day. News24. 2021 [cited
2021 Sep 9].
2) Parsa-Parsi RW. The revised declaration of Geneva: a modern-day physician’s pledge. JAMA.
2017;318:1971-1972.
3) World Medical Association. WMA Council resolution in support of medical personnel and citizens of
Myanmar. 2021 [cited 2021 Sep 9].
4) Solomon F. Myanmar doctors risk arrest to treat COVID-19 patients in secret. Wall Street Journal. 2021
[cited 2021 Sep 9].
5) Smith N, Theint N. ‘We can’t breathe… and the whole world is silent’: Myanmar begs for oxygen as
COVID crisis worsens. The Telegraph. 2021 [cited 2021 Sep 9].
6) Mahtani S. Myanmar shadow government declares war on military junta, escalating crisis. Washington
Post. 2021 [cited 2021 Sep 9].
Junior Doctors Network Newsletter
Issue 24
October 2021
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 61
The remaining physicians and other health care workers rescued
as many Myanmar lives as possible, while risking their own lives.
They will continue to protest the coup until democracy is restored
in Myanmar.
In 2010, the European Union implemented the working hour regulations for resident doctors
across all its member states, including Belgium. In Belgium, resident doctors – in the
context of the aforementioned working hours regulation – are all doctors enrolled in a
formal residency program. It does not apply to fellows, early-career consultants, and
attendings or any junior doctor working in a hospital while not enrolled in a residency
program recognized by the Belgian government.
These 48 hours should include all clinical activity in the hospital, including on-call duties,
and residents should be sent home when they surpass 48 hours in the hospital calculated
over the previous seven days. To exacerbate these regulations, the Belgian government
and hospital federations proposed a new resident contract in April 2021. The newly
proposed clauses included no paid sick leave (in the middle of a pandemic nonetheless),
no paid overtime for the “illegal” hours worked beyond 48 hours, and no dedicated research
and study time for board exams.
Where was all this coming from? Working condition regulations have not been updated
since 1983, so an update for the 21st century has been long overdue. For example, the
1983 regulations stipulated that residents were not normally “employed”, leaving them in a
legal vacuum between being a student and an employee. This vacuum was used favorably
by many hospitals to not offer residents any social benefits like pensions and
unemployment.
Junior Doctors Network Newsletter
Issue 24
October 2021
The Fight for Better Working Conditions
for Resident Doctors in Belgium
JUNIOR DOCTORS’ ACTIVITIES
Manon Pigeolet, MD MSc
Faculty of Medicine, University of Antwerp
Antwerp, Belgium
Page 62
Even though the legal limit has now been set at a 48-hour week,
60-to-80-hour weeks are still more of a norm than an exception.
During the coronavirus disease 2019 (COVID-19) pandemic, COVID-19 wards were run by
residents, who often had limited personal protective equipment and supervision.
Occasionally, they worked extra hours without compensation with complete neglect for their
educational needs in their specialty training. When these residents were informed that they
would be stripped of these social rights under the new contract, it was the breaking point.
In a country still under lockdown restrictions and with a ban on public gatherings, it was
impressive to see how fast that Belgium residents were able to gather a virtual community,
including with residents currently training outside of Belgium. Posters were made to create
awareness with fellow residents, supervisors, and patients about residents’ working
conditions. Press releases were written and shared with the medical and mainstream
media sources.
After one week, the mainstream media understood that Belgium residents meant business.
One representative of the Flemish Residents’ Organization was invited to primetime talk
show on national television to explain the position and recommend next steps.
This planned strike was an advantage for Belgium residents, since the government,
hospital federations, teaching hospitals, and universities had not envisioned the national
action. As a result, additional negotiations were organized between all partners involved,
and representatives of different resident organizations were invited to actively participate in
drafting amendments to the contract.
Now, these representatives owned the diplomatic game. Their legal knowledge, historical
perspective, and dedicated constituency surpassed that of many negotiators at the table.
Step by step, Belgium residents were able to negotiate and confirm a new agreement with
appropriate clauses by May 19, 2021. Hence, the first proposed national strike had been
averted.
Junior Doctors Network Newsletter
Issue 24
October 2021
JUNIOR DOCTORS’ ACTIVITIES Page 63
The ever-so diplomatic, committed, and constructive Belgian
residents decided that it was time to speak up.
The momentum had created an intense feeling of unity and
strength among Belgium residents. The first national strike of
residents in Belgium was planned for May 20, 2021.
The first contracts that aligned with the new regulations were signed on August 1, 2021.
Unfortunately, the implementation is not occurring smoothly as anticipated, and many
hospitals are still figuring out how to translate the fine details. The road towards a truly fair,
safe, and educational working environment for residents is still a long one.
Although we are aware that our situation is not unique among other junior doctors, we hope
that our experiences can inspire and motivate other junior doctors around the world to unite
and speak up for themselves, their patients, and their communities. For others, let it be a
reminder that previously obtained rights should never be taken for granted.
Junior Doctors Network Newsletter
Issue 24
October 2021
JUNIOR DOCTORS’ ACTIVITIES Page 64
However, the first hurdle has been passed, and residents have
established themselves as professional and reliable partners for
policy negotiations at the national level.
The Kenya Medical Association Young Doctors Network (KMA-YDN) held its second pre-
conference as a hybrid event on June 16, 2021, in Kisii County, Kenya. This event
attracted close to 200 virtual online and in-person participants, including medical students,
general practitioners, residents, and specialists (Photo 1). Using the theme, Career
Development and Entrepreneurship, organizers aimed to highlight the current employment
trends in Kenya, where an estimated 30-40% of the 600 doctors who graduate each year
move to other countries in search of improved training and employment opportunities after
completing their internship (1).
Junior Doctors Network Newsletter
Issue 24
October 2021
2021 KMA Young Doctors Network Pre-conference:
Career Development and Entrepreneurship
JUNIOR DOCTORS’ ACTIVITIES
Marie-Claire Wangari, MBChB
General Practitioner, Nazareth Hospital
Kiambu, Kenya
Lyndah Kemunto, MBChB
Membership Director (2020−2021)
Junior Doctors Network
World Medical Association
Page 65
Photo 1. Participants of the 2021 KMA YDN
hybrid pre-conference held on June 16, 2021 at
the Kamel Park Hotel in Kisii County, Kenya.
Credit: Kenya Medical Association.
Considering these statistics, the KMA-YDN aimed to bridge the
unemployment gap through hosting an array of experienced
speakers who tackled the conference theme in three broad areas.
The KMA-YDN promoted this pre-conference
theme to stressed three main challenges in
medical training and career development. First,
62.7% of Kenyan doctors are in private practice
(2), and those who are under government
employment are mostly overworked,
underemployed, and unmotivated. Second, high-
income countries continue to deprive Kenya of
millions of dollars’ worth of investments embodied
in human resources for health (3). Finally, Kenya
has reported an estimated 51% of healthcare
workers who emigrate in search of higher salaries
and better workplace conditions – with the second
highest emigration rate after South Africa (4).
Entrepreneurship, Branding, and the Young Doctor
The keynote address was delivered by Dr Amit Thakker (Chairman, Africa Health
Business), a renowned health entrepreneur and visionary industry leader, who encouraged
young doctors to increase their skills in healthcare management, finance, entrepreneurship,
and leadership through formal or self-directed informal learning. He recognized the KMA for
Finally, Professor Daniel Kiage (Founder, Kisii Eye Hospital) encouraged participants to
venture into social entrepreneurship, noting that young doctors should identify existing
problems in their communities and model solutions to the successful actions, such as the
Kisii Eye Hospital.
Career Development and Mentorship
The importance of building mental health and well-being throughout the medical career is
an integral part of career development. First, Dr Caroline Vundi, a psychiatry resident and
mental health advocate, highlighted the need to focus on building robust coping skills to
manage stressors and maintain optimal physical and mental health. Next, Dr Angela
Munoko (Pathologists Lancet Kenya) emphasized the importance of continuous learning,
where young doctors should actively seek professional opportunities and leverage peer
mentorship with colleagues. She also highlighted the importance of evidence-based
medicine and urged young doctors to explore opportunities to participate in research.
Finally, Dr Magare Magara (Managing Director Equity Afia Nakuru & Kisii) stressed the
importance of having mentors and thinking outside of the box regarding income sources
and entrepreneurship.
Junior Doctors Network Newsletter
Issue 24
October 2021
JUNIOR DOCTORS’ ACTIVITIES Page 66
Photo 2. Dr Were Onyino, KMA President and Founder of
Daktari Online, giving his address at the 2021 KMA-YDN
pre-conference. Credit: Kenya Medical Association.
serving as a strategic enabler during his
career and for recognising his service as a
former KMA Nairobi Division Chair. Next, Dr
Were Onyino (KMA President, Founder of
Daktari Online) recognised the significance of
this national platform to discuss career
development, at a time when medical doctors
were faced with various challenges such as
underemployment and unemployment. He
urged young doctors to gain additional
knowledge and skills in healthcare technology
innovation and entrepreneurship.
Emerging Career Development Challenges and Possible Solutions
This Town Hall shed light on some challenges – namely, unemployment and physician
emigration – faced during career development. First, Dr Davji Atellah (Secretary-General,
Kenya Medical Practitioners, Pharmacists and Dentists Union) highlighted the need to
directly involve communities in health advocacy efforts, as they have a responsibility to
hold their leaders accountable when they fail to ensure accessibility to healthcare services.
Meanwhile, Dr Frank Wafula (Strathmore University) urged young doctors to select
appropriate specialties and professional networks for their career path. He added that
although young doctors will inevitably make mistakes, it is important that they learn and
appreciate these life lessons.
Concluding Remarks
The KMA continues to make positive strides towards bridging the unemployment gap in
Kenya. The pre-conference agenda focused on business and technology opportunities in
the health sector. They closed the pre-conference by announcing their partnership with
Equity Bank, a financial institution that offers financing options as solutions for doctors
exploring health care entrepreneurship. The YDN made a strong call to the Government of
Kenya to invest in human resources for health and advocate for employment and fair
remuneration of thousands of unemployed healthcare workers.
In summary, the KMA-YDN urges junior doctors worldwide in a call to action. First, junior
doctors should seek opportunities to develop additional skills – beyond the classroom and
clinical workplace – related to entrepreneurship, healthcare management, and finance.
These skills can be acquired and refined through formal or self-directed informal learning.
Second, they should identify key mentors for their career development in the health sector.
Finally, they should invest in grassroots advocacy and primary healthcare strategies when
tackling community health challenges.
Acknowledgement: The authors acknowledge the Kenya Medical Association for their
support of the 2021 Young Doctors Network Pre-conference.
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Utilization of these highly trained doctors will greatly improve
the doctor-patient ratio, access to high-quality health care,
and reduce the brain-drain phenomenon.
References
1) Firsing S. How severe is Africa’s brain drain. London School of Economics blog. 2016 [cited 2021 Aug
21].
2) Ministry of Health (Kenya). Kenya health workforce: the status of healthcare professionals in Kenya, 2015.
Nairobi, Kenya: Ministry of Health (Kenya); 2017.
3) Kirigia JM, Gbary AR, Muthuri LK, Nyoni J, Seddoh A. The cost of health professionals’ brain drain in
Kenya. BMC Health Serv Res. 2006;6:89.
4) Mwaniki DL, Dulo CO. Migration of health workers in Kenya: the impact on health service delivery.
Regional Network for Equity in Health in East and Southern Africa. 2008.
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October 2021
JUNIOR DOCTORS’ ACTIVITIES Page 68