JDN_15NL_FinalVersionForWMA_11Apr2019[1]

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 Newsletter
Issue 15
April 2019
ISSN (print) 2415-1122
ISSN (online) 2312-220X
Junior Doctors Leadership 2018-2019
Junior Doctors Newsletter
Issue 15
April 2019
Dr Chukwuma
Oraegbunam
Nigeria
Dr Yassen Tcholakov
Canada
Dr Sydney Mukuka
Chileshe
Zambia
Dr Mike Kalmus
Eliasz
United Kingdom
Dr Audrey Chloe
Fontaine
France
Dr Lwando Maki
South Africa
Dr Helena Chapman
Dominican Republic
Dr Chiaki Mishima
Japan
Dr Anthony
Chukwunonso Ude
Nigeria
Dr Caline Mattar
Lebanon
Dr Paxton Bach
Canada
CHAIR
DEPUTY
CHAIR
SECRETARY
SOCIO-MEDICAL
AFFAIRS
OFFICER
EDUCATION
DIRECTOR
MEDICAL
ETHICS
OFFICER
MEMBERSHIP
DIRECTOR
PUBLICATIONS
DIRECTOR
COMMUNICATIONS
DIRECTOR
IMMEDIATE
PAST
CHAIR
IMMEDIATE
PAST
DEPUTY
CHAIR
Dr Konstantinos
Roditis
Greece
Dr Jeazul Ponce H.
Mexico
Dr Mariam Parwaiz
New Zealand
Dr Vandrome Nakundi
Kakonga
Democratic Republic
of the Congo
Dr Suleiman A. Idris
Nigeria
Dr Ricardo Correa
United States
Dr Victor Animasahun
Nigeria
Junior Doctors Newsletter
Issue 15
April 2019
Editorial Team 2018-2019
Table of Contents
TEAM OF OFFICIALS’ CONTRIBUTIONS
05 Words from the Chair
By Dr Chukwuma ORAEGBUNAM (Nigeria)
06 Words from the Communications Director
By Dr Anthony Chukwunonso UDE (Nigeria)
07 Words from the Publications Director
By Dr Helena CHAPMAN (Dominican Republic)
HISTORICAL PERSPECTIVES
08 Snake and Staff as Medical Symbols
By Dr Anthony Chukwunonso UDE (Nigeria)
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS
11 Why Doctors Need to be at the Centre of Primary Health Care
By Dr Lyndah KEMUNTO (Kenya)
14 Rural India: The Need for a Change
By Dr Aashish Kumar SINGH (India)
JUNIOR DOCTORS’ ACTIVITIES
16 Medical Graduates Reciting the Hippocratic Oath at Hippocrates’ Birthplace: International
Collaboration and Medical Ethics
By Dr Konstantinos RODITIS (Greece) and Dr. Konstantinos LOUIS (Greece)
20 Junior Doctors’ Challenges of Advocacy for Physicians’ Well-being in Japan
By Dr Kazuhiro ABE (Japan)
24 Innovative Workshop: Developing Critical Inquiry in the Dominican Republic
By Dr Helena CHAPMAN (Dominican Republic)
27 JDN in Nigeria – Bridging the Gap and Impacting Lives
By Dr Anthony Chukwunonso UDE (Nigeria)
29 JDN-SCHOMOS MMA Penang Declaration 2018
By Dr Vijay GANASAN (Malaysia)
INTERNATIONAL CONFERENCES
31 Empowering Junior Doctors
By Dr Benny LOO (Singapore)
32 Prince Mahidol Award Conference 2019
By Dr Mariam PARWAIZ (New Zealand), Dr Lyndah KEMUNTO (Kenya), Dr Hasan AL HAMEEDI
(Iraq), Dr Jade LIM (Australia)
WORKING GROUPS
36 World Antibiotic Awareness Week 2018
By Dr Mariam PARWAIZ (New Zealand), Dr Steen FAGERBERG (Denmark), Dr Ian PEREIRA
(Canada), Dr Helena CHAPMAN (Dominican Republic)
40 Safe Surgery and Anaesthesia for All: Let’s Take Action Now!
By Dr Manon PIGEOLET (Belgium)
Junior Doctors Newsletter
Issue 15
April 2019
Over the past eight years, we have seen a growing interest in the Junior Doctors Network
(JDN) from colleagues all over the world. This is a reflection of the progress that we have
made over the years, ensuring that the JDN remains an avenue for young doctors to gain
the capacity to achieve their professional goals in medicine and public health leadership.
We are appreciative for the World Medical Association (WMA) leadership, which continues
to support the JDN activities, including our attendance and ability to represent the WMA at
various high-level international meetings. As the JDN membership continues to grow, JDN
members are able to become more involved in the decisions that shape our future as well
as the health and well-being of our patients.
Internally, we continue striving to utilize approaches that can increase JDN member
participation in JDN meetings and activities. We now have an operational ‘Terms of
Reference’ and at the last stages of adopting our ‘Strategic Plan’, which will help our future
generations to understand where we have come from and the direction we are headed. We
also regularly track the completion of JDN officers’ and work groups’ tasks in order to
record improvements as well as encountered challenges.
As our meetings are experiencing increased attendance and participation, we are gradually
implementing changes that enhance JDN member involvement. In efforts to strengthen our
leadership capacity in the future, we have adopted the theme, Building the Next Generation
of Physician Leaders, for our JDN meeting (April 2019) in Santiago, Chile.
Finally, our progress and direction reflect our stated mission: “Empowering young
physicians to work towards a healthier world through advocacy, education, and
international collaboration”. Increased collaboration and feedback from all our JDN
members will allow us to maintain and improve on our past and present accomplishments,
which will dually benefit our future medical leadership and growing patient populations
across the world. I look forward to seeing many of you in Santiago!
Junior Doctors Newsletter
Issue 15
April 2019
Words from the Chair
TEAM OF OFFICIALS’ CONTRIBUTIONS
Chukwuma Oraegbunam, MBBS MWACP MRCPsych
Chair (2018-2019)
Junior Doctors Network
World Medical Association
Dear colleagues from around the world,
I am delighted to welcome you to the 15th issue of the Junior Doctors Network (JDN)
Newsletter. It is our editorial hallmark as we work together towards a healthier world
through advocacy, education, and international collaboration.
The newsletter aims to educate, inform, and entertain junior doctors worldwide, where the
next generation of junior doctors can share their stories, become inspired, raise awareness,
and find opportunities to better themselves and their communities. Each topic is relevant to
junior doctors across the world.
I offer my special appreciation to the Publications Team, led by Dr Helena Chapman, for
their priceless role in ensuring a contemporary, sound, and near impeccable JDN
Newsletter. I am incredibly proud of what the Publications Team has created and curated
on the pages that follow.
I hope that these articles will stimulate informed debate and a lively exchange of ideas. We
look forward to receiving your feedback on this issue. We also encourage your input on
topics to be covered in future issues, especially those local and global subjects that directly
impact the work of junior doctors across the world.
Stay with us, enjoy the read, and expect more!
Junior Doctors Newsletter
Issue 15
April 2019
Words from the Communications Director
TEAM OF OFFICIALS’ CONTRIBUTIONS
Anthony Chukwunonso Ude, MBBS MWACS
Communications Director (2018-2019)
Junior Doctors Network
World Medical Association
Dear colleagues,
Junior Doctors Newsletter
Issue 15
April 2019
Words from the Publications Director
TEAM OF OFFICIALS’ CONTRIBUTIONS
On behalf of the Publications Team (2018-2019) of the Junior Doctors Network (JDN), we
are honored to present and share the 15th issue of the JDN Newsletter to junior doctors
across the world.
The 14th issue of the JDN Newsletter, published in October 2018, included contributions
from junior doctors representing Belgium, Canada, Greece, Italy, Japan, Kenya, Lebanon,
Nigeria, Sudan, Tanzania, Venezuela, and the United States. These articles provided
reports and updates on essential global health topics, international health conferences, and
other JDN activities.
Likewise, this 15th issue of the JDN Newsletter incorporates additional articles from junior
doctors representing Australia, Belgium, Canada, Denmark, Dominican Republic, Greece,
India, Iraq, Japan, Kenya, Malaysia, New Zealand, Nigeria, Singapore, and the United
States. These articles included reports and updates on JDN activities, narrative pieces on
global health topics, and reflections on their community health experiences.
The JDN Newsletter serves as an important international platform for the global community
of junior doctors. We hope that junior doctors will continue to share their professional
experiences in the JDN Newsletter, which can showcase their global health leadership,
inspire other junior doctors across the world, and promote communication between World
Medical Association (WMA) and JDN members. By facilitating an open dialogue among
junior doctors, they can collaborate and develop innovative strategies to better understand
the health risks that directly influence health and well-being of our local, national, and
regional communities.
We wish to thank all editors of the JDN Publications Team 2018-2019 for their enthusiasm
and dedicated efforts to finalize this 15th issue. We also appreciate the continued support of
the JDN Management Team and WMA leadership for the dissemination of this essential
junior doctors’ resource. We hope that you enjoy reading the articles in this 15th issue!
Helena Chapman, MD MPH PhD
Publications Director (2018-2019)
Junior Doctors Network
World Medical Association
Dear JDN colleagues,
by origin and symbolism. The Caducaeus (or staff of Hermes) is a winged staff with two
serpents wound around it, and the Rod of Asclepius (or Asklepian) is a staff with a single
serpent. Although the Caduceus is the more commonly used symbol of medicine by most
health ministries, departments, and agencies, there is an increasing consciousness and
acknowledgement that it is a false symbol and has no historical substantiation as an
emblem of medicine. Consequently, this has led to changes of the logo by many global
academic and medical institutions. Based on historical texts, debate continues about the
origins and usage of these two symbols. This article briefly explores these perspectives by
laying credence to an ancient account that has been lost under a misapprehension so that
physicians will pay homage only to the true depiction and symbol of medicine.
THE CADUCAEUS
In Greek mythology, the Caducaeus described the staff of the Greek god Hermes (Roman,
Mercury) and of related undertakings. Hermes was the messenger of the gods and is often
portrayed as wearing winged sandals, a winged hat, and bearing a winged, golden
Caducaeus, entwined with snakes.
Among the Greeks, the Caduceus is thought to have originally been a herald’s staff, and
Hermes was the herald, or messenger, of the gods. The staff of the herald is thought to
have developed from a shepherd’s crook, in the form of a forked olive branch, which for this
purpose has been adorned first with two fillets of wool, then with white ribbons, and finally
with two snakes intertwined. Many people take for granted that the Caducaeus is the
symbol of medicine, and many medics still employ it. The staff of Hermes is not the symbol
of medicine, but was erroneously adopted in the late 19th century in North America, and
has persisted until today (1).
The staff of Hermes, the Caducaeus, is still used as a symbol by the United States Army
Medical Corps, who, it is alleged, adopted it as a symbol in 1902, leading to its widespread
acceptance into medical culture (2,3). The Oxford Illustrated Companion to Medicine puts it
best, “Though the Caduceus has long been accepted as a device to represent medicine, it
is the staff and serpent at Asclepius which has the more ancient and authentic claim to be
the emblem of medicine” (4).
Junior Doctors Newsletter
Issue 15
April 2019
Snake and Staff as Medical Symbols
HISTORICAL PERSPECTIVES
Anthony Chukwunonso Ude, MBBS MWACS
Communications Director (2018-2019)
Junior Doctors Network
World Medical Association
The snake and staff have become synonymous with medicine and
the healing arts worldwide. Today, they have two variations, distinct
THE ROD OF ASCLEPIUS
The traditional medical symbol, the rod of Asclepius, has only a single snake and no wings.
In Greek mythology, Asclepius was the god of medicine, one of the gods sworn by in the
original Hippocratic Oath (5). Asclepius represents the healing aspect of the medical arts;
his daughters are Hygieia (“Hygiene”), Laso (“Medicine”), Aceso (“Healing”), Aglaea
(“Healthy Glow”), and Panacea (“Universal Remedy”).
The rod of Asclepius is an ancient symbol associated with medicine and healing, consisting
of a serpent entwined around a staff. His attributes, the snake and the staff, sometimes
depicted separately in antiquity, are combined in this symbol. Hippocrates himself was a
worshipper of Asclepius (6). The symbolism has been explained that sometimes the
shedding of skin and renewal was emphasized as symbolizing rejuvenation. Another
explanation, however, centers on the serpent as a symbol that unites and expresses the
dual nature of the work of the physician, who deals with life and death, sickness and health
(7). A third explanation is that the staff was a walking stick associated with itinerant
physicians.
Asclepius derived his name from healing soothingly and deferring the withering that comes
with death. For this reason, therefore, they gave him a serpent as an attribute, indicating
that those who avail themselves of medical science undergo a process similar to the
serpent. As such, they grow young again after illnesses and slough off old age, since the
serpent is a sign of attention and required in medical treatments (8).
Another accepted alternative explanation of origin is the Jewish Nehustan, the bronze
serpent on the pole, which God told Moses to form in the Bible’s Book of Numbers
(Numbers 21:6-9, English Standard Version): “Make a fiery serpent and set it on a pole,
and everyone who is bitten, when he sees it, shall live”. This was the antidote to the
venomous bites from a plague of serpents. The rod and snake have thus been associated
with healing and the healing arts.
A less supported explanation is the worm theory, which purports in ancient times parasitic
worms, such as the guinea worm (Dracuculus medinensis), were common and extracted
from beneath the skin by winding them slowly around a stick (9). According to this theory,
physicians might have advertised this common service by using a sign depicting a worm on
a rod.
Junior Doctors Newsletter
Issue 15
April 2019
HISTORICAL PERSPECTIVES
DISCREPANCIES IN USE
The rod of Asclepius is the dominant symbol for health care professionals and
associations, although due to the long-standing error, many private facilities use the
Caducaeus. One survey in the United States found that 62% of health care professionals
used the rod of Asclepius, while 76% of commercial health care organizations used the
Caduceus (1). However, it should be emphasized that the Rod of Asclepius has a
significance more congruent with the principles and philosophy of medicine.
CONCLUSION
Numerous hospitals and medical schools may have changed their emblems after realizing
the false impression. However, the purpose of the article is not to unduly critique the choice
of the Caduceus as a medical symbol, but rather to correct an erroneous impression and
regain a part of the rich patrimony, tradition, and heritage of health care. It is not the
intention of the author that institutions, which have invested so much goodwill and effort in
establishing a well-recognized logo with good public perception, change them or adopt a
new one. The author aims to correct a false presumption and provide a historical
perspective.
References
1) Friedlander WJ . The golden wand of medicine: a history of the Caduceus symbol in medicine. New York,
NY: Greenwood Press; 1992.
2) Tyson SL. The Caduceus. The Scientific Monthly. 1932;34:492-498.
3) Engle B. The use of Mercury’s caduceus as a medical emblem. The Classical Journal. 1929;25:204-208.
4) Bohigian GM. The staff and serpent of Asclepius. Mo Med. 1997; 94:210-211.
5) Wilcox RA, Whitham EM. The symbol of modern medicine: why one snake is more than two. Ann Intern
Med. 2003;138:673-677.
6) Miles SH. The Hippocratic Oath and the ethics of medicine. 1st ed. Oxford, UK: Oxford University Press;
2005.
7) Jones KB. The staff of Asclepius: a new perspective on the symbol of medicine. WMJ. 2008;107:115-116.
8) Edelstein EJ, Edelstein L. Asclepius: collection and interpretation of the testimonies. Baltimore, MD; The
Johns Hopkins Press; 1945.
9) Hinek A, Backstein R. The magic wands of medicine. Univ Toronto Med J. 2004;82:68-70.
Junior Doctors Newsletter
Issue 15
April 2019
HISTORICAL PERSPECTIVES
Development Goals. Health experts and leaders from around the globe reaffirmed the
vision on having high-quality, safe, comprehensive, integrated, accessible, available, and
affordable PHC services. These services are provided with compassion, respect, and
dignity by health professionals who are well-trained, skilled, motivated, and committed (1).
As governments and various stakeholders commit to building sustainable PHC, doctors
working in lower- and middle-income countries (LMICs) should strategize and align their
commitment towards the delivery of PHC.
The role of doctors in PHC has been marginal in most LMICs. In Sub-Saharan Africa, PHC
is led by mostly nurses or non-physician clinicians, whereas doctors provide curative care
in secondary and tertiary hospitals (2). This is different in developed countries, where
general practitioners or family physicians are the first contact in primary care. The
substitution of middle-level cadres or non-physician clinicians for doctors as PHC providers
has been the result of perennial shortage of doctors, long training periods, and higher
training costs of doctors and specialists. This shortage has been further worsened by the
brain drain, as more doctors have migrated to developed countries to seek economic
opportunities or to escape conflict zones and achieve job satisfaction. However, non-
physician clinicians have fewer entry requirements and shorter training times, after which
they are assigned to technical and non-technical tasks. Therefore, they are regarded as a
stopgap, a cheap, temporary option to providing primary care (2,3).
Although the shortage of doctors still exists, there has been a remarkable increase in the
number of medical training institutions and highly trained and skilled health care workers in
Sub-Saharan Africa. In Kenya, the number of registered doctors has increased from 908
doctors at its independence in 1963 to 8,753 doctors in 2018 (4). Factoring in population
growth, the doctor-patient ratio has increased from 1 doctor to 9,811 persons in 1963 to 1
doctor to 5,678 persons in 2018. To further improve these metrics, governments should
reinforce strategies to train, recruit, develop, motivate, and retain doctors and other health
care providers.
Junior Doctors Newsletter
Issue 15
April 2019
Why Doctors Need to be at the Centre of Primary Health Care
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS
Lyndah Kemunto, MBChB
General Practitioner, Kisii County Government
Kisii, Kenya
In October 2018, the Global Conference on Primary Health Care took
place in Astana, Kazakhstan, in a bid to renew the commitment to
Primary Health Care (PHC) as an important building block towards
achieving universal health coverage and the Sustainable
As more doctors are being trained, they should be open to taking up jobs in rural areas and
lower tier PHC facilities. Statistics show that 80% of people’s health needs can be
addressed by effective PHC (5). Therefore, doctors should offer their expertise where they
are needed most, in PHC, as opposed to concentrating on providing services in the
secondary- and tertiary-level hospitals. Furthermore, it is necessary to integrate essential
services into PHC, services that were previously considered as specialized. In response to
the changing demographic and global health priorities, doctors and specialists are
compelled to provide these specialized services such as mental health, basic surgical care,
trauma, and emergency medicine care at primary care facilities. A comprehensive and
inclusive PHC system is crucial in achieving better outcomes.
In addition, having doctors in PHC increases the diversity of skills, knowledge, and offered
services. This diversity allows for the division of tasks and the ability to provide a wide
range of procedures and surgical interventions. This, in turn, reduces the number of
referrals to secondary- and tertiary-level hospitals, which are often located far away, and
hence reduces the financial burden on patients. Also, the public health system benefits
from reduced costs of referral and ambulance services and decongestion of tertiary-level
facilities, further improving the quality of care in these higher tier specialized centres.
By providing leadership, good stewardship, and technical input, continuous participation in
the formulation and implementation of strategies and policies at local and national levels
further strengthens the PHC journey (6). Investing in well-trained and highly skilled
professionals will go a long way in enhancing public confidence in PHC. Whether it is a
doctor-led or supported by a doctor primary care team approach, it is clear that the added
value of doctors in PHC cannot be understated.
Governments should therefore commit to ensuring that there is a doctor – general
practitioner or family physician – in every PHC facility or team. The example of Cuba is
evidence that PHC is achievable even for LMICs (7). Training institutions need to
adequately prepare doctors with the necessary skills to respond to the holistic health needs
of individuals, families, and communities. Doctors, on the other hand, must proactively
engage and collaborate with other stakeholders to reduce health inequalities, strengthen
primary care, and create a healthier society.
Junior Doctors Newsletter
Issue 15
April 2019
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS
Beyond clinical expertise, doctors contribute critical thinking,
collaboration, and capacity building as well as act as advocates
and change agents for sustainable PHC.
References
1) World Health Organization; United Nations Children’s Fund. Global conference on primary health care:
Declaration of Astana. WHO/HIS/SDS/2018.61. 2018 [cited 2018 Dec 29].
2) Mullan F, Frehywot S. Non-physician clinicians in 47 Sub-Saharan African countries. Lancet.
2007;370:2158-2163.
3) Dovlo D. Using mid-level cadres as substitutes for internationally mobile health professionals in Africa. A
desk review. Hum Resour Health. 2014;2:7.
4) Kenya medical practitioners and dentists board. Doctors’ retention register. 2019 [cited 2018 Dec 29].
5) The Lancet. The Astana Declaration: the future of primary health care? Lancet. 2018;392:1369.
6) Mash R, Almeida M, Wong WCW, Kumar R, von Pressentin KB. The roles and training of primary care
doctors: China, India, Brazil and South Africa. Hum Resour Health. 2015;13:93.
7) World Health Organization. Cuba’s primary health care revolution: 30 years on. 2011 [cited 2018 Dec 27].
Junior Doctors Newsletter
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JUNIOR DOCTORS’ COMMUNITY REFLECTIONS
the country. A total of nearly 70% of the population resides in small towns and villages (1),
working predominantly in agriculture, daily wage labor, and animal husbandry. Generation
after generation, only few migrate to cities, preferring the ancestral tradition of living in large
joint families and working in the agricultural field.
With a low per capita national income, rural communities face limited economic
development, often live below the poverty line, and struggle to provide basic necessities for
their families. Cardiovascular, chronic obstructive pulmonary, and cerebrovascular
diseases describe the top three causes of mortality, followed by lower respiratory
infections, diarrheal, tuberculosis, and neonatal disorders (2,3). Despite the government
expenditure of billions of dollars for rural health care services in India, health care
standards have not improved, and socioeconomic and health disparities persist.
In the remote area of Rajasthan, one medical officer, Dr Amit Tiwari, has provided care to
the underserved community for the past three years, learning about the social determinants
of health that negatively influence health outcomes (Photos 1-2). For the duration of one
month, I had the opportunity to assist him with rural health service delivery in a remote
village of about 1,000 residents.
This village has been characterized by high morbidity and mortality in adults and children,
influenced by several factors. First, low education levels among adult community members
can hinder how they fully understand health risks associated with communicable and non-
communicable diseases. Second, delayed health-seeking behaviors can increase risk of
disease complications or lead to missed immunizations. Third, poor hygiene and sanitation
practices in the household and community can increase environmental exposure of
infectious pathogens. Additionally, despite the allocation of national resources, many
primary health centers still lack basic equipment (e.g., electrocardiogram, x-ray,
ultrasonography) and medications (e.g., adrenaline, atropine, benzodiazepines), which
challenge how physicians can treat and manage life-threatening medical emergencies.
Without these resources, physicians can only refer patients to the closest tertiary-level
health center, which may take around two hours to reach by ambulance.
Junior Doctors Newsletter
Issue 15
April 2019
Rural India: The Need for a Change
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS
Aashish Kumar Singh, MBBS
General Physician, Ri-Bhoi Pharmacy
Nongpoh, India
India, the world’s second most populated nation with 1.3 billion (2018),
continues to experience rapid population growth with depleting
resources, corruption, and limited health and education infrastructure.
Over the past centuries, rural India continues to represent the heart of
Working as a doctor in rural India can be both rewarding and extremely challenging. Hence,
the moral obligation of health professionals is to serve as a community leader and
enlighten, encourage, and educate community members. The common phrase, “Rome was
not built in a day”, reflects the real-time situation of rural India as these communities
continue to face daily challenges to meet necessities and maintain physical and
psychosocial health status.
At the same time, authorities can implement appropriate policies to prioritize and advance
education and health care services in rural communities. With concrete steps towards
further investment in health care, all communities can be equipped with primary health
centers, tertiary-level medical services, and trauma centers. I see the future of rural
communities across India with optimism, which might lead to my follow-up article, entitled,
“Rural India: The Change did Occur!”
References
1) Chandramouli C. Rural urban distribution of population, 2011. 2011 [cited 2019 Feb 10].
2) University of Washington, Institute for Health Metrics and Evaluation. India. 2018 [cited 2019 Feb 10].
3) UNICEF. Under-five mortality. 2018 [cited 2019 Feb 10].
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JUNIOR DOCTORS’ COMMUNITY REFLECTIONS
Photo 1. Dr Amit Tiwari (far right) and two other
health workers supervise the nutrition program
for malnourished children.
Credit: Aashish Kumar Singh.
Photo 2. Health workers educate community
members about the importance of proper
sanitation and hygiene practices.
Credit: Aashish Kumar Singh.
By promoting leadership and perseverance to reform the health
system, physicians can lead health teams to care for and protect
community members of rural India.
Junior Doctors Newsletter
Issue 15
April 2019
Medical Graduates Reciting the Hippocratic Oath at Hippocrates’
Birthplace: International Collaboration and Medical Ethics
JUNIOR DOCTORS’ ACTIVITIES
Konstantinos Roditis, MD MSc
Vascular Surgery Resident
Hellenic Red Cross Hospital
Athens, Greece
Chair, JDN-Hellas
Past Secretary 2015-2018, JDN-WMA
Konstantinos Louis, MD PhD
Obstetrician-Gynecologist
“Attikon” University Hospital
National and Kapodistrian University
Athens, Greece
Deputy Chair, JDN-Hellas
The Hippocratic Oath (Ιπποκρατικός Όρκος in Greek) or the Oath of Hippocrates of Kos,
originally written in ionic Greek between the 3rd and 5th century BC, is one of the most
widely known pieces of Greek medical literature and is considered the earliest expression
of medical ethics in the Western World. It is believed to be the work of Hippocrates of Kos,
son of the physician Heraclides (descendant of Asclepius, the Greek god of Medicine), a
renowned physician of ancient Greece and founder of the Hippocratic School of Medicine
on the Greek island of Kos in the Southeastern Aegean Sea, that completely revolutionized
and modernized the practice of Medicine in ancient world and prepared the field for it to
become a profession.
Hippocrates, recognized as the “Father of Medicine”, established in this oath, many ethical
principles such as confidentiality and non-maleficence for the first time. He also strongly
bound the student to his teacher and the greater community of physicians with
responsibilities similar to that of a family member. Over the centuries, it has been rewritten
often in order to suit the values of different cultures influenced by Greek medicine (1,2).
Contrary to popular belief, the Hippocratic Oath is not required by most modern medical
schools, although some have adopted modern versions, such as the Declaration of
Geneva by the World Medical Association (WMA) (3).
For three consecutive years, the Panhellenic Medical Association (PhMA), member of the
WMA, and the International Hippocratic Foundation of Kos (IHFK) – a public benefit
organisation, founded in 1960 to honor the “Father of Medicine”, offering a broad spectrum
of activities aimed at disseminating the teachings and legacy of Hippocrates and ancient
Greek Medicine – have co-organized in partnership with the Medical Chamber of Kos, a
reenactment ceremony of reciting the Hippocratic oath at the Asclepieion of Kos. Medical
graduates from all seven medical schools of Greece who graduated with a distinction,
take the oath in front of their Deans, local authorities, family members, and the Press
(Photo 1). The event usually coincides with a scientific session on continuous medical
education and the medical profession in general with the participation of renowned
speakers and members of the Academia from Greece, Europe, and the rest of the world.
The idea of further opening the event to Europe and the rest of the world, inviting
international medical graduates to join their Greek colleagues and take part in this unique
celebration of medical ethics has been strongly supported by the organizers for years now,
as the Hippocratic principles have always been globally relevant and necessary to be
respected and considered in our clinical practice. JDN-Hellas, representing the voices and
interests of Greek junior doctors, was present at the event for two consecutive years, in
2017 and 2018, and has been involved in the discussion since the very beginning, offering
our ideas and suggestions for creating a long-lasting strategic plan for this international
event to become a reality (Photo 2).
As we envision this event as a global one, we could not think of a more appropriate partner
to ensure its continuity for years to come, than the WMA, its members – National Medical
Associations (NMAs) and its Junior Doctors Network (JDN-WMA). Following up on those
first deliberations, we presented a draft project proposal at the JDN Meeting (Chicago,
Illinois, USA) in October 2017, which included information on the event, proposed duration,
funding, logistics, and content, as well as the selection process, overseen by the WMA,
needed to ensure annual participation of a diverse group of medical graduates (Table 1).
Junior Doctors Newsletter
Issue 15
April 2019
JUNIOR DOCTORS’ ACTIVITIES
Photo 1. Participants at the reenactment ceremony
of reciting the Hippocratic Oath, Asclepieion, Kos,
Greece, September 2017.
Credit: Konstantinos Roditis.
Photo 2. JDN-Hellas’ Deputy Chair, Dr Konstantinos
Louis (left), with Athens Medical Association
President, Dr George Patoulis (middle), and local
authorities at the event in Kos, September 2018.
Credit: Konstantinos Louis.
Junior Doctors Newsletter
Issue 15
April 2019
JUNIOR DOCTORS’ ACTIVITIES
Project modules Description
Organizers PhMA, IHFK, WMA (JDN-WMA), Kos medical
association, other stakeholders
Duration 2-3 days (Friday to Sunday)
Periodicity Annually or biannually
Agenda • Friday: Arrival – Tour of Kos town,
Hippocrates’ famous plane tree, Asclepieion
archaeological site
• Saturday: Tour of Hippocratic Foundation
premises (morning), Hippocratic oath
Ceremony (afternoon), Greek social program
(evening)
• Sunday: Departure
Participants • 1 or more graduates from each country
(participating NMA)
• 1 graduate/10.000.000 citizens (1 graduate
for smaller countries) OR
• 1 graduate/1000 graduates OR
• 1 graduate/medical university, medical
school
Costs Accommodation: 50 EUR/night/participant
Boarding: 50 EUR/day/participant
Transportation: 20 EUR/day/participant
Travel: 200-1000 EUR/participant
Budget: 44.000-124.000 EUR for 100
participants
Funding ● Total budget to be covered 100% by
participating NMAs OR
● Covered 50/50 by participating NMAs and
organizers OR
● Covered 100% by the organizers OR
● Covered 50/50 by WMA and NMAs OR
● Covered 100% by participants (unlikely)
Selection process ● Each NMA could choose their participants
according to their own standards OR
● Each NMA could ask their respective Medical
Universities/Schools to nominate their best
graduates (e.g., those with highest grades)
Feedback and input of all Chicago
meeting participants and JDN-WMA
membership was also requested. We
have further considered inviting the
European Junior Doctors Association
(EJD) for their assistance and partnership
in approaching medical graduates and
junior doctors from the European
continent as participants, as well as other
European medical organisations as
possible partners. For that reason, a
detailed presentation will be delivered by
the JDN-Hellas delegation at the next
EJD meeting (Edinburgh, UK) in May
2019.
The rationale behind this idea of
“internationalizing” this ceremonial event
on the island of Kos, is that this would be
seen as a perfect opportunity for young
doctors from all around the world to come
together to share a common, thrilling
experience that would change them for
the better. At the same time, they would
be offered the chance to gain knowledge
and expertise by listening to a panel of
experts during the parallel scientific
symposium on medical education, ethics,
and the medical profession. Seen as a
whole, this event could foster
international collaboration among the new
generation of physicians, as well as serve
as a forum for debate on controversial
and challenging issues on medical ethics,
deontology, and continuous medical
education.
Table 1. Proposed project specifics.
The table shows suggestions made by
JDN-Hellas during the presentation of the
project proposal at the JDN Meeting
(Chicago, Illinois, USA) in October 2017. It
does not reflect any opinions of the event
organizers, whatsoever.
Junior Doctors Newsletter
Issue 15
April 2019
JUNIOR DOCTORS’ ACTIVITIES
The next steps in the process of realizing the project entail finalizing the project
proposal, incorporating feedback given by JDN-WMA members, as well as bringing all
stakeholders together to further discuss the details of such an undertaking. The logistics
and funding needed for it to become a reality might seem huge, but this must not be
seen as an obstacle in our work, but rather more like a reason to try harder to achieve
our goal. We honestly believe that such an experience, like the reciting of the
Hippocratic Oath, must be shared with the rest of the medical community and become a
“common property” of all junior doctors and young physicians.
References
1) National Institutes of Health; National Library of Medicine; History of Medicine Division. Greek
medicine: “I swear by Apollo physician…”: Greek Medicine from the gods to Galen. 2012 [cited 2019
Jan 13].
2) Britannica. Hippocrates: biography, definition & facts. 2019 [cited 2019 Feb 29].
3) World Medical Association. WMA Declaration of Geneva: the physician’s pledge. 2017 [cited 2019 Jan
13].
roles of the Junior Doctors Network (JDN) is to empower young physicians’ voices to the
WMA from its mission. For example, the WMA statement on physician well-being, adopted
in 2015, was originally drafted by the JDN from many junior doctors’ opinions all over the
world (2). The junior doctors in the National Medical Association (NMA) might have a
similar role to the JDN in the WMA.
In Japan, the Japan Medical Association (JMA) launched the Japan Medical Association
Junior Doctors Network (JMA-JDN) in 2012 (3). Its mission includes taking a survey of
junior doctors’ opinions on related topics and advocating for them. In 2017, the first
advocacy was conducted by JMA-JDN volunteers on the working condition reform. This
article aims to share the challenges of advocacy by junior doctors in Japan and the lessons
learned.
Background of the Physicians’ Working Conditions in Japan
Since 2016, the Japanese government has made forward steps to reform working in most
industries (4). This expects to improve productivity and develop human resources in
working places to maintain the economics against a relative decreasing working-age
population due to “super-aging” and low birth rate in the population structure. Along this
context, the physicians’ working condition reform has been started.
Japan’s Labor Standards Act regulates the upper limit of working hours, where there are
eight working hours per day, 40 working hours per week, and one day off per week.
Overtime and holiday work periods are possible by contracting labor-management
agreements. If it is contracted, the upper limit of overtime work hours could reach 100
hours per month and 960 hours per year (5).
In December 2016, Japan’s Ministry of Health, Labour and Welfare (MHLW) aimed to
examine physicians’ working hours with their characteristics, including age, sex, medical
specialties, and working styles (e.g., part-time employment), and conducted a survey with a
stratified random sample of physicians working in hospitals (6) (Figure 1).
Junior Doctors Newsletter
Issue 15
April 2019
Junior Doctors’ Challenges of Advocacy for Physicians’ Well-being in Japan
JUNIOR DOCTORS’ ACTIVITIES
Kazuhiro Abe, MD PhD
Japan Medical Association, Junior Doctors Network
Department of Public Health, Graduate School of Medicine
University of Tokyo
Tokyo, Japan
The World Medical Association (WMA) advocates achieving the
highest international standards in medical education, medical science,
medical art, medical ethics, and health care for all people in the world
through the declarations, resolutions, and statements (1). One of the
According to the survey, Japanese physicians have been exposed to long working hours.
Some reasons caused this dangerous condition might be the stipulation in the Medical
Practitioners Act and self-sacrifice from excessive professionalism. The law states that
physicians cannot refuse to see patients without physicians’ absence or serious illness
whenever and wherever patients request it (7). Established in 1948, it was necessary to
rapidly restructure a medical provision system after World War II. There were uninsured
people until the universal health insurance system started in 1961 (8). The physicians’
obligation was enacted for patients, who could not afford medical expenses by absolute
poverty, to have access to the medical treatment against some physicians who refused
them. Over the past 70 years, the medical provision system in Japan has been enhanced,
and uninsured people have utilized the universal health care system. Currently, the
stipulation has obscured management of the physicians’ working hours. Another cause of
physicians’ long working hours would be self-sacrifice from excessive professionalism. This
issue was pointed out in the WMA statement on physicians’ well-being in 2015 (2).
In August 2017, the MHLW launched the investigative commission on the physicians’
working condition reform to improve their labor conditions (9). Two junior doctors have
participated in this investigation. According to the survey, young physicians have worked
longer hours than older physicians, and previous studies have shown that younger
physicians tend to feel burnout (10,11). Therefore, more objective and representative
opinion of junior doctors as one of the main actors are required to improve the sustainability
of the health care system.
Junior Doctors Newsletter
Issue 15
April 2019
JUNIOR DOCTORS’ ACTIVITIES
For example, although the physicians’ working
hours identified differences in their
characteristics, the average number of working
hours of 20- and 30-year-old male physicians
was 75 hours per week, including 57 hours for
clinical practices, medical education, and
research, and 18 hours for the night shift and
on-call. The average number of overtime work
hours of 20- and 30-year-old male physicians
was about 140 hours per month and 1,680
hours per year. About 40% of physicians
greatly exceeded these upper limits of over-
time work hours.
Figure 1. Average of full-time physicians’ working
hours by age and sex in Japan (6).
Challenges of Junior Doctors in Japan
To strengthen advocacy among junior doctors, JMA-JDN volunteers organized a three-hour
workshop to describe the concept of advocacy and how junior doctors can advocate
effectively (12). This workshop was held in July 2017, with a total of 19 participants,
including nine junior doctors, eight medical students representing the International
Federation of Medical Students’ Associations (IFMSA) in Japan, one MHLW official, and
one public health researcher. The workshop agenda included the keynote lecture, “What is
advocacy?”, presented by professor Masamine Jimba, president of the Japanese Society
of Health Education and Promotion. Then, the participants simulated making the strategic
plan for the effective advocacy by each small group, using the worksheet suggested by Dr
Trevor Shilton (13) (Photos 1-2). In addition, they leaned the following keys of success
advocacy: dedicated, persistent, and “politically-astute» leadership; mobilization of
coalitions that are broad-based and well-coordinated; consensus on the most important
measures that will achieve the advocacy goal; commitment to a consensus on priority
actions; commitment to comprehensive operations; commitment to robust and long-term
implementation; and persistence.
Junior Doctors Newsletter
Issue 15
April 2019
JUNIOR DOCTORS’ ACTIVITIES
At the workshop, most groups selected the
theme related to the working condition re-
form. Thus, the Advocacy team of Young
Medical Doctors and Students (AYMDS)
was set from the interested participants in
the working condition reform. The AYMDS
included five junior doctors, three medical
students, and one researcher. In November
2017, the AYMDS disseminated the online
questionnaire to examine the perspectives
of junior doctors and medical students on
the current working conditions of
physicians. With a total of 821 responses,
the AYMDS summarized the results and
prepared a draft policy statement.
The public comments were collected, and the draft was revised. In December 2017, the
AYMDS presented the policy statement in the investigative commission on the physicians’
working condition reform of MHLW (14). These actions showcased an essential step for
Japanese junior doctors as they delivered their voices to reforming health policy.
Photo 1. Advocacy skills workshop, with instruction
from professor Masamine Jimba, where each small
group collaborated to develop the strategic plan for
advocacy. Credit: Kazuhiro Abe.
platform for junior doctors across Japan. These issues have created challenges in
mobilizing coalitions, reaching consensus, and ensuring sustainable commitments.
In summary, there is a need for junior doctors in Japan to be more active in the JMA and
represent the junior doctors’ voices. JMA-JDN can serve as a platform for junior doctors in
Japan to seek continued academic training and enhance productive and continuous
advocacy skills. With WMA support, the JDN can promote the importance of global
leadership and advocacy as junior doctors. I hope that the voices of junior doctors across
the world will facilitate open dialogue in health policy.
References
1) World Medical Association. Who we are. 2019 [cited Feb 14].
2) World Medical Association. WMA statement on physicians’ well-being 2015. 2019 [cited 2019 Feb 14].
3) Japan Medical Association-Junior Doctors Network. JMA-JDN webpage. 2019 [cited 2019 Feb 14].
4) Japanese Ministry of Health, Labour and Welfare. The action plan for the realization of work style reform. 2017
[cited 2019 Feb 14]..
5) Japanese Ministry of Health, Labour and Welfare. Revised Labour Standards Act. 2010 [cited 2019 Feb 14].
6) Japanese Ministry of Health, Labour and Welfare. The survey of physicians’ working condition. 2017 [cited
2019 Feb 14].
7) Japanese Ministry of Health, Labour and Welfare. Doctor’s duty of responding to call-up. 2018 [cited 2019 Feb
14].
8) Ikegami N, Yoo BK, Hashimoto H, et al. Japanese universal health coverage: evolution, achievements, and
challenges. Lancet. 2011;378:1106-1115.
9) Japanese Ministry of Health, Labour and Welfare. The investigative commission on the physicians’ working
condition reform. n.d. [cited 2019 Feb 14].
10) Tateno M, Jovanovic N, Beezhold J, et al. Suicidal ideation and burnout among psychiatric trainees in Japan.
Early Interv Psychiatry. 2017;12:1-3.
11) Thomas NK. Resident burnout. JAMA. 2004;292:2880-2889.
12) Abe K, Kato D, Sonoda K. Future perspectives on an advocacy skill workshop for junior doctors and medical
students in Japan. Japanese Journal of Health Education and Promotion. 2018;26:155-161.
13) Shilton T. Advocacy for non-communicable disease prevention; building capacity in Japan. Japanese Journal of
Health Education and Promotion. 2016;24:102-114.
14) Advocacy team of young medical doctors and students. Statement from young medical doctors and medical
students on legal regulations of physicians’ long working hours. 2017 [cited 2019 Feb 14].
Junior Doctors Newsletter
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April 2019
JUNIOR DOCTORS’ ACTIVITIES
Photo 2. Participants of the advocacy skills workshop.
Credit: Kazuhiro Abe.
Lessons Learned
Looking back at the case as compared to the
keys of success advocacy, there were two main
issues. First, junior doctors are not formally
trained in advocacy, and hence, are unfamiliar
with practical techniques to advocate on critical
health issues. Second, although effective
advocacy should have a robust framework to
collect objective and representative viewpoints
from junior doctors, there was no representative
throughout our medical education and training in the classroom and community setting. As
junior doctors engage in postgraduate medical training in diverse disciplines and
geographies, we should lead efforts to advance scientific knowledge among medical
students regarding key health topics that affect local, national, and global communities. The
following example in the Dominican Republic is a professional development workshop that
highlights how junior doctors can encourage, train, and mentor medical students in
scientific inquiry for their clinical practice.
Supported by the Standing Committee on Medical Education (SCOME), the Organización
Dominicana de Estudiantes de Medicina (ODEM), recognized as IFMSA-Dominican
Republic, organized a four-hour academic workshop for medical students in February 2019.
The workshop aimed to provide medical students with an understanding of scientific
publications, techniques to prepare a brief article or letter to an editor, and insight on the
importance of interdisciplinary skills for medical training. The agenda of the activity was
prepared by SCOME National Officers, Ms Marla Pelletier (Universidad Nacional Pedro
Henriquez Ureña, UNPHU) and Ms Camila González (UNPHU), and SCOME Local Officer,
Ms Isamar Fernández (Universidad Iberoamericana, UNIBE). An estimated 70 participants,
representing six medical schools from the cities of Santo Domingo and Santiago, attended
this event, which was held at UNIBE School of Medicine in Santo Domingo (Photos 1-2).
Junior Doctors Newsletter
Issue 15
April 2019
Innovative Workshop: Developing Critical Inquiry in the Dominican Republic
JUNIOR DOCTORS’ ACTIVITIES
Helena Chapman, MD MPH PhD
Publications Director (2018-2019)
Junior Doctors Network
World Medical Association
As Junior Doctor Network (JDN) members, we understand the
indispensable roles of professional development and mentorship
Photo 1. ODEM members who participated in the academic workshop.
Credit: ODEM.
Photo 2. ODEM logo.
Credit: ODEM.
Workshop: Key Skills in Preparing Scientific Publications
Dr Yessi Alcántara (UNPHU) and Dr Helena Chapman (UNIBE) coordinated this
collaboration to highlight the value of scientific publications to enhance professional
development as health professionals. Dr Alcántara described the article formats required
for the non peer-reviewed publication submission to the IFMSA’s Medical Student
International and Diario Salud Dominicana’s DiarioSalud Estudiantil (Dominican Republic)
and encouraged ODEM members to prepare their articles about ODEM community health
activities and topics. She also presented two examples of published articles to serve as a
general guide.
Then, Dr Chapman highlighted that participating in research projects and reviewing medical
literature were ways to strengthen scientific expertise, critical analysis, and communication
skills. As a first step, she recommended that ODEM members consider the preparation of a
letter to an editor to a medical journal as a training opportunity. She provided a thorough
review of two examples of published letters as models. After this technical portion of the
workshop, Dr Chapman offered a gratuitous virtual mentorship practicum, where teams of
two ODEM members would follow a strict timeline over a four-month period in order to
prepare their letters to an editor to a medical journal.
Panel: Interdisciplinary Knowledge for Future Physicians
As a complementary panel to the academic workshop, three experts shared key
perspectives from their individual disciplines as they relate to medical education. First, Ms
Haydeeliz Carrasco, economist and consultant for the World Bank, highlighted the low
public health expenditure in the Dominican Republic (2.7% of gross domestic product,
GDP), when compared to the expenditure in Latin America (3.5% of GDP), from 2011 to
2015. She mentioned that the country could achieve efficiency gains and higher impacts of
public expenditure, by allocating resources for priority health needs, designing evidence-
based interventions, and strengthening monitoring and evaluation systems.
Second, Mr Jamie Rudert, a veterans advocate attorney currently employed by Paralyzed
Veterans of America, emphasized that as health leaders, physicians should understand
their legal role in health service delivery, be prepared to document and evaluate
occupational exposures and other health concerns, and establish an appropriate medical
management plan. For patients who are military veterans, he stated that through
comprehensive medical evaluations, physicians can examine if the medical condition could
be related to military service and provide documentation to the appropriate authorities. In
turn, the respective authorities can subsequently review these records and consider the
adjudication of veterans’ benefits.
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JUNIOR DOCTORS’ ACTIVITIES
These collective actions can encourage medical students to gain further scientific insight on
interdisciplinary topics and enhance understanding of the research process, which may be
limited in existing medical curricula.
Junior Doctors Newsletter
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April 2019
JUNIOR DOCTORS’ ACTIVITIES
Photo 3. Ms Marla Pelletier, Dr Yessi Alcántara,
Ms Haydeeliz Carrasco, Mr Jamie Rudert, Dr
Helena Chapman, Ms Genesis Familia, and Ms
Camila González (left to right). Credit: ODEM.
Finally, Dr Chapman, a public health physician
working at the National Administration of
Aeronautics and Space (NASA), introduced
the “One Health” concept, which promotes
transdisciplinary collaborations to develop
strategies that mitigate disease risks shared
between humans, animals, and the
environment. She described the value of the
use of Earth observation data in health
education, research, and practice, to better
understand the dynamic processes of the
ecosystem and its influence on human, animal,
and environmental health.
JDN members should be motivated to be actively engaged in
developing academic workshops and panels with medical students
in their communities, so that they can foster medical students’
innovation and critical analysis on diverse scientific health topics.
educate community members living in low-resource areas through the development of
community health initiatives. Current members are junior doctors working in all levels of
health care delivery across the 36 Nigerian states in six geo-political zones and the federal
capital territory.
Using social media technology to bridge communication among Nigerian junior doctors,
DTOF identifies community health needs of vulnerable populations and develops
collaborative health activities to educate on essential health topics and mitigate disease
risks. Junior doctors organize annual free medical evaluations, award scholarships to
children from educationally disadvantaged communities, and provide educational talks on
proper hygiene and sanitation practices. They also coordinate social programs within
communities, including showcasing musical events and distributing donated food and
modest financial contributions. Funding for these health and social programs are through
DTOF donations, which illustrates positive social responsibility. As an African nation,
citizens must provide a means of taking care of the health and well-being of vulnerable
populations.
Using the theme, The Resident Doctor and Financial Planning – Medical Entrepreneurship,
Myth or Reality, junior doctors commemorated DTOF’s third anniversary throughout five
Nigerian geo-political zones and the federal capital territory (Photos 1-2). Between June
11-17, 2018, community health initiatives were coordinated across the country in line with
the DTOF’s mission and vision (Table 1).
Junior Doctors Newsletter
Issue 15
April 2019
JDN in Nigeria – Bridging the Gap and Impacting Lives
JUNIOR DOCTORS’ ACTIVITIES
Photo 1. DTOF volunteers after
deworming campaign at a primary school
in Ibadan, Nigeria. Credit: DTOF.
Photo 2. DTOF volunteers at an
orphanage in Umuahia, South-East
Nigeria. Credit: DTOF.
Anthony Chukwunonso Ude, MBBS MWACS
Communications Director (2018-2019)
Junior Doctors Network
World Medical Association
Doctors Time Out Family (DTOF) is a charitable, non-governmental
organization managed by Nigerian junior doctors that was founded in
June 2015 by Dr. Anthony Chukwunonso Ude. The mission is to
Junior Doctors Newsletter
Issue 15
April 2019
JUNIOR DOCTORS’ ACTIVITIES
In his closing remarks, Dr. Francis
Faduyile, the National President of the
Nigerian Medical Association (NMA),
commended DTOF for the dynamism and
sagacity regularly displayed in their
community initiatives. He hinted that his
team would be devising ways to maximize
interactions among junior doctor members
and promote all-inclusiveness in NMA
activities.
We sincerely appreciate everyone who
has contributed to the successful activities
surrounding the DTOF’s third anniversary.
As we prepare for the DTOF’s fourth
anniversary in June 2019, the Nigerian
junior doctors encourage junior doctors
across the world to bridge the gap and
impact lives of their local community
members. By identifying gaps in
established health promotion activities in
local communities, junior doctors can
collaborate and develop community health
initiatives, carving out a niche where the
next generation of junior doctors can
become inspired, raise public awareness,
and find opportunities to positively impact
their communities.
Together, junior doctors can
change the world and make it a
better place!
If you are interested to learn more about
DTOF, please visit our website, follow on
Twitter (@familytimeout), email our team
or send a Whatsapp message
(+2348036680438).
Zone
Junior Doctor
Participants Activities
South-
South
ARD University of
Port Harcourt
Teaching
Hospital
ARD Braithewaite
Memorial
Specialist
Hospital, Rivers
State
❑ Coordinated visits to orphanages
to deliver toiletry items (e.g.,
tissues, cleaning supplies), food
(e.g., yams, rice, spices, noodles,
cereals, beverages), and modest
financial contributions.
❑ Conducted health talks on proper
hygiene and sanitation practices.
❑ Organized a “Marathon for Life” to
promote physical activity.
South-
West
ARD Obafemi
Awolowo
University
Teaching
Hospital, Ile-Ife
Osun State
❑ Coordinated visits to orphanages
to deliver toiletry items, food, and
modest financial contributions.
❑ Conducted health talks on proper
hygiene and sanitation practices.
South-
East
ARD Federal
Medical Centre,
Umuahia Abia
State
❑ Coordinated visits to orphanages
to deliver toiletry items, food, and
modest financial contributions.
❑ Conducted health talks on proper
hygiene and sanitation practices.
North ARD Ahmadu
Bello University
Teaching
Hospital, Zaria
❑ Organized deworming campaign
for 115 street children and
planned for follow-up medical
services in 4 locations in Zaria.
❑ Distributed toiletry items and
clothing.
❑ Conducted health talks on proper
hygiene and sanitation practices
at four primary schools.
Central ARD University
College Hospital,
Ibadan
❑ Conducted Deworm and Educate
the Child Initiative (DECI) at the
IMG Primary School Oje Igosun
Ibadan: Donated 400 copies of
DTOF customised exercise books
and anti-helminthic drugs for
future deworming campaigns.
Conducted health talks on proper
hygiene and sanitation practices,
where prizes were awarded for
active student participation.
❑ Coordinated visit to Jesus
Children Mission Bodija
orphanage: Donated 100 DTOF
customised books. Provided
modest financial contributions to
low-resource students.
❑ Conducted gratuitous medical
evaluations to professors.
Table 1. Junior doctors from the Association of Resident
Doctors (ARD) coordinated DTOF activities in June 2018.
Association (WMA) and globally. In Malaysia, JDN was formed by the Malaysian Medical
Association in 2017 and was placed under the Section Concerning House Officers, Medical
Officers and Specialists (SCHOMOS), which is the section focused on the welfare of
government doctors in Malaysia. JDN Malaysia was formed to allow Malaysian doctors to
participate in the JDN international network and look at the issues affecting Malaysian
junior doctors.
JDN Malaysia organised the first JDN meeting within the Confederations of Medical
Associations in Asia and Oceania (CMAAO), preparing the first project, “Workplace
Bullying and Harassment”. In order to study the impact of this issue within Malaysia, we
prepared a JDN/SCHOMOS online survey on the topics of workplace bullying and
harassment. With over 2,000 respondents, our survey results showed that the incidence of
workplace bullying was highest amongst the junior doctors. Hence, we coordinated a
meeting agenda to facilitate a dialogue on identifying real-time challenges, developing
solutions to reduce these challenges, and proposing policies to be shared among
participating nations on these topics. A website was also launched to serve as a common
portal to update junior doctors on current news and events as well as efforts leading
towards a more harmonious workplace environment.
The CMAAO theme chosen for this inaugural meeting was, Leading the Way towards
Mutual Respect – The Role of Junior Doctors in Preventing Workplace Bullying. This
meeting was attended by over 30 participants representing the different CMAAO member
countries in Asia and Oceania. The majority of country delegates agreed that there was an
urgent need to define what constitutes bullying and harassment in the workplace and
acknowledged that it had affected all levels of health care, especially on the junior doctors.
Clear guidelines on acceptable behaviour and responsibilities of health professionals
should be made known to all health care workers.
Junior Doctors Newsletter
Issue 15
April 2019
JDN-SCHOMOS MMA Penang Declaration 2018
JUNIOR DOCTORS’ ACTIVITIES
Vijay Ganasan, MD
Chairman, Malaysian Chapter
Junior Doctors Network
Kuala Lumpur, Malaysia
The Junior Doctors Network (JDN) was formed in Vancouver in
October 2010, with the aim of creating a platform for junior doctors
worldwide to ensure their voice was heard within the World Medical
They agreed that strong high-level administrative leadership is required
to reform and enforce policies that confront workplace bullying.
Through this dialogue, delegates provided three recommendations to strengthen legislation
regarding workplace bullying and harassment. First, policies and laws should exist to
protect the victims, ensure just and prompt investigations into perpetrators, and sanction
those individuals who are found guilty of bullying and harassment. Second, the victim’s
anonymity and confidentiality should be maintained, and adequate physical protection or
psychological support should be provided to the victims of bullying and harassment. Third,
all levels of staff should undergo training in leadership and soft skills to ensure the
formation of a conducive environment for junior doctors to be nurtured and grow into
leaders of tomorrow.
At the end of the meeting, the JDN SCHOMOS MMA Penang Declaration 2018 was signed
by attendees at the first CMAAO JDN Meeting on September 14, 2018, on the sidelines of
the 33rd CMAAO General Assembly (Photos 1-2). This solidified a commitment from all
participating countries to work towards ending workplace bullying and harassment.
Our guest of honor, Dr. Mohd Fikri bin Ujang, a senior official within the Malaysian Ministry
of Health, stated that the declaration would be tabled at the next Head of Department’s
meeting at the Malaysian Ministry of Health. He also expressed the need to work together
for a healthier workplace environment.
Junior Doctors Newsletter
Issue 15
April 2019
JUNIOR DOCTORS’ ACTIVITIES
Photo 1. The Declaration Team at the closing ceremony
of the JDN-CMAAO Meeting 2019. Credit: CMAAO2018.
Photo 2. JDN Section Concerning House Officers,
Medical Officers, and Specialists (SCHOMOS)
Malaysian Medical Association (MMA) Penang
Declaration 2018. Credit: CMAAO2018.
the Icelandic Medical Association (IMA) office. It was my privilege to attend the meeting on
behalf of the Singapore Medical Association (SMA) Doctors in Training (DIT) Committee,
for I was able to renew the bonds formed during the 2015 JDN meeting held in Oslo,
Norway, and also make new acquaintances with representatives from other parts of the
world.
The JDN was formed in Vancouver in October 2010 to create a platform for junior doctors
worldwide and to ensure that their voices are heard both within the WMA and globally. Its
mission is to empower young physicians to work together towards a healthier world through
advocacy, education, and international collaboration. This is very much in line with the
purpose of SMA’s DIT Committee, which is to provide a platform for local junior doctors
across all training institutes to collaborate towards a better training environment, both intra-
institutional and on a national level.
At this JDN meeting, delegates from 16 countries across the globe came together to
discuss the new trends in postgraduate medical education. The IMA shared that until 2015,
they have had a limited postgraduate training structure, and that most trainees have to
complete their higher specialist training abroad. The Canadian Medical Association (CMA)
explained their system of competency-based curriculum. A representative from the
Foundation for Advancement of International Medical Education and Research also
presented on a potential collaboration with JDN to offer international exchanges for
residents to further their training.
Another topic covered was on the well-being of junior doctors and combating burnout. The
CMA shared survey results on burnout among their residents and the approach to
recognising the signs and degrees of burnout. They also highlighted the importance and
methods of training resilience in junior doctors. The meeting concluded with an “ideas cafe”
session to improve the JDN and an election for the next working committee.
It was a very refreshing experience as I was greatly inspired by the passion of the fellow
JDN delegates. I also received many interesting ideas on how to better serve my
Singaporean junior doctors. Last but not least, I wish the newly elected working committee
all the best in their future endeavours.
Junior Doctors Newsletter
Issue 15
April 2019
Empowering Junior Doctors
INTERNATIONAL CONFERENCES
Benny Loo, MBBS
Chairperson, Doctors in Training Committee
Singapore Medical Association
The Junior Doctors Network (JDN) meeting, under the World Medical
Association (WMA), was recently held in conjunction with the WMA
General Assembly in Reykjavik, Iceland, from October 1-2, 2018, at
*Editorial note: The Singapore
Medical Association (SMA) has
authorized the reprint of this
SMA News article in the 15th
issue of the JDN Newsletter.
The Prince Mahidol Award Conference (PMAC) is an annual global health conference held
in late January, in Bangkok, Thailand. It is co-hosted by the Prince Mahidol Award
Foundation, the Thai Ministry of Public Health, Mahidol University, and a range of major
global health organisations, including the World Health Organization (WHO) and the World
Bank. The theme for 2019 was The Political Economy of Non-Communicable Diseases: A
Whole of Society Approach.
The conference highlighted that non-communicable diseases (NCDs)
cause the highest global disease burden and are rooted in social,
economic, environmental, and commercial determinants of health.
The prestigious conference focusing on policy-related health issues is an invite-only event.
This year, four members of the Junior Doctors Network (JDN) of the World Medical
Association (WMA) were fortunate to attend PMAC 2019 as part of the tickets allotted to
the Thai JDN delegation. In this article, we share some of the key messages and highlights
of the conference.
The first three days (January 29-31, 2019) were pre-conference sessions, including side
meetings and field trips. JDN members enjoyed the field trip sessions, where we had the
opportunity to see first-hand the various Thai initiatives taking place at local and national
level to accelerate implementation of NCD prevention and control.
Junior Doctors Newsletter
Issue 15
April 2019
Prince Mahidol Award Conference 2019
INTERNATIONAL CONFERENCES
Mariam Parwaiz, MBChB MPH (Hons)
Public Health Medicine Registrar
Counties Manukau District Health Board
Auckland, New Zealand
Lyndah Kemunto, MBChB
General Practitioner, Kisii County Government
Kisii, Kenya
Hasan Al Hameedi, MBChB
MD Register, Consultant WHO
Baghdad, Iraq
Jade Lim, MD MPH
Paediatric Trainee, South Australia Health
Adelaide, Australia
One of the field trip sites visited was the Thai Health Promotion Foundation, an
autonomous government agency that focuses on health promotion. Thai Health is a good
example of how sin taxes can be used to promote health in a population. Their annual
budget of US$120 million is drawn from the 2% surcharge on alcoholic beverages and
tobacco products. The visit gave participants a practical glimpse into their day-to-day
activities, including physical exercise sessions that can be done in any office.
Another group participated in a field trip to the Kaeng Khoi District, Saraburi Province to
learn more about the Ministry of Public Health’s policy on District Health System (DHS), a
policy aimed at decentralizing health care decision-making and management. This was
launched in 2013 to create more unity in the health care sector, share resources, and
promote community participation at the district level. The participants visited two sites:
firstly, Kaengkhoi Hospital, where local stakeholders presented their efforts in managing
NCDs within the District Health System; and secondly, a local primary school, where
participants could see the implementation of health promotion within the education system.
The main conference (February 1-3, 2019) had four plenary sessions, 15 parallel sessions,
and many special events and e-poster presentations. In total, there were 1,090 participants
from 77 countries.
Plenary 0, Political Economy of NCDs: Players, Powers, and Policy Processes, set the
scene for the entire conference. Professor Michael Reich praised the organizers of PMAC
2019 for pushing boundaries and organizing the first global health conference on political
economy. He provided a simple and clear definition of political economy: “how the
allocation of political resources and economic resources affects who gets what, when, and
how”. Over the course of the event, we heard from many eminent global health leaders,
including Dr Margaret Chan, Professor Sir Michael Marmot, Dr Sania Nishtar, and
Professor Boyd Swinburn.
Junior Doctors Newsletter
Issue 15
April 2019
INTERNATIONAL CONFERENCES
Photo 1. WMA JDN delegation to PMAC2019:
Dr Lyndah Kemunto, Dr Jade Lim, Dr Mariam
Parwaiz, and Dr Hasan Al Hameedi (left to
right). Credit: PMAC2019.
Photo 2. Members of WMA JDN delegation, Thai JDN
delegation, and IFMSA delegation with Professor Sir Michael
Marmot: Dr Jade Lim, Dr Mariam Parwaiz, Sir Michael
Marmot, Dr Saowaluk Noon Srikajornlarp, Mr Hung Wei Pin,
and Dr Hasan Al Hameedi (left to right). Credit: PMAC2019.
The key debate at the conference was around the commercial determinants of NCDs. In
2016, Kickbusch et al. defined commercial determinants of health as the “strategies and
approaches used by the private sector to promote products and choices that are
detrimental to health” (1). Applied to the NCD sphere, these commercial determinants are
unhealthy commodities promoted by corporations, and include tobacco, alcohol, and
unhealthy foods. At PMAC 2019, there was broad agreement that we need to address the
commercial determinants of health, but the focus of the debate was on exactly how to
address them, and what should be the role of the industries themselves. Perspectives
ranged from those who viewed industries as part of the solution to NCDs, to those who felt
that industries cannot be trusted but merely regulated. These debates were largely focused
on the food and beverage industry, and to a lesser extent the alcohol industry; the tobacco
industry was universally condemned.
A key message for junior doctors is to appreciate the broader factors
that contribute to the growing burden of NCDs around the world,
including the commercial determinants of health.
Professor Sir Michael Marmot, Past President of the WMA, was inspiring as always, and
discussed the importance of addressing the fundamental drivers of ill health given the rising
health inequalities around the world. One of the highlights was when he described how
IFMSA medical students and WMA-JDN junior doctors have passionately supported the
cause of improving social determinants of health for all. He also mentioned the report that
was produced during his Presidency of the WMA, Doctors for Health Equity, an excellent
resource for junior doctors to use when advocating for health equity (2).
Over the course of conference, we heard from many academics, policy-makers, politicians,
and representatives from key global health institutions. However, we did not hear much
from civil society, particularly from those people living with NCDs. Kwanele Asante, a
lawyer, bioethicist, and cancer equity activist, was one of the few voices speaking on behalf
of people living with NCDs. She was a panelist for Plenary 3, Governance of the NCD
Response: Who is in Control?, and she eloquently and powerfully called for a reshaping of
the global health narrative to one where people are put at the centre. This was one of the
two plenaries where a member of the non-alcohol beverage industry was also a panelist,
and her presence was an issue of debate amongst the attendees. Ms Asante challenged
the industry speaker on the harms that their products create and reminded everyone of the
United Nations right to health as a fundamental human right. The Bangkok Statement on
the Political Economy of NCDs, produced at the end of the conference, rightfully began by
reaffirming this human right (3).
Junior Doctors Newsletter
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April 2019
INTERNATIONAL CONFERENCES
On a lighter and brighter side of the conference, PMAC 2019 had a number of initiatives to
walk the talk when it came to addressing NCDs. These included nutritional food labels and
warning signs for food high in fat, salt, or sugar; standing desks; massage and meditation
zones; and a physical activity segment at the start of each session. The food warning signs
had a mixed response from the attendees, but most appreciated the other initiatives. It was
definitely fun to be exercising to the “Baby Shark” song along with esteemed global health
leaders!
The JDN delegation engaged with the attendees in person and on Twitter (#PMAC2019).
We thoroughly enjoyed our time, learned more about the challenges in addressing NCDs,
particularly the political economy factors, and engaged with new and old friends and
colleagues. For more information about PMAC 2019, including the synthesis of the
conference, please visit the conference website. The conference theme for PMAC 2020 is
Accelerating Progress towards Universal Health Coverage. We anticipate JDN members
will have an opportunity to attend next year, and we highly recommend it.
Acknowledgements: We would like to extend our greatest thanks to the Thai JDN for
inviting us and to the PMAC organisers for hosting us.
References
1) Kickbusch I, Allen L, Franz C. The commercial determinants of health. Lancet Global Health. 2016;4:e895-
e896.
2) Institute of Health Equity and World Medical Association. Doctors for health equity: the role of the World
Medical Association, national medical associations and doctors in addressing the social determinants of
health and health equity. 2016 [cited 2019 Mar 11].
3) Prince Mahidol Award Conference. Statement on the political economy of non-communicable diseases: a
whole of society approach. 2019 [cited 2019 Mar 11].
Junior Doctors Newsletter
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April 2019
INTERNATIONAL CONFERENCES
Photo 3. Closing session of PMAC2019.
Credit: PMAC2019.
Junior Doctors Newsletter
Issue 15
April 2019
World Antibiotic Awareness Week 2018
WORKING GROUPS
Mariam Parwaiz, MBChB MPH (Hons)
Public Health Medicine Registrar
Counties Manukau District Health Board
Auckland, New Zealand
Steen Fagerberg, MD MSc PhD
Anesthesiology and Intensive Care Medicine
Resident
Regional Hospital of Northern Denmark
Hjørring, Denmark
Ian Pereira, MD BASc
Radiation Oncology Resident
Queen’s University
Ontario, Canada
Helena Chapman, MD MPH PhD
Publications Director (2018-2019)
Junior Doctors Network
World Medical Association
Figure 1. A total of 10 million people may die from
antimicrobial resistance (AMR) by 2050 (1).
From the early 1900s, antimicrobials such as
penicillin helped improve the lives of millions
of patients worldwide. Since then, microbes
such as bacteria, viruses, fungi, and
parasites have evolved to evade these drugs
through a process called antimicrobial
resistance (AMR). Recent estimates suggest
that AMR causes nearly 700,000 deaths
worldwide each year and up to 10 million by
2050 (Figure 1). It will become more fatal
than cancer, diabetes, diarrheal diseases,
and road accidents, making AMR one of the
world’s most significant global health risks
impacting the health of humans, animals, and
the environment (1).
“Antimicrobial resistance will take us back to a time when people
feared common infections and risked their lives from minor surgery”
-Dr. Tedros Ghebreyesus, Director-General of the WHO
The World Health Organization (WHO) Global Action Plan on AMR was endorsed by
Member States at the 68th World Health Assembly. This formed the agenda of the High-
Level Meeting at the United Nations (UN) General Assembly in 2016. Heads of state, non-
governmental organizations, civil society, the private sector, and academic institutions
adopted a resolution to collaboratively respond and established the Interagency
Coordination Group (IACG) (2). Although this meeting was instrumental in highlighting
AMR on a global scale, Member State engagement, especially from low- and middle-
income countries (LMICs) has remained low. Only 20 of 194 countries responded to any
consultations (3). By the WHO Global Action Plan’s target of 2017, only 44% of countries
produced surveillance data on prevalence, 20% had comprehensive action plans (Figure
2), and 14% had no plan at all (4).
Nonetheless, endorsement of this plan by Member States reflected global consensus on
the reality of AMR and need to work together to meet its objectives (5). One key objective
was to improve awareness and understanding of AMR through effective communication,
education, and training. This formed the basis of World Antibiotic Awareness Week.
Members of the World Medical Association’s (WMA) Junior Doctors Network (JDN) have
been working over the last few years through the JDN AMR Working Group to help develop
solutions for AMR. More and more patients and their families are going online for health
information to platforms including Twitter and Facebook, while health care professionals
are doing the same to share scholarly research or clinical guidelines, build professional
networks, and advocate for positive change (6,7). This suggested an online opportunity.
Junior Doctors Newsletter
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April 2019
WORKING GROUPS
Figure 2. The world lacks solutions for comprehensive national antimicrobial
resistance (AMR) action plans. This includes plans with identified funding
sources that are being implemented and have the relevant sectors involved with
a defined monitoring and evaluation process in place (4).
Every November, the WHO commemorates World Antibiotic Awareness Week with an
online campaign to increase public awareness and promote adherence to the best clinical
and community practices. Under the WHO 2018 theme of Change Can’t Wait, Our Time
with Antibiotics is Running Out, the WMA JDN went online to combat AMR, by raising
awareness and work collaboratively to develop solutions.
A team from the JDN AMR Working Group led discussions on Twitter and Facebook
highlighting key high-level policies, current statistics, and potential next steps to address
AMR. This included informational “tweets”, which were messages using the Twitter
platform, authorized by the WMA as prompts for discussion. Junior doctors and the WMA
leadership provided trustworthy health information including best antimicrobial stewardship
practices for the general public and practitioners, dissected current scientific evidence, and
helped develop solutions, such as leveraging existing resources including WMA campaigns
such as #PreventFlu (Figures 3-5).
Junior Doctors Newsletter
Issue 15
April 2019
WORKING GROUPS
Figure 3. Screenshot of a Twitter tweet. Figure 4. Screenshot of a Twitter tweet.
Figure 5. Screenshot of a Facebook message.
AMR continues to challenge scientists and practitioners in the human, animal, and
environmental disciplines. A key barrier may be silos. Overall awareness of the
consequences of unnecessary use of antibiotics is needed at all levels of health care,
including patients, providers, and policy makers. The One Health approach encourages all
stakeholders to work together for better health outcomes (8). One of many platforms we
need to use is social media. Acting as trusted sources of information for the general public
through social media has the potential to lower demand for unnecessary antibiotics.
Now more than ever before, health care professionals, scientists, private industry, and
policy makers, including those from human, animal, and environmental industries, are
accessible to advance policies and guidelines. Working together across geographies and
sectors, we can develop and promote better antimicrobial stewardship practices.
The JDN AMR Working Group looks forward to sharing more results from our work in future
publications, including the work we do to contribute to internal and external policy
development. We are also preparing to expand for the WHO World Antibiotic Awareness
Week in 2019. If you are interested in joining the JDN AMR Working Group, please contact
our team (Dr Caline Mattar, Chair of the AMR Working Group) for further information.
References
1) O’Neill J. The review on antimicrobial resistance. 2014 [cited 2019 Feb 16].
2) Davies OL. At UN, global leaders commit to act on antimicrobial resistance. 2016 [cited 2019 Feb 16].
3) ReAct Group. Member States engagement needed to shape future action on antibiotic resistance – 2018
– ReAct. 2018 [cited 2019 Feb 16].
4) World Health Organization. Global database for antimicrobial resistance country self-assessment. 2017
[cited 2019 Feb 16].
5) World Health Organization. Global action plan on antimicrobial resistance. 2015 [cited 2019 Feb 16].
6) Gallo T. Twitter is trending in academic medicine. 2017 [cited 2019 Feb 16].
7) Fox S. The social life of health information. 2014 [cited 2019 Feb 16].
8) World Health Organization. One health. 2017 [cited 2019 Feb 16].
Junior Doctors Newsletter
Issue 15
April 2019
WORKING GROUPS
Junior doctors who are often the frontline practitioners not only
have the most up-to-date real-world information, but are also
more likely to have the skills to engage online.
history, ranging from the rise of human immunodeficiency virus (HIV) to the erroneous
perception that surgery is not cost-effective in low- and middle-income countries (LMICs).
Over the past five to 10 years, we observed an increase in attention given to surgery in
LMICs and universal health coverage at various global health. Various big players, like the
World Health Organization (WHO) and the World Bank, umped on board to support further
development of the emerging field of “Global Surgery”.
As junior doctors, we believe that the World Medical Association (WMA), and the Junior
Doctors Network (JDN) should not stay behind, but rather, become actively involved in this
new movement. At the JDN meeting in Iceland in October 2018, an introductory session to
Global Surgery was delivered, and consequently the idea for a new working group was
born!
At the moment, the Global Surgery working group represents 16 young doctors from 12
different countries. What makes this working group so interesting is the variety of
professional backgrounds we represent. Aside from various surgical subspecialties and
anesthesia, we also have members working in pediatrics, public health, and general
medicine. This variety is an absolute must, in order to best advocate for surgical patients in
a holistic manner.
If we want global surgery to become a local reality, we need the collaboration of health
professionals, irrespective of their professional qualifications. If we want universal health
coverage to become a reality for all, access to timely, qualitative, and affordable surgical
care should be integrated in health schemes around the world.
Junior Doctors Newsletter
Issue 15
April 2019
Safe Surgery and Anaesthesia for All: Let’s Take Action Now!
WORKING GROUPS
Manon Pigeolet, MD MA
University Hospital Antwerp
Department of Orthopaedic Surgery
Edegem, Belgium
Surgery has historically been a neglected specialty in the global health
sphere. Various reasons can be named for this unfortunate course of
Together, we can spread the word that surgery as a cost-
effective intervention can make a difference for patients with
cancers, non-communicable diseases, and musculoskeletal
trauma, in LMICs and other low-resource settings.
Led by Dr Manon Pigeolet and Dr Victoria Von Salmuth, this Global Surgery working group
aims to provide a platform for residents and young doctors alike to increase professional
networks, exchange essential information about global surgery, advocate for surgical
patients at the local level and effective surgical health systems at international meetings,
and provide opportunities for collaborations on policy or scientific papers on global surgery
(Photo 1).
To contribute to existing efforts to achieve the vision of surgery and anesthaesia care for
all, various projects will be developed by this working Group. A WMA/JDN policy paper on
“Access to Safe, Qualitative and Timely Surgery and Anesthaesia Care”, an opinion piece
on “The Role of Junior Doctors and Residents in Global Surgery”, and an open letter about
“Maternity Leave Regulations in Surgery around the World”, are just a small selection of
topics and projects that we will be working on in the near future.
If you are interested in global surgery and would like to participate in upcoming activities,
please contact our team (Dr Manon Pigeolet) to obtain more information.
Junior Doctors Newsletter
Issue 15
April 2019
WORKING GROUPS
Photo 1. Dr Manon Pigeolet and Dr Victoria Von
Salmuth are the co-chairs of the JDN Global Surgery
working group. Credit: Manon Pigeolet.