WMAJDN-Newsletter-Issue-05-2014-

The World Medical Association, Inc.
L’association Medicale Mondiale, Inc.
Associación Médica Mundial, Inc.
Newsletter
JUNIOR DOCTORS NETWORK
ISSN 2312-220X
Aug
WMA Press Release
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Picture: AFP/CELLOU BINANI
Serious deficiencies in the working conditions of junior doctors dealing with the Ebola virus in West Africa have been highlighted by the
World Medical Association.
Following concern raised by its junior doctor members about the situation in Guinea, Liberia and Sierra Leone, the WMA has urged the
authorities to take immediate action to protect junior doctors and other health personnel who are on the front line treating those with Ebola
virus infection. Since the outbreak began several months ago, hundreds of people have died or become infected, including physicians and
health care staff.
Dr. Nivio Moreira, Chair of the WMA’s Junior Doctors Network, said: ‘Junior doctors are the most vulnerable healthcare staff as they are in first
line contact with the infected and their next of kin. We are appalled by reports that many junior doctors are not provided with protective
equipment essential for dealing with such a deadly disease.
“We are also concerned about reports of unsupervised junior staff in the current Ebola outbreak, which needs high level of expertise to
support the junior staff. These are major threats to all those working in these situations and go to the heart of safe working conditions.”
Dr. Margaret Mungherea, President of theWMA, said:‘The authorities and stakeholders must take appropriate action to constitute supervised
and protected working conditions for junior doctors and all healthcare staff. The WMA also would like to emphasize the importance of
handling all suspected cases of Ebola as seriously as the diagnosed ones. While engaging the infected individuals, WHO endorsed protocols
should be adopted by health authorities.
“Governments have a responsibility to ensure that health workers are trained and provided with a safe
workplace and protective gear.”
Junior Doctors Condemn Working Conditions in Dealing With Ebola Fever
This issue includes:
-Elizabeth Wiley, MD, JD, MPH highlights our Current project on
wellbeing.
-Caline Matter, MD shares update from WMA-JDN and IFMSA
collaboration at the Alumni meeting.
-Chiaki Mishima, MD presents social activities from the WMA
Council meeting at Tokyo.
-Eugene Macalinga reports on AMSA Philippines alumni club
activities.
-Pasqualina Coffey, MBBS discuss about physicians’ work hour
survey in Australia from the national Doctors in Training Annual
Meeting.
-Roy Shen et al recounts medical services given by Taiwanese
Doctors to the local population in Malawi and to flood victims in
Solomon Islands.
-Joanna Xanthaki, MD share about the newly created JDN in
Greece.
-Ahmet Murt MD Share share about his observing report on
European Junior Doctors Meeting.
I am sure you will enjoy the stories in this issue.
Starting from last issue, World Medical
Association Junior Doctors’ Network (JDN)
Newsletter received its own ISSN (2312-220X) as
WMA JDN continues to grow and becomes the
leading voice for young doctors globally.
Dr. Elizabeth Wiley Socio Medical Affairs Officer WMA JDN
for consideration at the last WMA General Assembly in Fortaleza.
NMAs submitted a diverse array of comments.
During the WMA Executive Board meeting held in April in Tokyo,
an Expert Working Group was established to provide recommen-
dations on the physician well-being policy statement. The Expert
Working Group includes representatives from the American
Medical Association (chair), Japanese Medical Association,
German Medical Association, French Medical Association and
South African Medical Association. This group has begun its work
and will presentits recommendations on the physician well-being
policy statement at the next WMA General Assembly in Durban,
South Africa. JDN Chair Nivio Moreira will be representing the JDN
on the Expert Working Group.
Within the JDN, the Physician Well-being Working Group
continues to meet to prepare the physician well-being white
paper for consideration at the up coming WMA General Assembly
in Durban, October 6-11, 2014. The white paper focuses on several
dimensions of physician well-being:
Stress and distress
Mental health
Fatigue, sleep deprivation and medical error
Bullying and harassment
Substance abuse
Physician support
Physician Well-being
Earlier this year, National Member Associations
(NMAs) were invited to submit comments on the
physician well-being policy statement initially
submitted by the Junior Doctors Network (JDN)
Aug
The cover highlights recent WMA and WMAJDN statement on
about « Junior Doctors Condemn Working Conditions in Dealing
With Ebola Fever ».
Issue 5
Dr. Wunna Tun, Editor in Chief, WMAJDN Newsletter
Editorial
The views expressed in this newsletter are opinions of authors
and not necessarily reflect the opinion of WMA.
The Junior Doctors Network of the World Medical Association
was formed in 2010 and is the first global platform representing
all Junior Doctors worldwide.
JDN at the IFMSA General Assembly in Hammamet, Tunisia
Caline Mattar, M.D. Deputy Chair, WMA JDN
Things gained from the behind-the-scenes activities of Tokyo meeting
Chiaki Mishima, M.D, Deputy Chair, JMA-JDN
Since the foundation of JDN by IFMSA alumni, several more have joined our network, and have participated
in shaping its work. JDN was represented at the IFMSA General Assembly by three officials, Elizabeth Wiley,
Socio-Medical Affairs officer and Supervising Council Member of the IFMSA, Fabian Klein, Liaison to IFMSA
and IFMSA Alumni Director, as well as Caline Mattar, JDN Deputy Chair.
JDN actively participated in the Alumni meeting, and we had the chance to present JDN and its activities as
Drs. Margaret Mungherera,(WMA President), Xavier Deau (WMA President Elect), Dana Hanson (former
WMA President), and Mukesh Haikerwal (Chairman of the Council) were also present at the meeting,
and we had the opportunity to discuss JDN and its future with them. The WMA organized the North African Regional Forum in parallel to
the IFMSA Meeting in Hammamet, Tunisia which featured local health leaders alongside leaders in health care from Morocco, Algeria and
Libya.
Overall, it was a wonderful collaboration experience with the IFMSA, and an opportunity to reach out to the North African Region, both for
the WMA and the JDN.
In conjunction with the WMA Council Meeting in Tokyo, JDN meeting was held on 27 April. We would like to report on social activities and
a facility visit to a Japanese medical institution, arranged primarily by Japanese JDN members. On 25 April, 10 JDN members visited
Disease Control and Prevention Center (DCC) of National Center for Global Health and Medicine. DCC was established in 2004 when SARS
outbreak took place, and it is made up of three departments; Global Infectious Disease Prevention Division, Travel Clinic (health checkup
services for overseas travelers) and Infectious Disease Division.
Furthermore, in sightseeing tours of Japan arranged by JMA, people walked aroundTokyoTower, Asakusa and ZoujoujiTemple, and I am sure
they had enjoyable experiences of the comfortable Japanese public transportation systems, Japanese food and considerate “ omotenashi
(hospitality)” culture of Japanese people. By having those events held before the meeting, participants were able to share their thoughts
and background with each other, which surely made the discussion in JDN meeting smoother and helped with creation of new ideas
generated from offline conversations. We hope that this friendship and ties of JDN that had deepened in Tokyo would help with the
development of future activities, and that such social events would be organized as part of JDN meeting in the future as well.
Opinions were exchanged regarding preventative measures of infectious diseases,
vaccination systems, and reporting frameworks of new/re-emerging infectious diseases in
various countries. It had been an immensely interesting experience to share and discuss
the different systems and social backgrounds.
In addition, during WMA conference social gatherings were organized at izakaya (Japanese
style pub) and karaoke. Fellow members who actually met each other face to face for the
first time enjoyed music and food together. This mixture of music of numerous languages,
enjoyment of singing together even if words are unknown must be something unique to
JDN. In addition, with WMA members joining, we were able to deepen the conversations
beyond the boundaries of nations and generations.
Aug Issue 5
AMSA Philippines Alumni Club (AMSA-PAC) talks about Junior Doctors Network (JDN)
Dr. Eugene Tordecilla Macalinga
AMSA-PAC, a network of young medical doctors from the Philippines, The AMSA Philippines Alumni Club (AMSA-PAC) is an organization of
young medical doctors in the Philippines involve in several projects related to health and it actively participates in both local and internatio-
nal medical and health related conferences.
AMSA-PAC members are once members of Asian Medical Students’Association (AMSA). Now, as most members are pursuing their residency
and specialty programs, the group is continuously finding ways to make its organizations active though its regular meetings plan of actions
and future activities.
Among the young doctors who initiated the formation of AMSA-PAC included Dr. Wilfredo Santos, Dr. Joel Buenaventura, Dr. Eugene Torde-
cilla Macalinga, Dr. Joanna Choa, Dr. John Ong, Dr. Michael Pineda, and Dr. Renzo Guinto.
In the last meeting of AMSA-PAC, Dr. Eugene introduced Junior Doctors Network and distributed printed of JDN Newsletters. AMSA-PAC is
continuously working to engaged and is active for future collaborations and activities.
Working hours and access to quality training –havewe got the balance right?
Dr. James Churchill, MD CDT Chair & Dr. Pasqualina Coffey, MD Northern CDT representative
In March the Australian Council of Doctors inTraining (CDT) held its annualTrainee Forum.This yearly event brings together young doctors from
all around Australia who are training in their respective specialties to discuss common issues, share ideas and formulate priorities for Australia’s
strong medical training system.
One of the issues discussed was the perception of trainees regarding working hours and quality of their training. While many junior doctors feel
that limits on working hours are a beneficial development that improve work life balance, fatigue and stress, to many it represents an
unnecessary limitation on their training and ability to gain skills. To inform the discussion the Australian Medical Association conducted a
Training Hours survey of hospital-based trainees. The survey was conducted over a one-week period from 5-12 March 2014. A total of 619
responses from college trainees working full time hours were received, with a rough half-half split between basic and advanced trainees.
The key results were:
•The average weekly hours worked was 54.6 hours.
•51% said they were working about the same hours in 2014 compared to 2013.
•69% said their working hours were‘about right’and adequate for training, including meeting College requirements.
•55% said their working hours were‘about right’and provided an appropriate work/life balance.
In contrast, the Royal Australian College of Surgeons trainee Association found that surgical trainees felt that approximately 60 hours per week
proved an appropriate balance of working hours for surgical training. Study and lifestyle demands were better met at around 55 hour a week.
This is consistent with the average weekly hours reported by procedural trainees in the AMA survey who reported working 60.8 hours a week
on average, compared to 52.8 hours a week for non-procedural trainees. Interestingly, the same proportion of trainees among both procedural
and non-procedural specialties felt their hours were excessive (22-23%).
Historically, trainees across a range of disciplines worked additional hours and incurred significant overtime.
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However, growing trainee numbers have introduced the option to state health departments to employ more trainees and reduce their
overtime udgets. Surgical trainees at the Forum reiterated their concerns that that any mandated decline in working hours would have an
adverse impact on training, with insufficient clinical exposure and potential patient safety issues.
This tension has lead to the proposal for procedural trainees to seek alternative industrial agreements that would allow certain trainees to
work longer on a salaried basis without needing overtime payments. Individualising industrial arrangements risks hard won entitlements,
entrench long working hours, and create difficult precedents for other trainee groups.
As such CDT will continue working with college trainee groups to forge workable answer that balances quality of training with doctor safety
and wellbeing. We would be very interested if this is an issue that you have faced in your own countries and what the outcomes were.
February 27, 2014 marks the formation of Junior Doctors’Network Hellas – JDN-Hellas. A group of 8 young doctors, sharing the same views on
international communication and collaboration in the fields of Medicine and Health, decided to join JDN-WMA as a team willing to participate
in various actions.
In our first online meeting, after we established our internal regulation as an independent, nonprofit or ganisation of Greek junior doctors, we
started planning our orientation and goals. Shortly after, our Facebook page (https://www.facebook.com/pages/Junior-Doctors-Network-JD-
N-Hellas) and Twitter account (https://twitter.com/jdnhellas) were created in order to make our existence more widely known. Celebrating the
World Health Day on 7th April 2014, we promoted a video based on WMA’s campaign about influenza vaccination and we also spread helpful
information as far as flu symptoms, cautions and vaccination against it are concerned. The reason we dedicated WHD 2014 to influenza
vaccination awareness, especially aiming to motivate vaccination among our peers and other healthcare workers, is because of the very high
annual death rates from the flu in Greece, the highest in Europe.
As a result, our first action as JDN Hellas proved quite effective and it also raised our popularity; making us even more willing to schedule and
organize lots of other actions in the future. More information about us and our WHD 2014 campaign can be found at our above mentioned
Facebook page.
We hope to a fruitful international collaboration with all of you, our colleagues in JDN-WMA. Hopefully, you will be hearing more news from
us in the near future, as our team grows… Greetings from Greece!
The Republic of Malawi, located in southeast Africa, is also nicknamed“The Warm Heart of Africa”. It is still developing
and relatively densely populated, while around 85% of the population lives in rural areas. More than one-third of GDP
and 90% of export revenues come from agriculture. Under pilot training program of Taiwanese Ministry of Health
and Welfare (Taiwan MOHW) and Luke- International-Norway (LIN), we were relocated to the office in Mzuzu. About
80% of the staff are local Malawians. As we know, the contemporary concept of community empowerment
emphasize the grass roots effort to improve health of its residents.
We would like to share the medical part in this article, and would like to share the community projects in the next
newsletter.
Junior Doctors’ Network Hellas
Dr Joanna Xanthaki, MD
Stepping into the Warm Heart of Africa – Malawi
Dr. Shun-Chun Richard Lo & Dr. Jen Hsiang Roy Shenna Xanthaki, MD
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We were introduced to the Mzuzu Health Center (MHC), and arranged to take part in their outreach services to . The
MHC has pediatric OPD, adult OPD, maternity, VCT, pharmacy, dental, eye, and health education. There is no official
inpatient facility, but a make-shift room with 4 beds were available for observation. The staff are supported with
clinical officers and technicians. The clinical officers are health workers empowered to provide basic medical
services to the community that they serve.
On the following days, we went to Kaweche, a town 21km away from Mzuzu. Its health center is still under
construction, but already has many operating departments like the MHC. Another service module is needed, in
which near-households posts stand out. We visited a CCM (child care manager) in Doroba Village. CCM offer the first
aid to children under 6 years old. There is a flow-chart for the CCM to distinguish the danger and non-danger signs,
such as the respiratory rate, or seizures. If there is no danger sign, basic medicine will be given. Though it may seem
simple, it is an effective way to disseminate medical services in a region lacking medical resources. Additionally, the
CCM is also in charge of monitoring children’s nutritional status. If there are under-nourish children, the CCM will
give proper education or supplements to the caregivers.
Young Doctor in Medical Rescue Action toward Solo mon Islands’ Flash Flood
Dr. Yin-Shuo Chang & Dr. Jen-Hsiang Shen
After learning about the infrastructure, we had rotations in the Mzuzu Central Hospital (MZH). It is really touching to see how the staff there
are putting up their service to their highest quality with the limited resources available to them. There are also many UN volunteer doctors
working there alongside the grass roots efforts.
Thinking back to the JDN concepts, we are trained strictly under well-equipped hospitals. The actual service module in the rural area would be
different from what we have learned in the classroom. Doctors could not work alone; they must cope with the restrictions, and take account
of the socio-economic determinants. We will elaborate about the community projects in our next briefing.
In end, we humbly grab this chance to convey a message from one intern doctor, Dr. Enerst Katiyi. We have spoken about the shortage of
pocket medical books for Malawian young doctors. There is very limited access for these books. We frankly don’t have a sustainable model for
providing young doctor in need of pocket medical books. However, if you would like to donate your resources, please contact ( Dr. Enerst
Katiyi: katiyiene@gmail.com). As we plan, our next JDN meeting in Durban, we hope to continue our efforts to integrate young doctors,
particularly ones from challenging socio-economic situations.
Solomon Islands is a charming tropical island country locate in the South Pacific with plenty of natural resources and beautiful beaches. Never-
theless, Solomon Islands encountered a tremendous heavy rain on April 3-5, 2014 and resulted in massive flooding in Honiara, the capital city,
and the rest of Guadalclcanal province. The disaster has caused at least 23 death and more than 52,000 people lost their homes, livelihoods
and basic infrastructure. Until now, there are only 31 temporary evacuation centers housing more than 9,000 people. The Government of
Solomon Islands has declared a state of emergency in Honiara and Guadalclcanal province.
As a young medical doctor and a member of Junior Doctors’Network of World Medical
Association, I have engaged myself in the medical rescue action efforts to help victims of the
flash flood in Honiara and the rest of Guadalclcanal province. I participated in general
treatment of patients at the temporary evacuation centers and the Good Samaritan Hospital in
east Guadalclcanal.
Due to the increasing number of emergency patients, shortage of medical doctors and poten-
tial outbreak of diseases after the flood, I also collaborated with the National Referral Hospital
medical team. The National Referral Hospital is the final retreat for all advanced care in
Solomon Islands. However, they have also encountered similar shortages of medications and
doctors during this disaster period.
Health cluster coordination meeting in WHO
Solomon Islands of fice: From left to right: Dr.
Audrey Aumua(WHO SI head officer), Austra-
lian medical rescue doctor, Dr Arun K Mallik(He-
alth Cluster Coordinator)
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I provided medical service in the emergency department and the mobile clinic that visited
many temporary medical sites to render free medical services to people in the flooded
communities.
The World Health Organization (WHO) and Ministry of Health and Medical Services have also
made priorities for health including access to safe water and sanitation facilities, nutrition and
food safety, maternal and child health services, mental health and psychosocial support,
preventing the spread of communicable diseases as well as environmental sanitation.
As the health cluster lead of the disaster response, WHO Solomon Islands also held several
meeting to coordinate the works and medical recourses provided by other health partners like
UNICEF, Austral ian Aid, MSF, Taiwan Health Centre, etc. As one of the doctor form Taiwan
Health Center, I have the chance to participate in the health cluster coordinate briefings and
Flash flood hit Solomon Islands on April 3-5
caused tremendous damage to the people of
Honiara and Guadalclcanal province.
shared the lessons and mistakes of our efforts and account for resources we have in hand right
now. It’s a good opportunity to be part of the international effort and cooperation as mentio-
ned at the recentWorld Health Assembly, global warming is a problem and it has made the sea
level rising and caused drastic weather changes. This kind of natural disaster may become
more frequent in this Pacific island country in the future. Dr. Audrey Aumua, head officer of
WHO Solomon Islands, said “Health is our first priority, and we need to make a Humanitarian
Action Plan for this kind of disaster immediately.”I am so glad to have the chance to engage in
the rescue action and participated in the international cooperation. It’s an unforgettable and
useful experience for young doctor like us to keep practicing medicine in the emergency and
medical rescue status.
From 2006, the Taiwanese government has implemented global health training into the
national military service system, served by all healthy male for 1 year. Annually, 2 – 6 MD or DDS
graduates would be trained to be the officers for international co-operation in the Ministry of Health and Welfare. This year, 2 other
doctors, Dr. Shun-Chun Lo and Dr. Jen-Hsiang Shen and I have completed this training before we were expatriated for service.
Dr. Eugene Yin-Shuo Chang(middle) provided
free medical service with mobile clinic from
Taiwan Health Center in temporary evacuation
centers, Honiara, Solomon Islands.
European Junior Doctors Spring Meeting(Observing Report)
Dr. Ahmet Murt (Secretary of WMAJDN)
Representatives of 25 European Countries and Medical Organizations met on 9th-10th May
2014 in De brecen, Hungary for the Spring Meeting 2014 of the European Junior Doctors (EJD)
Permanent Working Group to discuss main issues related to working conditions and education
of junior doctors. The meeting was hosted by Hungarian Resident Doctors Association. The
meeting also included General Assembly of the organization where rules and procedures as ell
as new membership issues and other managerial plans were discussed. One of the hot topics
for in Europe for a while is Working Times and invited speaker European Commissioner Laszlo Andor gave a presentation about EU Commis-
sion’s perspective for the issue. Junior Doctors were happy to hear that EU Commission does not only initiate court cases for the countries
who fail to apply European Working Time Directive, but they also provide technical assistance to countries. The discussion continued with
specific examples from France and Ireland. With 19 member countries presenting their interim reports, working conditions, the
employability and brain drain, mobility and migration, and specificities and challenges related to postgraduate educa-tion were discussed to
provide a wide European perspective. Sweden has been approved by General Assembly to join EJD as a member country.
In the past year, EJD has organized several workshops in different countries across Europe to touch specific issues related to junior doctors in
own environment.This helped EJD to get closer to country specific topics. These initiatives helped junior doctors to raise awareness about
their working conditions. In order to cope with potential pitfalls in health workforce, joint action on the planning is crucial and this was also
discussed by the representatives at the meeting
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WMA JDN OFFICERS 2013/2014
Aug
NOW Accepting
Submissions for our next Issue!
Save the date!
Upcoming meetings in 2014-2015
Send to:
Acknowledgements
Dr. Xaviour Walker(Founding Member,JDN)
Editors:
Dr. Wunna Tun (Editor in Chief, JDN Newsletter
and Communication Director of WMAJDN)
Dr. Hyunyoung Deborah Shin (Publication Director)
Join the group of
Junior Doctor Network of
World Medial Association
Contact: jdn@wma.net
White Paper
Social media and medical professionalism
Relevant Junior Doctor Policy
Ethical Implications of Collective Action
by Physicians
Current projects
Doctors’ health and wellbeing
Global health training and its ethical implications
Quality in postgraduate medical education
and training
November 22-23 2014 : Eastern Mediterranean
Regional Meeting Beriut, Lebanon
October 6 – 7 , 2014 :WMA Junior Doctors Network
Meeting Durban, Africa
April 15 , 2015 (tentative): WMA Junior Doctors
Network Meeting Oslo, Norway
May 16- 17, 2015 (tentative): JDN Working Meeting
in WMA, France
onlinwunna@gmail.com
shy801117@gmail.com
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The views expressed in this newsletter
are opinions of authors and not
necessarily reflect the opinion of WMA