JDN_21NL_April2021

JUNIOR DOCTORS
NETWORK
empowering young physicians to work together towards a healthier
world through advocacy, education, and international collaboration
Published by the Junior Doctors Network of the World Medical Association
The information, perspectives, and opinions expressed in this publication do not
necessarily reflect those of the World Medical Association or the Junior Doctors
Network. WMA and WMA-JDN do not assume any legal liability or responsibility
for the accuracy, completeness or usefulness of any information presented.
Junior Doctors Network Newsletter
Issue 21
April 2021
ISSN (print) 2415-1122
ISSN (online) 2312-220X
Junior Doctors Leadership 2020-2021
Junior Doctors Network Newsletter
Issue 21
April 2021
CHAIR DEPUTY CHAIR SECRETARY
SOCIO-MEDICAL
AFFAIRS OFFICER
EDUCATION
DIRECTOR
MEDICAL ETHICS
OFFICER
MEMBERSHIP
DIRECTOR
PUBLICATIONS
DIRECTOR
COMMUNICATIONS
DIRECTOR
IMMEDIATE PAST
CHAIR
Dr Yassen Tcholakov
Canada
Dr Julie Bacqué
France
Dr Wunna Tun
Myanmar
Dr Manon Pigeolet
Belgium
Dr Helena Chapman
Dominican Republic
Dr Lyndah Kemunto
Kenya
Dr Lwando Maki
South Africa
Dr Uchechukwu Arum
Nigeria/United Kingdom
Dr Maki Okamoto
Japan
Dr Chukwuma
Oraegbunam
Nigeria
Page 2
Editorial Team 2020−2021
Junior Doctors Network Newsletter
Issue 21
April 2021
Dr Victor Animasahun
Nigeria
Dr Nishwa Azeem
Pakistan
Dr Sejin Choi
Republic of Korea
Dr Ricardo Correa
Panama/United States
Dr Giacomo Crotti
Italy
Dr Mashkur Isa
Nigeria/United Kingdom
Dr Jooyoung Moon
Republic of Korea
Dr Jeazul Ponce H.
Mexico
Dr Parth Patel
Malawi
Dr Vandrome Nakundi
Kakonga
Dem. Rep. of Congo
Dr Mellany Murgor
Kenya
Dr Suleiman A. Idris
Nigeria
Page 3
Table of Contents
TEAM OF OFFICIALS’ CONTRIBUTIONS
07 Words from the Chair
By Dr Yassen TCHOLAKOV (Canada)
08 Words from the Communications Director
By Dr Maki OKAMOTO (Japan)
09 Words from the Publications Director
By Dr Helena CHAPMAN (Dominican Republic)
PUBLICATIONS TEAM’S CONTRIBUTIONS
10 Reflections about Lessons Learned during the COVID-19 Pandemic
By JDN Publications Team
WORKING GROUP UPDATES
15 Medical Ethics Working Group
By Dr Lwando MAKI (South Africa)
16 Comprehensive Primary Health Care Working Group
By Dr Flora KUEHNE (Germany)
18 Medical Exchange, Education, and International Mobility Working
Group
By Dr Uchechukwu ARUM (Nigeria/United Kingdom)
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES
20 Public Health Doctors in the Republic of Korea and their Role in
Promoting One Health
By Dr Jeagu KANG (Republic of Korea), Dr Geon YONG OH (Republic of
Korea), and Dr Sejin CHOI (Republic of Korea)
24 Child Abuse in the Republic of Korea and the Role of Junior Doctors
By Dr Jaehyun LEE (Republic of Korea) and Dr Sejin CHOI (Republic of
Korea)
Junior Doctors Network Newsletter
Issue 21
April 2021
Page 4
Table of Contents
28 From Border Control to One of the First Countries Enjoying Economic
Recovery: Taiwan’s Measures for Crisis Relief
By Dr Chiang KUAN YU (Taiwan)
32 Foreign Affairs, Human Resources, and Junior Doctors as Insiders
By Dr Samuel D’ALMEIDA (France)
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS
35 The COVID-19 Effect: Italian Junior Doctors Adapt to Career Changes
during the COVID-19 Pandemic
By Dr Giacomo CROTTI (Italy) and Dr Federica BALZARINI (Italy)
38 Second Wave and Uncertainties: Experiences with Emotional Stress
and Burnout
By Dr Maymona CHOUDRY (Philippines)
41 Ethiopia’s Medical Talent: The Dilemma
By Dr Eleleta Surafel ABAY (Ethiopia)
44 Call for Solidarity from Junior Doctors: Civil Disobedient Movement in
Myanmar
By Dr Wunna TUN (Myanmar)
JUNIOR DOCTORS’ ACTIVITIES
46 Advanced Field Epidemiology Training Program: A Nigerian Junior
Doctor’s Experience
By Dr Suleiman Ahmad IDRIS (Nigeria)
49 Betrayed and Undermined during a Pandemic: The Plight of Young
Physicians and Surgeons in India
By Dr Manu PRADEEP (India)
Junior Doctors Network Newsletter
Issue 21
April 2021
Page 5
Table of Contents
53 JDN Working Groups: A Platform for International Networking and
Career Advancement
By Dr Dabota BUOWARI (Nigeria)
55 Kick-off of the Public Health Interest Group: Significance and Future
Steps
By Dr Hangyeol LEE (Republic of Korea) and Dr Sejin CHOI (Republic of
Korea)
58 The First Junior Doctors Network’s eHealth Working Group
By Dr Lisa GONZÁLEZ LÓPEZ (Dominican Republic) and Dr Ankush
BANSAL (United States)
INTERNATIONAL CONFERENCES
61 Introducing Policy at the World Medical Association: The Global
Surgery Experience
By Dr Manon PIGEOLET (Belgium)
Junior Doctors Network Newsletter
Issue 21
April 2021
Page 6
Dear colleagues from around the world,
It is my pleasure to introduce this 21st Issue of the Junior Doctors Network (JDN)
Newsletter. As we are approaching the middle of this first fully virtual JDN term, the team
has deployed many efforts to make the best of these circumstances. These efforts include
connecting with members through other modalities and making our meetings more
engaging with discussions and thematic activities beyond our administrative tasks. The
JDN Newsletter, even before the pandemic, served the noble role of bringing junior doctors
together from across the globe. Now, these connections are more important than ever, and
I hope that you will enjoy the coming pages.
On behalf of the JDN Management Team, I would like to thank all participants who joined
the JDN biannual meeting and the World Medical Association (WMA) Council meeting in
April 2021. Since the work of the JDN stems from the ideas and policies set forward by the
WMA, understanding the logistics for these decision-making activities can provide insight
on how JDN members can contribute to this process.
The last few months have been filled with important discussions on the organization of the
WMA Associate Membership. Since the JDN forms part of the WMA Associate
Membership, these changes are relevant to our network. I am happy that many JDN
members were invited to participate in these discussions, and we hope that the outcome
will provide more opportunities for all WMA members, including junior doctors.
Lastly, as the 2020-2021 term approaches its halfway point, we would like to invite JDN
members to learn more about upcoming JDN leadership roles. We would be happy to
share more about our leadership positions, as we hope to recruit JDN leaders for the next
term!
Sincerely,
Yassen Tcholakov
Junior Doctors Network Newsletter
Issue 21
April 2021
Words from the Chair
TEAM OF OFFICIALS’ CONTRIBUTIONS
Yassen Tcholakov, MD MScPH MIH
Chair (2020−2021)
Junior Doctors Network
World Medical Association
Page 7
It is my pleasure to welcome you to the 21st issue of the Junior Doctors Network (JDN)
Newsletter.
Over 18 months have passed since the start of the coronavirus disease 2019 (COVID-19)
pandemic. Although the world has changed in numerous ways – how people interact,
spend time, and work – we must look toward a better future! As most conferences were
held on virtual platforms, junior doctors were able to join conferences without additional
expenses or leave time. This unique time has highlighted opportunities for strengthening
online learning and discovering new collaborations across countries and clinical specialties.
Supported by the World Medical Association (WMA), the JDN provides this international
platform, where JDN members can share their passion and enthusiasm to enhance medical
practices and support global health initiatives. We recognize the efforts of our wonderful
JDN Publications Team, led by Dr Helena Chapman, for preparing this outstanding 21st
issue of the JDN Newsletter.
We hope that you enjoy the articles – and despite social distancing – feel that your
colleagues are close and support your dedicated efforts on the frontline!
Take care and stay safe, Maki Okamoto
Junior Doctors Network Newsletter
Issue 21
April 2021
Words from the Communications Director
Maki Okamoto, MD
Communications Director (2020−2021)
Junior Doctors Network
World Medical Association
Dear colleagues,
TEAM OF OFFICIALS’ CONTRIBUTIONS
Figure 1. List of JDN media resources.
To learn more information about
JDN activities and updates,
please visit the JDN media
accounts (Figure 1).
Media Resource
Website https://www.wma.net/junior-doctors/
Mailing List https://goo.gl/forms/jCP774K1fldLIoWj1
Twitter @WmaJdn
Facebook (Members) WMA-JDN
Facebook (Public) WMA JDN
Instagram wma_jdn
Page 8
Dear JDN colleagues,
On behalf of the Publications Team (2020-2021) of the Junior Doctors Network (JDN), we
are excited to share the 21st issue of the JDN Newsletter with junior doctors across the
world.
Now, more than one year since the start of the coronavirus disease 2019 (COVID-19)
pandemic, junior doctors have led response efforts for national health systems. Our
contributions to clinical management, community health, medical education, policy
activities, and research applications are valuable assets to advance the scientific
knowledge base.
The JDN Newsletter offers a global platform where junior doctors across the globe share
their medical and public health leadership activities in local and national health initiatives.
This 21st issue includes articles from junior doctors from Belgium, Canada, Dominican
Republic, Ethiopia, France, Germany, India, Italy, Japan, Myanmar, Nigeria, Philippines,
Republic of Korea, South Africa, Taiwan, United Kingdom, and the United States. These
reports disseminate updates on JDN activities, scientific perspectives on pressing global
health issues, and reflections on community experiences. Their leadership can empower
other junior doctors to develop health promotion activities and enhance communication
between World Medical Association (WMA) and JDN members.
We recognize the leadership of all editors of the JDN Publications Team 2020-2021 as we
finalized this 21st issue. We appreciate the continued support of the JDN Management
Team and WMA leadership as we prepared this high-quality resource for junior doctors. We
hope that you enjoy reading about junior doctors’ experiences in this 21st issue!
Together in health,
Helena Chapman
Junior Doctors Network Newsletter
Issue 21
April 2021
Words from the Publications Director
Helena Chapman, MD MPH PhD
Publications Director (2020−2021)
Junior Doctors Network
World Medical Association
TEAM OF OFFICIALS’ CONTRIBUTIONS Page 9
Junior Doctors Network Newsletter
Issue 21
April 2021
Lessons Learned during the COVID-19 Pandemic by the
JDN Publications Team (2020−2021)
PUBLICATIONS TEAM’S CONTRIBUTIONS
Dr Helena Chapman (Dominican Republic)
The COVID-19 pandemic has highlighted the need for the One
Health approach to guide global efforts to mitigate disease spread.
By building transdisciplinary collaborations that integrate innovative
scientific data and approaches, we can better understand the
interconnectedness between humans, animals, and the surrounding
ecosystems. As junior doctors, we can lead local, national, and
international initiatives that prepare health systems to manage
emerging One Health threats and protect population health.
Dr Victor Animasahun (Nigeria)
The COVID-19 pandemic has made me realise that I am stronger
than I think, and that we are stronger together. I am amazed at how
quickly that I have been able to adapt to remote learning and
consultations and advance my professional development and
proficiencies in patient care.
Dr Nishwa Azeem (Pakistan)
During the pandemic, I have realised that innovative measures can
be devised to prioritize health at the forefront of global dialogue.
Since low-income countries have mobilised resources in such a
sophisticated manner, I am hopeful that we can strengthen our
future collaborations that address global challenges like
antimicrobial resistance and climate change.
.
Page 10
Junior Doctors Network Newsletter
Issue 21
April 2021
PUBLICATIONS TEAM’S CONTRIBUTIONS
Dr Sejin Choi (Republic of Korea)
During the COVID-19 pandemic, telemedicine became an essential
tool for communication between doctors and patients, and virtual
meetings and conferences were the new normal. Moving forward,
understanding that virtual technology will be implemented into our
clinical training and professional development, I believe that in-
person interactions can strengthen doctor-patient rapport. As junior
doctors, we should develop innovative approaches to build rapport
with patients, even as telemedicine becomes a part of our clinical
practice.
Dr Ricardo Correa (Panama/United States).
The COVID-19 pandemic has accelerated a new era of technology,
not only for patient care (telemedicine), but also for education and
training (telehealth). Although the first months were difficult, we
slowly adapted to these changes. In telemedicine, we encountered
the influence of the social determinants of health on health
outcomes. For example, patients without reliable internet access
may have limited access to medical services and health
information. In tele-education, trainees and students learned
alternative techniques in medical assessment, but missed the in-
person interactions with patients and supervisors, which are vital for
training. Moving into the future, I envision that health care will
incorporate in-person and virtual approaches.
Dr Giacomo Crotti (Italy)
The COVID-19 pandemic has taught us the value of the health
workforce. Building more resilient health systems requires pursuing
the best standards of safety, training, and well-being for health care
workers.
Page 11
Junior Doctors Network Newsletter
Issue 21
April 2021
PUBLICATIONS TEAM’S CONTRIBUTIONS
Dr Suleiman Ahmad Idris (Nigeria)
Throughout my medical training, I had only read about pandemics
in textbooks. Now, as a junior doctor working in field epidemiology
in Nigeria, I have firsthand experience of the role of infection
prevention and control measures during the COVID-19 pandemic. I
have been able to learn more about this novel coronavirus, train my
colleagues in field epidemiology techniques, and contribute to
contact tracing that aims to curb disease transmission in Nigeria.
Dr Mashkur Abdulhamid Isa (Nigeria/United Kingdom)
The COVID-19 pandemic has brought to limelight the deep and
longstanding health inequities plaguing the world. I realize that the
goal of ‘Health for All’ cannot be achieved without addressing health
inequities. As junior doctors, we have a role to play in promoting
fairness and equality in health across the world.
Dr Jooyoung Moon (Republic of Korea)
Over the past year, I was able to participate in more international
conferences than ever before because most were held virtually.
When life gives you lemons, make lemonade!
Page 12
Junior Doctors Network Newsletter
Issue 21
April 2021
PUBLICATIONS TEAM’S CONTRIBUTIONS
Dr Mellany Murgor (Kenya)
The pandemic has been a reminder of how we are all in a global
village and fully depend on each other. Now more than ever, we
need to rally behind the achievement of Universal Health Coverage.
The observation of unprepared health systems highlights the need
for better investment and restructuring. As healthcare workers are
resilient and committed to healthcare service delivery, we must
ensure that they have safe and well-equipped work environments.
Dr Vandrome Nakundi Kakonga
(Democratic Republic of the Congo)
The current pandemic has highlighted the weaknesses of global
health systems. As junior doctors, we should reconsider the role of
health policy and patents on pharmaceuticals and vaccines, in
efforts to advocate for equal distribution of public health resources
to all communities.
Dr Parth Patel (Malawi)
The COVID-19 pandemic has carved a well versed and globally
relevant healthcare leader in me. As the pandemic has been
restrictive in nature, it surely has brought forth numerous
opportunities for me to expand my global network and enhance my
leadership skills.
Page 13
Junior Doctors Network Newsletter
Issue 21
April 2021
PUBLICATIONS TEAM’S CONTRIBUTIONS
Dr Jeazul Ponce Hernández (Mexico)
As a global community, I realized that governments and national
leaders must understand the intricate links between health and
economy and hence prioritize public health and health promotion
initiatives. As junior doctors, we are trained health leaders who can
directly impact the health and well-being of our community citizens.
Page 14
Medical Ethics form the foundation of the medical profession and comprise an integral part
of global health. Over the past decade, health professionals have encouraged discussions
on diverse topics related to Medical Ethics, including clinical competencies and
responsibilities, human and animal research, patient confidentiality, and end-of-life care. As
such, junior doctors should be engaged as active leaders, promoting continued dialogue
among the global health workforce on these themes.
Founded in June 2019, the Medical Ethics Working Group – the largest Junior Doctors
Network (JDN) Working Group to date – aims to strengthen a global network, where junior
doctors can share essential information, resources, and activities on Medical Ethics topics
with JDN membership. It has a vibrant and diverse membership, where members represent
the majority of World Health Organization regions as well as various medical and surgical
specialties. The team has planned exciting activities for this term, but some have been
delayed due to COVID-related response efforts (Figure 1).
Junior Doctors Network Newsletter
Issue 21
April 2021
Medical Ethics Working Group Update
WORKING GROUP UPDATES
Lwando Maki, MBCHB DiPEC AHM MRSSAf
Medical Ethics Officer (2020−2021)
Chair, Medical Ethics Working Group (2020−2021)
Junior Doctors Network
World Medical Association
Page 15
❑ Medical Ethics Alive: To coordinate a webinar on the
International Code of Medical Ethics.
❑ Medical Ethics Media: To explore targeted opportunities to
host sessions in specific global regions (e.g. South
America).
❑ Medical Ethics Delegation: To form a delegation to the
14th World Conference on Bioethics, Medical Ethics, and
Health Law in Porto, Portugal (April 2022).
❑ Medical Ethics Papers: To finalize three scientific
manuscripts for the World Medical Journal. To coordinate a
second collaboration (Medical Ethics Special Edition of the
JDN Newsletter) with the Publications Team.
❑ Medical Ethics Policy: To contribute policy in World
Medical Association (WMA) documents that are shared by
the JDN Medical Ethics and Socio-Medical Affairs Officers.
If you are interested in Medical
Ethics and would like to
participate with other JDN
colleagues in collaborative
activities, please contact Dr
Lwando Maki (Chair, JDN
Medical Ethics Working Group:
dr.lwando.maki@gmail.com).
Stay connected, and let your
voice reach the world!
Sincerely,
Maki
Figure 1. Coordinated Medical Ethics Working Group activities for 2021.
This holistic approach focuses on individual and community health, addressing the
integrated health care needs of patients and focus on preventive, curative, palliative, and
rehabilitation services to improve population health and well-being.
In order to build a platform within the Junior Doctors Network (JDN) for discussion,
collaboration, and related activities, the JDN founded the Comprehensive PHC Working
Group in January 2020. During the initial phase, we established the PHC Working Group
structure. As our clinical responsibilities transitioned to coronavirus disease 2019 (COVID-
19) response efforts, we prepared and submitted a review article about advocacy priorities
for PHC physicians and providers across countries. Team members successfully
collaborated on the established tasks for this article.
In January 2021, we disseminated a new call for JDN members to join the PHC Working
Group. Since many JDN members of diverse clinical and public health specialties were
interested in joining the Working Group, we can now expand our scope to work on
additional projects within the field of PHC. In the upcoming months, we plan to develop
activities that explore the following topics: PHC Workforce (International Year of Health and
Care Workers), PHC and the COVID-19 Pandemic, and Community Involvement in PHC.
Furthermore, we would like to increase our engagement in advocacy activities within the
JDN and the World Medical Association (WMA).
Junior Doctors Network Newsletter
Issue 21
April 2021
Comprehensive Primary Health Care Working Group Update
WORKING GROUP UPDATES Page 16
Flora Kuehne, MD
General Practice and Family Medicine Resident
Munich, Germany
Primary Health Care (PHC) is recognized as a cornerstone to
achieve universal health coverage (UHC) and the targets of the
Sustainable Development Goals (SDGs).
As the chair of the PHC Working Group, I have observed that JDN members continue to
share their global leadership through the development and delivery of pioneering projects. I
would like to recognize the current and past JDN Management Team members – Dr
Christian Kraef (Germany), Dr Yassen Tcholakov (Canada), Dr Manon Pigeolet (Belgium),
and Dr Caline Mattar (Lebanon/United States) – for their continued support of this PHC
Working Group.
If you are interested in PHC and would like to participate with other JDN colleagues on our
monthly virtual meetings and collaborative activities, please contact Dr Flora Kuehne
(Chair, JDN Public Health Care Working Group: Flora.Kuehne@med.uni-muenchen.de).
Sincerely,
Flora Kuehne
Junior Doctors Network Newsletter
Issue 21
April 2021
WORKING GROUP UPDATES Page 17
I appreciate the enthusiasm expressed during our virtual meetings,
sharing of resources and methodological advice, and inspiring
discussions that foster exchanges of experiences and visions.
Founded in last quarter of 2020, the Medical Exchange, Education, and International
Mobility Working Group is comprised of energetic, highly motivated, and dedicated Junior
Doctors Network (JDN) members who are interested in the advancement of medical
education.
Over the past few months, our Working Group has coordinated several activities for
continued learning and networking (Figure 1).
Junior Doctors Network Newsletter
Issue 21
April 2021
Medical Exchange, Education, and International Mobility
Working Group Update
WORKING GROUP UPDATES
Uchechukwu Arum, MD
Education Director (2020−2021)
Chair, Medical Exchange, Education, and International Mobility
Working Group (2020−2021)
Junior Doctors Network
World Medical Association
Page 18
❑ January 2021: JDN members connected on the first quarterly Working Group
telecon.
❑ February 2021: The Working Group participated in the Accreditation Council for
Graduate Medical Education (ACGME) annual conference, which was held virtually
from February 24-26, 2021. Using the theme, “Meaning in Medicine: Mastering the
Moment”, JDN members attended various conference sessions and expanded their
networks within the graduate medical community.
❑ March 2021: The Working Group Lead (Dr Uchechukwu Arum) coordinated the
“Doctors’ Well-being” webinar on March 20, 2021. The keynote speakers included
Dr Stuart Slavin, a renowned ACGME Senior Scholar on Doctors’ Well-being, and
Dr Elizabeth Gitau, Chief Executive Officer of the Kenya Medical Association.
❑ April 2021: The Working Group Lead (Dr Uchechukwu Arum) coordinated the
Working Group sessions at the JDN biannual meeting.
❑ February-June 2021: The Working Group is currently collaborating with the JDN
Publications Team to publish the Doctors’ Well-being Special Edition of the JDN
Newsletter.
Education is one of the vital mission statements of the
JDN, since the adequate education of healthcare workers
ultimately translates into optimal patient care.
Figure 1. Coordinated Medical Exchange, Education, and International Mobility Working Group
activities for January-June 2021.
Moving forward, our Working Group is currently organizing plans for additional activities in
Fall 2021:
First, the Working Group will coordinate the International Organizations webinar to offer
JDN members with a better understanding of overall function and career opportunities with
international organizations – like the World Bank, World Health Organization, and United
Nations. Second, in collaboration with the World Federation of Medical Education, the
Working Group will conduct a postgraduate medical survey with JDN members in efforts to
develop a global postgraduate medical directory. Finally, the Working Group will explore
avenues to partner with health institutions that encourage medical exchange and
international mobility. With the increased mobility of the medical workforce across countries
and continents, interdependence of nations in combating disease, and globalisation, there
is need for continued exchange of innovative ideas and expertise.
The Working Group welcomes JDN members to contribute ideas and participate in
activities that will help advance medical education. These efforts will ultimately advance the
delivery of high-quality medical care and positively impact population health. If you are
interested in medical education and would like to participate with other JDN colleagues on
our virtual meetings and collaborative activities, please contact Dr Uchechukwu Arum
(Chair, JDN Medical Exchange, Education, and International Mobility Working Group:
arumaco@gmail.com).
Sincerely,
Uchechukwu Arum
Junior Doctors Network Newsletter
Issue 21
April 2021
WORKING GROUP UPDATES Page 19
As JDN members, we are leaders at the forefront of health
advocacy and can empower other physicians to learn more
about pressing health topics associated with medical
exchange and international mobility.
With multiple pandemics with zoonotic disease links – such as severe acute respiratory
syndrome (SARS), Middle East respiratory syndrome (MERS), and coronavirus disease
2019 (COVID-19) – One Health has been placed at the forefront of global discussions in
medical sciences (2). Amid this global trend, the Ministry of Health and Welfare of the
Republic of Korea has supported two research studies that emphasize the One Health
approach: Research on the Korean Approach to One Health for Improved Citizens’ Health
(2018) and the Second Master Plan for Prevention and Control of Infectious Diseases
(2018-2022) (3). These plans, however, neglected the role of the public health doctors
(PHDs) in the Republic of Korea, who can potentially serve as community leaders in
promoting the One Health approach.
Junior Doctors Network Newsletter
Issue 21
April 2021
Public Health Doctors in the Republic of Korea and
their Role in Promoting One Health
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES
Jeagu Kang, MD
Public Health Center of Buyeo-gun
Buyeo, Republic of Korea
Geon Yong Oh, MD
Public Health Center of Imsil-gun
Imsil, Republic of Korea
Sejin Choi, MD MSc
Seoul Detention Center, Ministry of Justice
Department of Translational Medicine
Seoul National University College of Medicine
Seoul, Republic of Korea
*Members of the Korean Association of Public
Health Doctors
Page 20
The One Health concept promotes the view that human, animal, and
ecosystem health should be approached in a holistic and integrated
manner and strengthened through interdisciplinary and
interdepartmental collaborations (1).
PHDs are junior doctors who serve medically vulnerable areas in public facilities across the
Republic of Korea for a period of three years. This public health service is an alternative
pathway to the military service requirement. Notably, from February to March 2020, PHDs
played a pivotal part in curbing the explosive increase of the coronavirus disease 2019
(COVID-19) in the Republic of Korea. Currently, they have continued to contribute
significantly to the national COVID-19 quarantine procedures.
Contributions to One Health
As PHDs currently serve vulnerable communities focusing on primary health care services,
they also have One Health related roles. Even before the COVID-19 pandemic, PHDs
worked with veterinarians and livestock quarantine teams to support response efforts for
zoonotic disease outbreaks, such as the highly pathogenic avian influenza (H5N1) and
African swine fever (4,5). They were swiftly deployed to block off areas with the livestock
quarantine team and performed medical evaluations of local residents and team members.
PHDs also prescribed Tamiflu (Oseltamivir) as prophylaxis measures to farm workers.
Their past and present contributions demonstrate that PHDs can successfully manage risks
and lead One Health activities in the Republic of Korea’s public health system. First, PHDs
work directly with local populations and can understand the nexus between their unique
health challenges as well as animal and environmental exposures. Since many PHDs work
at local public health centers, they manage infectious and chronic disease risks of small
rural villages. Second, PHDs have access to government data and resources, which can
allow them to analyze epidemiological data, contact government officials from
corresponding departments, and form multi-sectoral collaborations. Finally, PHDs have a
representative organization – Korean Association of Public Health Doctors (KAPHD) –
where they can receive prompt educational updates and training for their primary care
services.
Junior Doctors Network Newsletter
Issue 21
April 2021
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 21
Moving forward, PHDs are competent health leaders who can
identify gaps and strengthen the implementation of the
Republic of Korea’s One Health system.
However, the One Health concept is still not widely recognized among the medical
community in the Republic of Korea. There is also a lack of systematic state-led PHD
education on One Health.
Future Recommendations
As PHDs serve the local communities, some recommendations may encourage the
national health system to incorporate PHDs with leadership roles in One Health. First, an
epidemiological survey can be conducted by health leaders – including the KAPHD, Korea
Disease Control and Prevention Agency, Animal and Plant Quarantine Agency, and
National Institute of Environmental Research – to determine how many PHDs support the
One Health concept. This survey can help identify knowledge gaps and provide
recommendations for structured One Health education and training programs. Second,
regional-level interest groups – such as PHDs, public quarantine veterinarians, physicians,
veterinarians, and farm workers – can be developed to translate One Health knowledge to
active collaborations that meet the unique needs of local public health units. Hence, One
Health collaborations can recognize, share, and develop solutions to challenges in local
regions. Finally, a systematic education system with government support can strengthen
how PHDs analyze, plan, execute, and evaluate public health programs.
Future Steps
If PHDs are properly trained in One Health, two potential steps will be achieved. First,
zoonotic infection control and management can be improved through the development of
regional-specific collaborative models. For example, in the Republic of Korea, the infection
rates of rabies and brucellosis in humans and animals have different regional distributions
(6). Hence, in areas where bovine brucellosis is common, an interest group consisting of
PHDs, veterinarians, and farm workers can provide information exchange (7). PHDs can
then preemptively plan appropriate clinical diagnosis and management, surveillance
reporting, and educational activities about human brucellosis.
Junior Doctors Network Newsletter
Issue 21
April 2021
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 22
To address these limitations, common goals must be established
to foster One Health transdisciplinary and multi-sectoral
collaborations and empower PHDs in their community activities.
Second, environmental health systems can be strengthened through a collaborative model
with the water sector that can facilitate information exchange and inspection requests. For
example, as of 2020, 99.2% of the water supply in the Republic of Korea has been installed
and managed by public institutions. However, since many rural areas still use low-cost
water supplies such as wells and groundwater, it is difficult to identify sources of water
pollution after the occurrence of natural disasters. Hence, as PHDs can promptly examine
water supplies, they can report gastrointestinal infections for surveillance reporting, identify
sources of pollution in local areas, and request site inspections by water supply
businesses.
Moving forward, PHDs in the Republic of Korea have the potential to pioneer activities that
promote the One Health approach across local communities. Other One Health topics to
address are deforestation and changes in land use, air quality, vector-borne disease
transmission, and other environmental pathogens like scrub typhus infections (8).
References
1) Stadtlander CT. One Health: people, animals, and the environment. Infect Ecol Epidemiol. 2015;5:30514.
2) El Zowalaty ME, Jarhult JD. From SARS to COVID-19: a previously unknown SARS-related coronavirus
(SARS-CoV-2) of pandemic potential infecting humans − call for a One Health approach. One Health.
2020;9:100124.
3) You J. Lessons from South Korea’s COVID-19 policy response. Am Rev Public Adm. 2020;50:801-808.
4) Kim HK, Jeong DG, Yoon SW. Recent outbreaks of highly pathogenic avian influenza viruses in South
Korea. Clin Exp Vaccine Res. 2017;6:95-103.
5) Yoo D, Kim H, Lee JY, Yoo HS. African swine fever: Etiology, epidemiological status in Korea, and
perspective on control. J Vet Sci. 2020;21:e38.
6) Yang DK, Kim HH, Lee KK, Yoo JY, Seomun H, Cho IS. Mass vaccination has led to the elimination of
rabies since 2014 in South Korea. Clin Exp Vaccine Res. 2017;6:111-9.
7) Lee BY, Higgins IM, Moon OK, et al. Surveillance and control of bovine brucellosis in the Republic of
Korea during 2000–2006. Prev Vet Med. 2009;90:66-79.
8) Min K-D, Lee J-Y, So Y, Cho S-i. Deforestation increases the risk of scrub typhus in Korea. Int J Environ
Res Public Health. 2019;16:1518.
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April 2021
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This call to action will require the distribution and analysis of
national epidemiological surveys, the formation of regional-
level interest groups for transdisciplinary collaborations, and
robust One Health educational programs with sustainable
government support for health professionals.
According to the World Health Organization (WHO), child maltreatment refers to the
physical or emotional abuse and neglect, leading to potential harm to a child’s health, often
in the context of relationships of power or trust (1). Although current estimates vary by
country, the WHO reported that an estimated 300 million children between 2-4 years of age
experience regular physical or psychological harm from their caregivers (1).
Junior Doctors Network Newsletter
Issue 21
April 2021
Child Abuse in the Republic of Korea and
the Role of Junior Doctors
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES
Jaehyun Lee, MD
Sunchang Health Center & Country Hospital,
Sunchang, Republic of Korea
Sejin Choi, MD MSc
Seoul Detention Center, Ministry of Justice
Korean Association of Public Health Doctors
Seoul, Republic of Korea
Page 24
Table 1. The number of child abuse cases and the rate of
increase from 2015-2019, Republic of Korea. Credit:
Ministry of Health and Welfare, Republic of Korea (3).
Figure 1. The number of confirmed and suspected cases
of child abuse from 2015-2019, Republic of Korea. Credit:
Ministry of Health and Welfare, Republic of Korea (3).
In the Republic of Korea, there were an
estimated 30,000 child abuse cases in
2019 (2) (Table 1). The numbers of
confirmed and suspected child abuse
cases are increasing due to social
awareness on child abuse (2) (Figure 1).
Although the official report for 2020 has
not yet been finalized, many citizens
worry about cases being underreported
due to the closure of schools and day
care centers during the coronavirus
disease 2019 (COVID-19) pandemic.
Since the perpetrators of 76.9% of the
reported child abuse cases in 2019 were
parents, it demonstrates that some
parents believe that corporal punishment
is the way to educate children (2). This
cultural perception may serve as a
source for the increased cases of child
abuse in the country (3).
This health burden can be highlighted in two recent examples. First, Jeongin, a 16-month-
old, who was physically abused by her adoptive mother, passed away in Fall 2020 (4). Her
death was a result of severe nutritional deficiencies and pancreatic rupture, as a result of
the physical abuse. This tragic event even led to the #sorryjeongin social media campaign,
including a post by a BTS member (K-pop music star) on Weverse (5). Second, when
police responded to a reported case of child abuse in 2020, they released the name of the
reporter’s identity (6). As a result, this reporter, a public health doctor, was then threatened
by the perpetrator (7). The mismanagement in this reported case of child abuse – where
the police were unaware of investigation protocols and related laws on child abuse – is
evidence of the problems of the current policies related to child abuse in the Republic of
Korea.
Lack of Expertise and Standardization
In the Republic of Korea, the Child Protection Agency (CPA) and the police are the only
entities involved in the management of child abuse cases. Since they both experience a
heavy workload with insufficient human resources, they are challenged to manage the
complex aspects of such incidents. For this reason, a multidisciplinary approach is
paramount, where experts from diverse fields – such as social welfare, economics, and
healthcare – can collaborate and propose appropriate action plans that incorporate funding
and educational programs to reinforce a swift, multifaceted response.
Another challenge involves the discrepancy of the legal conclusions between the CPA and
the police, which suggest that there is no standardization over child abuse and no
designated individual to mediate discussions. This was noted as about 80% of all
suspected reports of child abuse were confirmed as child abuse cases, while 20% were
categorized as misreports in 2019 (2). In contrast, in the case of sexual abuse, family
violence, and sex trafficking cases, the Seoul Crisis Intervention Center for Women and
Children serves as the designated agency to provide all related services, including legal
services, medical care, and psychological counseling for women of all ages, children under
13 years of age, and the mentally handicapped who have experienced sexual abuse (8). As
such, identifying an agency to serve as the mediator can facilitate the step-by-step
protocols to offer ethical services. For example, doctors at medical facilities can examine
victims, secure evidence for legal authorities, and provide medical treatments and
psychological counseling. They can also offer psychiatric interventions for perpetrators.
Junior Doctors Network Newsletter
Issue 21
April 2021
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 25
Calls for action to improve policies related to the prevention of
childhood maltreatment and implement educational campaigns
have gained support among the general population.
In Japan, child abuse is also a serious problem, and authorities have observed an increase
in cases each year. Since current child guidance centers have limited resources, Japanese
leaders introduced the Child and Family Support Center as the designated agency to
connect all related organizations, such as municipal administrations and medical centers.
Child abuse prevention and child protection teams were also established in university
hospitals and pediatric hospitals.
Need for Medical Interventions
In efforts to prevent child abuse, the Republic of Korea has emphasized moral obligations
for legal authorities who prepare investigative reports as well as strong punishments for
perpetrators. However, sufficient physical and mental support services for victims is
essential, especially since victims rarely receive close health evaluations after the event.
Although doctors must prepare a report when they discover suspected cases, their medical
opinions are often not chosen as evidence. About 10% of child abuse cases in the Republic
of Korea are repeated cases committed by the same perpetrator, which demonstrate that
countermeasures are not effective enough (2). One potential solution is to mandate
psychiatric counseling, diagnosis, and treatment for perpetrators.
In cases of limited access to medical care, community-based support should strengthen
links between the child, non-offending family members, and community members. Mental
health support and treatment – whether formal or informal – should include the child’s
caregivers and be closely coordinated with legal efforts to protect the child. Since the
perpetrators of 94.5% of repeated cases are the victims’ parents, it is important to separate
the victim from the perpetrator (2). However, as 83.9% of abused children are not
separated from perpetrators and live in their original homes, the vicious cycle continues (2).
More Training Opportunities
Currently, there are limited education and training opportunities on child abuse for
healthcare workers, including junior doctors. The Korean Medical License exam includes a
“child abuse” section, but there are few chances for doctors to receive continued medical
education on this topic. Some solutions can include introducing a subspecialty for child
abuse pediatricians (CAP) and integrating regular continued education courses or seminars
on child maltreatment.
Junior Doctors Network Newsletter
Issue 21
April 2021
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 26
Junior doctors in the Republic of Korea are willing to equip themselves with essential
knowledge and skills to standardize the process for assessing suspicious injuries and
reporting confirmed or suspected cases of child abuse. By providing proper training through
robust policies and legislation, these certified doctors will serve as health leaders and
advocates to protect our children.
References
1) World Health Organization. Child maltreatment. 2020 [cited 2021 Mar 15].
2) Ministry of Health and Welfare (Republic of Korea). Child abuse and neglect annual report 2019. Seoul:
Ministry of Health and Welfare; 2020. Korean.
3) Child Welfare Institute, Republic of Korea. Child abuse prevention guidelines. Seoul: Child Welfare
Institute; 2014. Korean.
4) Hye-Yeon S, Myo-Ja S. Death of abused toddler shocks Korea. Korea Joong Ang Daily. 2021 [cited 2021
Feb 2].
5) Jae-Yeon W. Death of adopted baby ignites reckoning over systematic failure to stop child abuse. Yonhap
News Agency. 2021 [cited 2021 Feb 2].
6) Yoonha C. Reports of child abuse neglected. SBS. 2021 [cited 2021 Feb 2]. Korean.
7) Taewoong J, Minsoo K. Teachers and doctors hesitate to report child abuse. MBN. 2021 [cited 2021 Feb
2]. Korean.
8) Seoul Crisis Intervention Center for Women and Children. Seoul Crisis Intervention Center for Women
and Children. 2021 [cited 2021 Feb 2]. Korean.
Junior Doctors Network Newsletter
Issue 21
April 2021
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES
Junior doctors can raise their voices to hospitals and medical
associations to develop appropriate education and training
programs on child maltreatment.
Page 27
On January 7, 2020, Chinese health officials confirmed that a novel coronavirus (2019-
nCoV) was associated with the cluster of acute respiratory illness threatening the Chinese
city of Wuhan since December 2020. The person-to-person transmission became quickly
evident as nosocomial infections were reported in China. The newly emerged virus,
designated as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), had
over 70% similarity with SARS-CoV-1. It was an alarming reminder of the preceding
coronavirus that caused hundreds of severe illness cases and at least 73 deaths in Taiwan
in 2003 (2).
Junior Doctors Network Newsletter
Issue 21
April 2021
From Border Control to One of the First Countries Enjoying
Economic Recovery: Taiwan’s Measures for Crisis Relief
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES
Chiang Kuan Yu, MD
Hospitalist, Taipei City Hospital
Deputy Chief Executive, Global Taiwan Medical Alliance
Taipei, Taiwan
Page 28
Photo 1. Physicians at the Taoyuan General
Hospital commemorate the last reported
nosocomial infection. Credit: Wealth Magazine
Through strict precautions taken at the border
and well-organized hospital networks, the Taiwan
Central Epidemic Command Center had
achieved a 254-day record without local cases of
the coronavirus disease 2019 (COVID-19) since
May 2020. The outstanding outcome of a near-
zero conversion rate of imported cases to local
cases came from timely actions and accumulated
expertise from the epidemic emergencies
managed during the past 20 years. Nevertheless,
nosocomial transmission remained a concern,
since two nosocomial infection outbreaks had
occurred over a period of nine months. The last
incident was reported at the Taoyuan General
Hospital, directed by the Ministry of Health and
Welfare, in January 2021 (Photo 1).
The return of millions of travelers from the Chinese New Year
celebrations in Mainland China in early 2020 heralded an
increased number of imported SARS-CoV-2 cases (3).
From Total Lockdown to an Effective Entry Management Strategy
In 2003, a hospital-acquired case of SARS occurred at Taipei City Hospital (Heping
Branch). Although inexperienced in infection control activities, government officials ordered
an immediate lockdown as the first cluster of SARS cases was confirmed. As a result, staff
and patients were confined to the hospital, where they were exposed to the pathogen since
they were unable to establish a quarantine ward. During the 14-day lockdown, 57 medical
personnel were infected and seven died, while 97 non-medical personnel were infected,
and 24 died (1 committed suicide) (4).
Taiwan developed the “Zero Clearing” plan, which relied on rigorous epidemic surveillance
as the standard containment method for countries of advanced border control. In 2020,
when the Taoyuan General Hospital reported a positive COVID-19 case, emergency
measures were implemented. A widespread testing protocol was immediately initiated for
patients and staff in order to quantify the size of the hospital outbreak and avoid the
hospital lockdown. Patients with low or moderate risk of infection were transferred to other
hospitals, while patients with high risk were quarantined individually.
Junior Doctors Network Newsletter
Issue 21
April 2021
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES
Figure 1. Epidemiologic investigation of COVID-19 cases.
Credit: Taiwan Central Epidemic Commander Center (5).
Within the local community, the Taiwan
Central Epidemic Commander Center
coordinated an efficient contact tracing
network successfully isolated 5,000
contacts for a 14-day home quarantine
(Figure 1). Authorities reported 10
nosocomial cases (2 physicians, 3
nurses, 1 caretaker, 2 patients, 2
patients’ dependents) and 11 local cases
and one death (80-year-old dependent)
(5). At the time of preparing this article,
no further cases had occurred after
February 13, 2021.
Page 29
Lessons learned from this 2003 outbreak set the framework for the
unexpected COVID-19 pandemic.
After Taiwan implemented the epidemic prevention model at the border, no additional
domestic COVID-19 cases had been reported since May 2020. However, with the opening
of airline travel and discoveries of virus mutations, nosocomial infections were reported in
early January 2021, and authorities initiated national control measures. In mid-February
2021, authorities reported that the eradication efforts were successful, with no new cases of
domestic infection (Figure 2). The Taiwan Central Epidemic Command Center also
expanded the contract tracing network of suspected COVID-19 cases to approximately
5,000 people (Figure 3).
Success Factors for a Country Relying on Border Control
Since Taiwan has yet to initiate the COVID-19 vaccination campaign, border control and
public health and social measures remain the primary keys to curb the pandemic. Several
aspects have emerged crucial in dealing with the crisis.
1. Adequate professional knowledge of national leadership
Based on lessons learned from the SARS pandemic in 2003, government officials in
Taiwan have established a crisis relief network between the major hospitals to manage
imported cases. Moreover, the upgrade of contact tracing and testing protocols proved to
offer a more suitable and successful measure, compared to a total lockdown to manage the
nosocomial outbreak.
2. Effective communication between authorities and hospital personnel
The early coordination of a temporary outpost of the Taiwan Centers for Disease Control
(CDC) enabled direct communication among government officials, hospital personnel, and
local administrators (6). This communication strategy – emphasizing video calls and
telephone calls over documents and e-mails – fostered the clear identification of roles and
responsibilities.
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April 2021
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 30
Figure 2. Reports of COVID-19 cases from January
2020 to February 2021, Taiwan. Credit: Taiwan Central
Epidemic Commander Center (5) and Open Data by
National Development Council.
Figure 3. Number of PCR samples screened for
SARS-CoV-2 infections, Taiwan. Credit: Taiwan
Central Epidemic Commander Center (5) and Open
Data by National Development Council.
3. Effective communication with citizens
In January 2021, when local cases were reported, citizens were anxious about the lack of
available vaccines and harboured doubts about the competence of the Taiwan CDC. In
response, the Taiwan CDC held daily press conferences to communicate the effective
implementation of border control and public sanitation measures. On February 10, 2021,
government officials announced the successful purchase of five million Moderna vaccines
and a prospective purchase of 10 million AstraZeneca vaccines. Citizens were informed
that inoculation would begin before the third quarter of 2021.
Conclusion
According to the World Health Organization (WHO) guidelines, communication among
national authorities, hospitals, and the community is pivotal for an effective crisis
management strategy (8). As government officials provided daily updates on these national
measures, citizens gained confidence in their oversight of the border control and public
sanitation measures. Strict triage, quarantine, and effective entry bans to high-risk hospitals
were recognized as the most efficient prevention and mitigation efforts. Through the
outstanding performance in managing the pandemic crisis and massive vaccination
program, Taiwan is expected to become one of the first countries to regain economic
momentum by the end of 2021 (7).
References
1) Singhal T. A review of coronavirus disease-2019 (COVID-19). Indian J Pediatr. 2020;87:281-286.
2) Wang C, Ellis S; Bloomberg. How Taiwan’s COVID response became the world’s envy. Fortune. 2020
[cited 2021 Feb 20].
3) Chien L-C, Beÿ CK, Koenig KL. Taiwan’s successful COVID-19 mitigation and containment strategy:
achieving quasi population immunity. Disaster Med Public Health Prep. 2020:1-4.
4) Focus News Agency, Taiwan. 2003 SARS outbreak and Helping Hospital in Taiwan. 2020 [cited 2021 Feb
20]. Traditional Chinese.
5) Jie C. COVID-19 Toyuan Hospital infection analysis, Taiwan. The Reporter. 2021 [cited 2021 Feb 20].
Traditional Chinese.
6) Taiwan Centers for Disease Control. Press release. 2021 [cited 2021 Jan 22]. Traditional Chinese.
7) Buchholz K. Global vaccine timeline stretches to 2023. Statista. 2021 [cited 2021 Feb 20].
8) World Health Organization. Outbreak communication: best practices for communicating with the public
during an outbreak. Geneva: WHO; 2005.
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Issue 21
April 2021
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 31
Taiwan represents a model among other Asian countries, by
implementing this strict national prevention and control
strategy to curb disease transmission.
This statement was made at the first World Medical Association (WMA) seminar on the
human resources for health (HRH) crisis, which highlighted a partnership with the World
Health Organization (WHO)’s Global Health Workforce Alliance (GHWA) – now repurposed
as the Global Health Workforce Network.
Intergovernmental Aspects of Health Employment
HRH was traditionally seen as a domestic issue on the supply-side, which incorporates
medical education and bilateral immigration policies. In the 2000s, the international
community acknowledged that the HIV/AIDS crisis was protracted by a global HRH crisis.
An Agenda for Global Action emerged following the 2008 Kampala Declaration, which
focused on three aspects of workforce development as a whole − supply, demand, and
mobility from the transnational to the local level (1). This health policy field became more
institutionalised, with the adoption of new soft laws such as a WHO Global Code of
Practice on the International Recruitment of Health Personnel, and the emergence of a
global policy community for HRH.
However, the 2007-2008 global financial crisis and the Great Recession placed an
enormous strain on resource mobilization. Following the 2014–2016 Ebola virus disease
crisis in West Africa, the United Nations (UN) High-Level Commission on Health
Employment and Economic Growth rekindled the Kampala narrative. It must be said that
only US $7.3M out of US $70M (as planned by end line) have so far been committed to the
corresponding 2016-2021 UN Multi-Partner Trust Fund (MPTF) called ‘Working for Health’.
Junior Doctors Network Newsletter
Issue 21
April 2021
Foreign Affairs, Human Resources, and Junior Doctors as Insiders
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES
Samuel d’Almeida, MD MPH
London School of Economics and Political Science
London School of Hygiene and Tropical Medicine
Fort-de-France, France
Page 32
“As long as the rich countries do not get their human resource
issues in order, the poor countries will continue to suffer from
an enormous brain drain”
− Dr Otmar Kloiber (World Medical Journal, May 2009)
The Domestic Sphere
At the domestic level, health often commands the second biggest share of government
expenditure worldwide – often 5-10% – and HRH often amounts for two-thirds of health
budgets (2). Therefore, the whole government is lurking on HRH spending. As highlighted
by Greek Junior Doctors – Hellas in the Junior Doctors Network (JDN) Newsletter of April
2020, the Great Recession took a heavy toll on junior doctors’ perspectives of their future
workplace. Although many junior doctors have considered working abroad, Greece is far
from being the only European country to face HRH maldistribution (3).
HRH policies have ebbs and flows. Since the coronavirus disease 2019 (COVID-19) crisis,
finance ministers have paid more attention to HRH. Many governments and central banks
have responded with countercyclical measures – such as stimulus – rather than initial cuts
in health expenditure. However, traditional donor countries shifted their burden by
deregulating the international market of HRH recruitment (4).
The Foreign Sphere
The year 2021 became WHO’s International Year of Health and Care Workers, a
glorification which remains obscured by the tenace lack of commitment to official
development assistance (ODA) to the UN MPTF.
First, the theory of realism would depict the international system as anarchic and HRH
mobility as a zero-sum equation. In realism, states aim at being self-reliant. If one state is
gaining, then another state must be losing, and therefore brain drain is conceptualized as a
geopolitical strategy. Second, the theory of constructivism implies that states want to
uphold and comply with international norms and laws related to HRH because of
international prestige. Although, from such a perspective, states will not share information
about failed domestic or development politics because this would damage their image.
Third, the theory of neoliberal institutionalism implies that states tend to increase
interdependence to win mutual benefit. A subset, the theory of liberal
intergovernmentalism, postulates three central planks of engagement that can be applied
Junior Doctors Network Newsletter
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April 2021
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 33
However, new insights can be drawn on the international
theory, which includes realism, constructivism, and neoliberal
institutionalism like liberal intergovernmentalism (5,6).
to the home-foreign affairs nexus in HRH. These include: 1) national interest shaped by
state’s constituencies and interest groups (e.g. national junior doctors’ associations); 2)
asymmetric interdependence between states; and 3) institutional framework (e.g. financing,
norms, laws, expertise).
Conclusion
There is an osmotic relationship between domestic and foreign HRH policies. Taken in
isolation, national plans are inherently widening global inequities. The COVID-19 pandemic
re-exposed sound countercyclic measures in high-income countries, lack of commitment in
multilateral ODA, and deregulation of the international market. As health services remain a
significant issue for governments, junior doctors should pause and reflect on the future of
health service delivery across the globe.
Policy Recommendations
More attention needs to be placed on the international economics of HRH mobility. National
junior doctors’ associations, based on their traditional insider status in domestic policies,
should join efforts with their foreign affairs’ policy community on HRH and develop
innovative ideas. In turn, the JDN may move to institutionalise these international efforts at
the national level with a novel normative standpoint (7,8).
References
1) World Health Organization, Global Health Workforce Alliance. The Kampala Declaration and Agenda for
Global Action. Geneva: WHO; 2008.
2) Chen L, Evans T, Anand S, Boufford JI, Brown H, Chowdhury M, et al. Human resources for health:
overcoming the crisis. Lancet. 2004;364:1984-1990.
3) d’Almeida S. Time for a European ‘Health Union’? LSE Blog Social Policy, International Social and Public
Policy. 2021 [cited 2021 Feb 22].
4) European Commission. Guidance on free movement of health professionals and minimum harmonisation
of training in relation to COVID-19 emergency measures – recommendations regarding Directive
2005/36/EC. Brussels: European Commission; 2020.
5) Paxton N, Youde J. Engagement or dismissiveness? Intersecting international theory and global health.
Glob Public Health. 2019;14:503-514.
6) Schimmelfennig F. Liberal intergovernmentalism and the crises of the European Union. Journal of
Common Market Studies. 2018;56:1578-1594.
7) World Medical Association. Archived: WMA Council Resolution on the Healthcare Skills Drain. 2017 [cited
2021 Feb 22].
8) World Medical Association. WMA Statement on Ethical Guidelines for the International Migration of Health
Workers. 2003 (revised in 2014) [cited 2021 Feb 22].
Junior Doctors Network Newsletter
Issue 21
April 2021
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 34
The coronavirus disease 2019 (COVID-19) pandemic marked 2020 in many ways. Now,
one year later, it continues to influence our lives as we enter the new normal. The virus has
challenged global clinicians and scientists as they learned about this novel coronavirus
through its clinical presentation and rapid spread through aerosols and droplets when in
close contact with infected individuals. The impact of the pandemic has also affected the
economic and health sectors, where vulnerable communities have been most affected.
The epicentre of the Italian first wave of the severe acute respiratory syndrome coronavirus
2 (SARS-CoV-2) was the Lombardy region, with 105,000 infections and 17,000 fatalities
reported from March to September 2020 (1). The peak of the pandemic in the Lombardy
region was reached on March 21, 2020, when over 3,200 new cases were reported,
including 1,500 hospitalizations, and 150 admissions to intensive care units (1). This surge
created an unprecedented, localized health system collapse, which then spread across
Italy (1). From February 20, 2020 until March 24, 2021, Italian national authorities reported
3,440,862 confirmed COVID-19 cases and 106,339 deaths (2). Just like Italy, other
countries experienced stressors to their national health system, including workforce
shortage, to highlight the lack of human resources to manage this unprecedented crisis (3).
According to official figures, Italy stands over the Organization for Economic Co-operation
and Development (OECD36) average for the number of doctors, with four physicians per
1,000 population, with half of them being over 55 years old, and moving toward retirement
over the next 10 years (4-5). By 2030, there is an estimated deficit of 80,000 clinicians in
Junior Doctors Network Newsletter
Issue 21
April 2021
The COVID-19 Effect: Italian Junior Doctors Adapt to Career
Changes during the COVID-19 Pandemic
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS
Giacomo Crotti, MD
Public Health Doctor
Milan, Italy
Federica Balzarini, MD
Public Health Doctor
Brescia, Italy
Page 35
Following the outbreak in Wuhan, China, Italy was the first
Western country to experience a massive COVID-19
outbreak, with the first cases reported on February 20, 2020.
hospitals and general practice, thus making workforce governance an absolutely urgent
matter (4-6). The most natural way to manage resource scarceness is by examining its
production process.
In 2013, the competition to access medical residency programs in Italy, held annually in
every single university independently, was centralized. The establishment of a unified
competition for all the positions on the national territory was aimed to overcome
When the Italian health service came under increasing pressure by the emergence of
SARS-CoV-2, the workforce shortage issue regained appeal. Immediately, significant
actions were put in place by the Italian Government, including changing de facto the career
path of junior doctors and coordinating appropriate contracts to hire doctors for urgent
activities of contact tracing, diagnostic testing, and home-care services.
Additionally, two groundbreaking measures had been considered for a long time and were
subsequently implemented under the pressure of the COVID-19 crisis. First, the health
authorities enacted a decree that allowed medical residents and general practice trainees
to work inside the regional health system during their final years of training. Authorities
provided them with the same accountability and benefits of specialized doctors, but in
addition to their clinical responsibilities, they were required to complete eight hours of
weekly supervised work (7). Second, medical graduation became a qualification for
permission to enter general practice without completion of the Ministry of Health
examination. This exception increased the number of junior doctors who entered the
National Health Service and hence offered relief to the strained health system.
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April 2021
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 36
Figure 1. Mismatch between candidates and funded positions
for medical residency programs. Source: Italian Ministry of
Education, Universities, and Research (MIUR).
meritocracy concerns and to ensure the
access and quality of the medical
training uniformly throughout the
country (Figure 1). Hence, the age-old
question of the gap between candidates
and ministerial scholarships for medical
residency programs remained
unsolved, and the opportunity was
missed to enforce a strong and decisive
action plan. Today, the prospect of
filling the void left by mass retirements
expected in the next decade is unlikely
(6).
As the second wave arrived at Italy, the COVID-19 pandemic continued to stress the health
system. After months of increased workload, reduced time for formal training, and changes
to the work environment, resident doctors came back classified as students, and they had
been offered university credits and no financial incentives to support the COVID-19
community vaccination efforts (8). Hence, this extraordinary emergency fostered a call to
action for reform of Italian medical education and training programs.
Despite the challenges experienced during the COVID-19 pandemic, the Italian health
authorities have not yet developed the strategic and farsighted vision needed to enforce a
successful policy for medical training. Indeed, by implementing short-term actions to
manage the current crisis and temporarily fill the workforce shortage, policymakers are
likely to miss the chance to build a robust medical training. Since an effective medical
training system is the cornerstone for high-quality clinical and public health services, a
successful reform requires continued investment to examine the results within the next
decade. Lessons learned from the COVID-19 community response underline the value of a
well-proportioned and trained health workforce.
References
1) Perico L, Tomasoni S, Peracchi T, Perna A, Pezzotta A, Remuzzi G, et al. COVID-19 and lombardy:
TESTing the impact of the first wave of the pandemic. EBioMedicine. 2020;61:103069.
2) Il Sole 24 Ore. Coronavirus in Italy, data and map. 2021 [cited 2021 Mar 24]. Italian.
3) Organization for Economic Co-operation and Development. Skill measures to mobilise the workforce
during the COVID-19 crisis. Paris: OECD Publishing; 2020.
4) Organization for Economic Co-operation and Development. Health at a Glance 2019: doctors (overall
number). Paris: OECD Publishing; 2019.
5) Nebo Ricerche PA. NHS Health Report 2019: employees of public health companies. 2019 [cited 2021
Feb 23]. Italian.
6) Randstad Research Italia. The figures of medical profiles in Italy and the impact of the coronavirus. 2020
[cited 2021 Feb 23]. Italian.
7) President of the Republic (Italy). Measures to strengthen the National Health Service and economic
support for families, workers and businesses related to the COVID-19 epidemiological emergency. Italian
Official Gazette: General Series No. 70. 2020 [cited 2021 Feb 23]. Italian.
8) Panorama della Sanità. Medical residents, Anelli (Fnomceo) to Manfredi (Miur): they are not students,
they are doctors in all respects: treat them as such. 2020 [cited 2021 Feb 23]. Italian.
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April 2021
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 37
Globally, all junior doctors must advocate for an effective and
accessible medical training in order to strengthen and preserve
the real asset of every health system: the health workforce.
Burnout is one of the most common mental health issues among doctors in training,
especially those in surgical specialties. This can contribute to poor job satisfaction and
have a negative impact on mental and physical health (1).
The term burnout, first defined by Freudenberger, was used to describe emotional
exhaustion experienced by civil servants. There are three components of burnout:
overwhelming exhaustion, feelings of cynicism or depersonalization, and sense of
ineffectiveness and lower efficacy. Evidence shows that burnout can affect patient safety
and patient outcomes, increase prescription errors, reduce quality of medical services, and
weaken interprofessional relationships (1).
According to one meta-analysis, the global prevalence of burnout among residents is
considerably high and estimated at over 50% (1). The following causes of burnout were
identified: bureaucratic requirements, continually changing work environments, micro-
management by the hospital administration, poor clinical supervision, sensationalist media
reports of medical errors, limited health care resources, litigious environments, and poor
work-life balance among residents.
Junior Doctors Network Newsletter
Issue 21
April 2021
Second Wave and Uncertainties:
Experiences with Emotional Stress and Burnout
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS
Maymona Choudry, MD MPH
General Surgery Resident
Vicente Sotto Memorial Medical Center
Cebu City, Philippines
“…If you feel burnout setting in, if you feel demoralized and exhausted,
it is best, for the sake of everyone, to withdraw and restore yourself”
– Dalai Lama
Page 38
Burnout syndrome is characterized by emotional exhaustion,
depersonalization, and reduced personal achievement.
Aliyah’s Experiences
Aliyah is a second-year surgical resident, assigned to Cardiovascular and Thoracic Surgery
in a tertiary hospital, as part of her subspecialty clinical rotations. Since she was on-call
every day, she was responsible for managing any referrals from the emergency room or
hospital ward. This meant that she had to stay at the hospital for long periods of time, with
no fixed time and little to no leisure time. Eventually, she was able to cope with multiple
tasks and referrals, performing bedside procedures, and scheduling emergency and
elective cases on certain days.
She was able to observe and participate in numerous types of surgeries, which piqued her
interest in thoraco-cardiovascular surgery. At the end of her rotations, she was promoted to
her third year of residency, where new challenges and adversities would await in 2021.
In December 2020, the coronavirus disease 2019 (COVID-19) cases in Cebu city
decreased to fewer than 10 cases per day. It had appeared that daily routines were
returning to the new normal. At the start of January 2021, Aliyah was assigned to the
Trauma Service with a team of nine residents from various training years. She felt happy to
become a part of a team again and have colleagues with whom she could brainstorm and
discuss issues. She also knew that she could rely on her colleagues for additional support
whenever she encountered difficulties during the rotation.
During the first week, they received mandatory swabbing for COVID-19 testing. Some
residents were asymptomatic but tested positive for the infection. Once again, they had to
go back on skeletal workforce, and there were numerous changes in teams, rotations, and
schedules. As she managed these new changes, she was assigned to the COVID-19 team
and was on the first team to be assigned one week of straight duty. She felt overwhelmed
and disconnected from her colleagues and patients, which stimulated feelings of
exhaustion and stress. As she neared day seven, she was already feeling hopeless and
exhausted, to the point where she just wanted to quit and go home. She stopped
everything, realizing that enough was enough, and she had to retreat and recuperate to
find herself again. She realized that she was experiencing burnout.
Junior Doctors Network Newsletter
Issue 21
April 2021
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 39
Although it was fun and satisfying to complete her clinical
responsibilities, she started to feel isolated and alone during the
rotation. It did not bother her much, or so she thought.
Forward Steps
Burnout is commonly experienced across health care professions. Although we cannot
avoid stressful clinical scenarios, we must adapt to our profession and adopt techniques
and strategies to significantly lower the risk of burnout. However, there is a burgeoning
literature base to support the assertion that resilience is a skill that may be learned and
cultivated, which is instrumental in preventing burnout (2). Emotional intelligence has also
been reported as a strong predictor of resident well-being (2).
Individual physicians should work hard to combat burnout by actively nurturing their
personal and professional lives and prioritising work-life balance. Furthermore, they can
place greater emphasis on finding meaning in their daily work, focusing on what is
important in life, and maintaining a positive outlook.
References
1) Low ZX, Yeo KA, Sharma VK, et al. Prevalence of burnout in medical and surgical residents: a meta-
analysis. Int J Environ Res Public Health. 2019;16(9):1479.
2) Moalem J. Resources in Surgical Education: Burnout in surgery. 2017 [cited 2021 Feb 7].
Junior Doctors Network Newsletter
Issue 21
April 2021
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS
Moving forward, these strategies – such as employing
mindfulness techniques, consciously expressing gratitude, and
celebrating small victories – can be effective in reducing burnout.
Page 40
Low-income countries, including Ethiopia, continue to struggle with national investment in
health workforce education and training (1). As a country with a fast growing population,
Ethiopia has faced severe gaps in the demand and provision of essential health services,
mainly due to a shortage of trained workers (2). In light of this fact, the Ethiopian
government has focused on strengthening the health care system by establishing new
health care facilities and expanding physician training through the “flood and retain”
strategy (3).
Currently, over 30 recognized medical schools in Ethiopia produce an oversized output of
physicians. Despite the increased number of health care facilities, these medical graduates
struggle to find proportional opportunities of employment, career, and professional
development. Since medical education directly impacts public health and the quality of
care, it must base its framework on the health system through strictly regulated
governance. Unfortunately, the disproportionate focus on the “flood” (rather than the
“retain”) policy has left room for career preference, urban concentration, and talent exodus.
Such results suggest that the strategy has inadvertently negated the very aim it was
established to achieve.
A recent research study examined career preferences from medical students across six
Ethiopian medical schools. Authors reported that medical students favor of specialties of
Internal Medicine and Surgery, leaving gaps in the crucial fields of Pediatrics and
Obstetrics and Gynecology (4). These findings present an alarming challenge for the
Junior Doctors Network Newsletter
Issue 21
April 2021
Ethiopia’s Medical Talent: The Dilemma
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS
Eleleta Surafel Abay, MD
Public Health Analysis Intern
Global Health and Education Projects, Inc
Addis Ababa, Ethiopia
Page 41
The enforcement of this policy, through the expansion of the
medical program and increased enrollment, has been a clear
attempt to encourage meaningful change in the number of
available health care workers at all levels.
country, especially as they relate to maternal and child mortality rates. Ultimately, career
choice is a dynamic process that is subject to continuous change as students advance in
their coursework and clinical rotations. Given the complexity of the phenomenon, in order
to develop evidence-based strategic interventions, robust longitudinal studies should
examine how the factors associated with career preference change across medical
education.
Compared to other professional areas, the medical pool is most susceptible to talent
exodus. This is a result of the increasing demand for health professionals in high-income
countries that offer better financial incentives, conducive training and working
environments, and better living conditions. Given how educating medical doctors is an
expensive initiative for any low-income country, focusing on devising mechanisms to tap on
the knowledge and skills of those professionals who have already left can be one mitigation
strategy (3).
As medical interns continued to face bureaucratic hurdles in license acquisition, poor
working conditions, lack of social security and financial benefits, and limited career
advancement opportunities, they led a nationwide strike in May 2019. Notably, the strike
brought several unexpected consequences, including the cessation of central deployment
of medical graduates by the country’s Ministry of Health. This central deployment freeze left
the new graduates alone in the job search and shifted the hiring mandate to regional and
city administration health bureaus, which fostered corruption and nepotism (Photos 1-2).
Junior Doctors Network Newsletter
Issue 21
April 2021
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 42
Ethiopia continues to be one of the countries with the highest
physician emigration in Sub-Saharan Africa, due to inadequate
professional support and substandard retention strategies.
Photo 1. University of Gondar medical doctors on
strike, May 2019. Credit: UoG official Facebook page.
Photo 2. Recent medical graduates in line for job
applications, September 2020. Credit: Ethio Doctors
Jobs and Vacancies official Telegram page.
In conclusion, the shortsighted national governance of the health system has jeopardized
past efforts and overlooked the health workforce shortage and emigration trends. This has
left the country in the frustrating paradox of unmet health care needs for the general
population as well as concerns about continued medical training and employment for recent
medical graduates (5). Moving forward, there is an imminent necessity to develop high-
quality, large-scale longitudinal analyses of existing medical training and retention
strategies that support evidence-based policies.
References
1) World Health Organization. Global strategy on human resources for health: Workforce 2030. Geneva:
WHO; 2016.
2) Berhan Y. Medical doctors profile in Ethiopia: production, attrition and retention. In memory of 100-years
Ethiopian modern medicine and the new Ethiopian millennium. Ethiop Med J. 2008;46 (Suppl 1):1-77.
3) Tamrat W. Medical education and the Ethiopian exodus of talent. Center for International Higher
Education. 2019 [cited 2021 Feb 3].
4) Assefa T, Mariam DH, Mekonnen W, Derbew M. Medical students’ career choices, preference for
placement attitudes towards the role of medical instruction in Ethiopia. BMC Med Educ. 2017;17(1):96.
5) Biniam E. Op-ed: the “Flood and Retain” strategy and the future of Ethiopian doctors. 2019 [cited 2021
Feb 3].
Junior Doctors Network Newsletter
Issue 21
April 2021
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 43
Robust research protocols coupled with effective implementation
strategies have the potential to effectively mitigate this national
burden to the health system.
On February 1, 2021, the Myanmar military junta illegally seized all the three powers of the
State. They detained the legal government leaders and parliamentarians who were elected
systematically in the general election of November 2020, according to the democracy rules
and free wish of the people. On February 3, 2021, junior doctors from Myanmar – together
with other health professionals – started the Civil Disobedience Movement (CDM) and
vowed to close public hospitals across the country. They aimed to defy the new military
regime that took control of the government and seized civilian leaders in a coup (1).
While joining the CDM, we are providing gratuitous medical care at private clinics and
hospitals, with the help of well-wishers with conscience and dignity and in accordance with
appropriate medical practice (2).
Currently, some doctors are fleeing their homes to hide from the military regime, while
other doctors have been seized (3). Soldiers have opened fire at ambulances and medical
personnel who provide emergency treatment (4). Doctors have been targets while providing
care at private clinics. For this reason, senior doctors in Myanmar also strongly support the
CDM, which is described as the peaceful demonstration by junior doctors and medical
professionals in Myanmar.
Junior Doctors Network Newsletter
Issue 21
April 2021
Call for Solidarity from Junior Doctors:
Civil Disobedient Movement in Myanmar
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS
Wunna Tun, MBBS MD
Secretary (2020−2021)
Communications Director (2013−2016)
Junior Doctors Network
World Medical Association
Page 44
As junior doctors, our duty is to first consider our patient care
and manage their health needs. However, how can we provide
clinical care and use our medical knowledge without violating
human rights and civil liberties under military dictatorship?
We will continue to support the CDM until power is returned to the civilian government.
International specialty bodies support and stand in solidarity with doctors from Myanmar
(5). On behalf of the doctors in Myanmar, I would like to call for solidarity and
understanding from the Junior Doctors Network (JDN), WMA, and doctors around the globe
during these challenging times in Myanmar.
References
1) Shepherd A. Myanmar medics resist military coup. BMJ. 2021;372.
2) World Medical Association. WMA Declaration of Geneva. 2021 [cited 2021 Feb 22].
3) Htwe ZZ. 2021. Myanmar medics in hiding as regime targets hospital-led disobedience movement. 2021
[cited 2021 Feb 22].
4) JURIST Staff. Mandalay death toll rises after Myanmar police, soldiers open fire on protesters. 2021 [cited
2021 Feb 22].
5) Royal College of General Practitioners. Statement on Myanmar – February 2021. 2021 [cited 2021 Feb
22].
Junior Doctors Network Newsletter
Issue 21
April 2021
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 45
The Field Epidemiology Training Program (FETP) is a two-year fellowship, modelled after
the United States’ Centres for Disease Control and Prevention’s (US CDC) Epidemic
Intelligence Service (EIS) fellowship. This global program trains physicians, veterinarians,
and laboratory scientists to become field epidemiologists through didactic sessions of class
lectures (25%) and fieldwork experiences (75%) (1). A professional network called the
Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET),
which was formed in 1997, manages the accreditation of 87 FETPs in more than 165
countries and territories (1).
In Nigeria, the FETP has a laboratory and a veterinary component to address One Health
challenges and is therefore called Nigeria Field Epidemiology and Laboratory Training
Program (NFELTP) (2). The NFELTP is coordinated by the Nigeria Centre for Disease
Control and US CDC, through the Africa Field Epidemiology Network. Notably, NFELTP
residents and graduates were instrumental to help contain the Ebola virus outbreak in 2014
(2).
Prior to my admission into the 11th cohort of the NFELTP in 2019, I served as a paediatric
emergency physician at a local public hospital. My clinical responsibilities included the
evaluation and treatment of acute cases of infectious diseases (e.g. diarrhoeal diseases,
malaria, pneumonia), febrile seizures, malnutrition, and vaccine-preventable diseases (e.g.
measles). Since vaccine-preventable diseases continue to increase morbidity and mortality
in Nigerian children, prompt medical treatment is key to reduce the risk of complications.
Junior Doctors Network Newsletter
Issue 21
April 2021
Advanced Field Epidemiology Training Program:
A Nigerian Junior Doctor’s Experience
JUNIOR DOCTORS’ ACTIVITIES
Suleiman Ahmad Idris, MBBS
Field Epidemiology and Laboratory Training Program Resident
Global Immunization Division Fellow
Africa Field Epidemiology Network
Katsina, Nigeria
Page 46
Since its initiation in 2008, over 200 epidemiologists have
received this NFELTP advanced training.
During the first six weeks, sessions were made up of academic lectures, group exercises,
formal presentations, and asynchronous content. Topics included biostatistics,
epidemiology, disease surveillance, outbreak investigation, case studies, and software
programs (e.g. Microsoft Excel, Epi Info, QGIS). After classroom lectures and exams, we
were deployed to our field sites at the Ministries of Health around all the 36 Nigerian States
as epidemiology, immunization, and surveillance support staff. Our field supervisors and
mentors were instrumental in providing optimal support during this field training.
In February 2020, my first field experience was a response to a Lassa fever outbreak in
Katsina state. Although I was initially terrified when the index case was reported at my field
site, I felt prepared after my FETP training in infection prevention and control of Lassa
fever. In this case, nine family members attended a wedding in another Nigerian state with
an ongoing outbreak of Lassa fever. Four family members were diagnosed with Lassa
fever, and three died. As a FETP fellow, I collected blood samples, conducted the case
investigation and contact tracing, performed data management and analysis, and
generated the situation report.
In April 2020, as the coronavirus disease 2019 (COVID-19) was spreading across the
world, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases were
diagnosed at my field site. Prepared for response efforts, I supported disease surveillance
by collecting nasopharyngeal samples for data collection, performing data management
and analysis, developing appropriate surveillance reporting and risk communication
strategies, and training health workers (Photos 1-2). From my earlier field experiences with
Lassa fever, I felt more confident and prepared to manage the epidemiology team.
Junior Doctors Network Newsletter
Issue 21
April 2021
JUNIOR DOCTORS’ ACTIVITIES Page 47
Photo 1. NFELTP resident Dr Suleiman Idris
prepares to collect nasopharyngeal samples from
suspected COVID-19 cases in Katsina State,
Nigeria. Credit: Dr Suleiman Idris.
Photo 2. NFELTP residents Dr Bello Suleiman
Abdullahi (left) and Dr Ahmad Suleiman Idris
(right) trace contacts of COVID-19 cases in
Katsina State, Nigeria. Credit: Dr Suleiman Idris.
In summary, learning is ongoing, and epidemiology skills are important to clinical and public
health practitioners. Through the integrated coursework with fieldwork applications, learning
is accelerated, and mentors provide essential guidance and support. Through my
fellowship, I have sent two manuscripts to peer-reviewed journals for publication, three
more manuscripts are in preparation, and three research proposals are pending ethical
approval.
The FETP fellowship program – which enhances the training of health professionals in field
epidemiology – should be expanded, supported, and sustained in all countries. For now, I
am exactly where I want to be, and I look forward to completing my fellowship as an official
field epidemiologist in late 2021.
References
1) Training Programs in Epidemiology and Public Health Interventions Network. Training programs. 2021
[cited 2021 Feb 14].
2) Nigeria Centre for Disease Control. Nigeria Field Epidemiology and Laboratory Training Program. 2021
[cited 2021 Feb 14].
Junior Doctors Network Newsletter
Issue 21
April 2021
JUNIOR DOCTORS’ ACTIVITIES Page 48
The COVID-19 pandemic has illuminated the importance of
the FETP program across the world, highlighting the need
for skilled epidemiologists.
In 2019, as the Union Government of India aimed to reform medical education, the
pandemic offered the perfect opportunity to impose several ill-conceived, undemocratic,
and regressive laws on the battered medical fraternity. Despite outright condemnation and
outcry from the Indian Medical Association (IMA), the Indian Dental Association as well as
several specialty organizations, the Government of India stood resolute in its decision.
Notably, two laws were swiftly enforced the National Medical Commission Act of 2019 and
the Indian Medicine Central Council (Post-graduate Ayurveda Education) Amendment
Regulations of 2020.
Autonomous Regulator or Government Guard Dog?
The first challenge was observed on August 8, 2019, with a significant policy change. The
National Medical Commission Act of 2019 called for the National Medical Commission
(NMC) to replace the existing autonomous regulatory body, the Medical Council of India
(MCI). Since the MCI had been involved in numerous past scandals, including several
corruption allegations, many leaders rejoiced at this national action. Unfortunately, this
move came with a notable departure from the democratic norms of electing medical
professionals to lead the MCI, which key positions were replaced with nominated senior
government administrative officials (1,2).
A Bridge Course for All
Historically, the delivery of primary care services has been limited in rural India, due to poor
accessibility, health workforce shortages, limited community participation, and lack of
national oversight. To address this challenge, the National Medical Commission Act of
2019 authorized the NMC to expand medical prescribing practices in primary healthcare
settings to certain mid-level practitioners called Community Health Providers (CHP) (1).
This approach – which extended Modern medicine prescription practices to allied Modern
and traditional health practitioners – offered them an opportunity to pursue basic clinical
training and obtain this national registration. This model is similar to that observed in the
United States, where nurse practitioners undergo rigorous clinical training to be eligible for
prescribing medicines.
Junior Doctors Network Newsletter
Issue 21
April 2021
Betrayed and Undermined during a Pandemic:
The Plight of Young Physicians and Surgeons in India
JUNIOR DOCTORS’ ACTIVITIES
Manu Pradeep, M.B.B.S.
Junior Medical Officer
Indian Council of Medical Research − National Institute for Research
in Tuberculosis BCG Vaccine Trial
Department of Community Medicine, Amrita School of Medicine
Kochi, India
Page 49
Alas, the curriculum for CHPs has a limited scope that hindered comprehensive
preparation for Traditional medicine practitioners (3). Hence, the National Medical
Commission Act of 2019 explicitly overlooked the sustainable solution of employing skilled
primary care physicians with respectable salaries, supporting medical staff, and providing
appropriate infrastructure. As a result, public and private rural hospitals could employ
traditional medicine practitioners and benefit from substantial budget savings. Notably,
traditional medicine practitioners are exploited as low-cost labour with salaries as low as
one-fifth of those of Modern medicine, who ironically remained unemployed despite
possessing required expertise (2).
Woes of Medical Training
Through the National Medical Commission Act of 2019, the regulatory oversight of the
private medical education sector was relinquished on key accreditation standards, including
infrastructural (mandatory digitised classrooms) and teaching faculty standards (part-time
visiting faculty) for new medical universities (4). As a result, private institutions will be able
to conduct undergraduate courses on virtual platforms and use more part-time faculty,
while requiring high tuition fees. Notably, the NMC proposed the national adoption of the
National Exit Test (NEXT) for postgraduate entrance examination, in lieu of distinct final
graduation examinations by individual universities.
Stressors among Post-graduate Medical Trainees
By omitting the mandate to stipulate post-graduate course fees on 50% of unreserved
seats, private medical universities will be unregulated, and they can increase fees for post-
graduate candidates as they prepare for NEXT. NEXT is poised to replace the National
Eligibility cum Entrance Test (PG) (NEET-PG) in 2022 (1). Moving forward, post-graduate
course fees are speculated to rise by 5-to-10-fold on the prevailing structure, as the
National Medical Commission Act of 2019 did not have stringent mandates to regulate
these practices by private medical universities (2). With 83,175 medical graduates
graduating each year, more low- and middle-income junior doctors will be forced to assume
enormous student debt, which will cripple their finances for decades.
Junior Doctors Network Newsletter
Issue 21
April 2021
JUNIOR DOCTORS’ ACTIVITIES Page 50
This approach utilized a one-year bridge course to grant the
legitimacy of Modern medicine to all Traditional medicine
practitioners albeit no stringent oversight.
Together with economic debt, junior doctors will continue to
endure significant stressors throughout their post-graduate
training programs, characterized by intense work demands,
challenges in work-life balance, and risk of burnout.
Future of Surgery under Assault
The Indian Medicine Central Council Amendment Ordinance of 2020 authorised Ayurvedic
medicine practitioners (Bachelor of Ayurvedic Medicine and Surgery, B.A.M.S.), who
represent most traditional medicine practitioners, to pursue a two-year post-graduate
training in 58 common surgeries, including laparotomies and cataract surgeries. This
specialty training results in the Master of Surgery (Ayurveda) Shalya Tantra (General
Surgery) or the Master of Surgery (Ayurveda) Shalakya Tantra (Diseases of Eye, Ear,
Nose, Throat, Head, and Oro-dentistry) (5). This training, however, includes the advanced
principles of surgical techniques, surgical disinfection, and anaesthetic practices, adapted
from Modern medicine, which was only offered to B.A.M.S. practitioners in a very limited
scope. Hence, as they are expected to be trained by their Modern surgical colleagues, this
scenario has created a false equivalency between Modern and Ayurvedic medicine.
Notably, the IMA has vehemently opposed this “mixopathy” and continues to protest
peacefully with hunger fasts, for the future of modern medicine in India (6).
Junior Doctors’ Voices of Dissent
The IMA Junior Doctors Network (JDN) National Council has actively organised protests
and public awareness campaigns, such as “Janta Ki Awaaz” (Voice of the People), where
Indian junior doctors facilitated a productive dialogue with the general population about the
pitfalls of this law. They continue to advocate for the formal repeal of these two laws and
engage with the Union Government of India to reform the health sector with the medical
fraternity seen as a productive partner and stakeholder (Photos 1-2).
.
Junior Doctors Network Newsletter
Issue 21
April 2021
JUNIOR DOCTORS’ ACTIVITIES Page 51
Photo 1. At the “Janta Ki Awaaz” campaign, the
symbolic black arm band represents solidarity with
the IMA-JDN (Delhi, India). Credit: Dr Shiv Joshi.
Photo 2. Hunger Fast Protest by IMA and Indian
Dental Association leaders (Kerala, India) in
February 2021. Credit: Dr Manu Pradeep.
The health of 1.36 billion Indians and the fate of nearly 926,000
doctors hang in the balance, as India bravely fights the relentless
pandemic with our junior doctors managing the frontlines.
References
1) Ministry of Law and Justice (Government of India). National Medical Commission Act 2019. 2019 [cited
2021 Feb 11].
2) Indian Medical Association. Point by point rebuttal to public stance of GoI. 2019 [cited 2021 Mar 23].
3) National Institute of Public Health Training and Research, Ministry of Health and Family Welfare
(Government of India). Post graduate diploma in community health care (PGDCHC). 2021 [cited 2021
Feb 11].
4) National Medical Commission (Government of India). Minimum requirements for annual M.B.B.S
admissions regulation. 2020 [cited 2021 Feb 23].
5) Central Council of Indian Medicine (Government of India). Indian Medicine Central Council (Post-graduate
Ayurveda Education) Amendment Regulations. 2020 [cited 2021 Feb 11].
6) Indian Medical Association. No to mixopathy (relay hunger strike against mixopathy). 2021 [cited 2021
Feb 11].
Junior Doctors Network Newsletter
Issue 21
April 2021
JUNIOR DOCTORS’ ACTIVITIES Page 52
The medical field fosters collaborations between diverse groups of health practitioners
working in clinical practice, community health promotion, and research. One key example is
the role of the Junior Doctors’ Network (JDN) in promoting these academic collaborations.
The JDN aims to empower young doctors to work together towards a healthier world
through advocacy, education, and international collaboration. JDN members participate in
working groups focused on specific topics, such as medical ethics, antimicrobial resistance,
primary health care, and climate change and health. Team members gain skills by
preparing project tasks, such as writing statements, organizing webinars, producing health
promotional videos, and writing articles for peer-reviewed journals.
The expansion of these professional networks was exemplified by my experience as a
member and co-lead of the JDN Medical Ethics Working Group. These collaborations can
be fruitful as junior doctors connect with colleagues from different countries and combine
their expertise to established projects, including the development of scientific manuscripts.
Example: JDN Medical Ethics Working Group
As a member of the JDN Medical Ethics Working Group since 2020, I participated in the
ethics paper writing project, where members prepared articles on topics related to medical
ethics and the coronavirus disease 2019 (COVID-19) pandemic. As Dr Shiv Josh (India)
and I served as co-leads of the ethics paper writing project, our direct interactions allowed
us to learn more about our professional interests and hence foster potential collaborations.
Junior Doctors Network Newsletter
Issue 21
April 2021
JDN Working Groups: A Platform for International Networking
and Career Advancement
JUNIOR DOCTORS’ ACTIVITIES
Dabota Yvonne Buowari, MD
Department of Accident and Emergency
University of Port Harcourt Teaching Hospital
Port Harcourt, Rivers State, Nigeria
Page 53
As these JDN working groups facilitate ongoing partnerships,
relationships, and networking, junior doctors may expand their
professional networks beyond the JDN.
Months later, Dr Joshi and his team at the College Union of the Calicut Medical College
(Kerala, India) were organizing the MEDMEET International UG Medical Conference,
scheduled for August 2020. He invited me to participate on the international panel, World
Amidst Pandemic: Will the Human Race Fight It Down, which highlighted the global
response efforts during the COVID-19 pandemic. This international panel included seven
speakers representing Columbia, India, Nigeria, Taiwan, United Kingdom, and the United
States (Figure 1).
In summary, the diverse connections and professional networking from participation in
various JDN working groups can lead to achieving additional career goals and
advancement. For example, my JDN connection afforded me the opportunity to serve as a
panelist on an international webinar for the first time. Furthermore, since medicine is a
dynamic field with frequent scientific discoveries, such networking opportunities can result
in valuable knowledge sharing and continued professional development. This personal
experience demonstrates that JDN collaborations have the potential to extend beyond
finalizing one single project of a working group and offer professional networks for a
lifetime.
Junior Doctors Network Newsletter
Issue 21
April 2021
JUNIOR DOCTORS’ ACTIVITIES Page 54
During the conference, each panelist responded to
questions about the ongoing COVID-19 pandemic,
such as national health actions by health systems,
implemented measures to reduce disease
transmission, research advancement for a vaccine,
and recommended coping strategies for society.
During my panel presentation, I shared my
experiences as an emergency physician in Nigeria
during this challenging COVID-19 pandemic. I also
described the epidemiological trends in Nigeria,
including the economic impact on the health system
and mental health implications due to the restricted
movements during lockdowns and curfews.
Figure 1. Promotional flyer for the
MEDMEET International UG Medical
Conference 2020. Credit: MEDMEET.
The perception of ideal healthcare differs among doctors, just as doctors appear
homogeneous on the outside but heterogeneous on the inside. For the past 30 years, since
the term public health first appeared in government documents (1), how to revolutionize
and improve public health has always been disputable, partly due to the vague definition of
publicness and its complex nature with multiple stakeholders. Meanwhile, various attempts
have been made through policy-making to ensure a healthier society. However, despite its
significance, junior doctors in the Republic of Korea have felt powerless and unheard in the
health policy issues, including policy-making activities.
Notably, pivotal moments for junior doctors arrived in 2020. In the Republic of Korea, an
unprecedented era of the pandemic was not the only highlight of the year. The government
tried to increase the admission quotas at the medical colleges and develop a new medical
school focused on public health. However, since these policies were made without
consultations with doctors or medical societies, authorities faced stiff resistance (2). As a
result, doctors – including junior doctors – staged a walkout to protest these policies, noting
that these measures would have negative effects on the national healthcare system.
As junior doctors, we reflected on these health policy topics: Have we ever had the chance
to freely and openly discuss these issues? Why have we not had an opportunity to discuss
these issues on a local or national level? Realizing that the answers were no and rarely, the
solution was clear: junior doctors need more academic opportunities to share knowledge
and debate these essential health policy issues.
Junior Doctors Network Newsletter
Issue 21
April 2021
Kick-off of the Public Health Interest Group:
Significance and Future Steps
JUNIOR DOCTORS’ ACTIVITIES
Hangyeol Lee, MD
Department of Family Medicine
Seoul National University Hospital
Seoul, Republic of Korea
Sejin Choi, MD MSc
Seoul Detention Center, Ministry of Justice
Seoul, Republic of Korea
Page 55
These events aroused attention among junior doctors on healthcare
systems and health policy, especially on the potential impact on
infectious disease management and population health.
Forming a Public Health Interest Group
To tackle this topic, several young doctors formed a Public Health Interest Group to
promote shared knowledge and jumpstart the national dialogue on public health issues.
Junior doctors with different backgrounds, working across diverse healthcare facilities,
joined this project. These team members included one emergency medicine resident, two
interns at university hospitals who will become family medicine and public health residents
in March 2020, one public health doctor (under military service) working at a correctional
facility, two doctors working at the Korea Disease Control and Prevention Agency, and one
board-certified radiologist.
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Photo 2. Screenshot of the
Public Health Interest Group
meeting. Credit: Dr Sejin Choi.
Photo 1. Publicness in Health and
Health Care. Credit: Dr Hangyeol Lee.
As a group, we decided to read Publicness in Health and
Health Care by Prof Chang-yup Kim of Seoul National
University Graduate School of Public Health (Photo 1).
This book contains six sections. The first section
introduces the background of publicness, a concept that
can be defined as ownership or formal legal status or
degree of attachment to public values (3). The second
section covers theories and terms related to publicness,
including public sphere, public value, public dominance,
and publicness of civil society. The third section describes
how to apply these theories or concepts to the health
system. These sections include theories of historic figures
(Jürgen Habermas, Michel Foucault, Amartya Sen). The
fourth and fifth sections include discussion about the public
health system of the Republic of Korea and other
countries. The sixth section incorporates the future of
publicness and public health.
Starting in September 2020, virtual meetings were held
monthly to discuss book chapters (Photo 2). Since team
members had different working environments, their
interpretations of concepts offered insight and a more
comprehensive view on theories, reality, and potential
solutions. For example, when discussing the best
approaches to recruit doctors to public health, the dialogue
included emphasizing economic incentives and supporting
policies.
Notably, Prof Kim described the concept of health regime, which adds to the definition of
Diane Sainsbury of regime is “a complex of rules and norms that create established
expectations”. However, Prof Kim defines health regime to emphasize that public health
should be approached through conventional components (e.g. facility, human resources,
finance, governance) as well through political, economic, and sociocultural conditions. In
this manner, doctors can conceptualize public health as a totality and multi-layer, multi-axial
phenomenon. Hence, by adopting the concept of health regime, we learned that public
health should be reinforced by reforming all related aspects of health systems.
Forward Steps
In the forward of the book, Prof Kim wrote: “The process of producing and accumulating
knowledge is social and collective… If the knowledge is not produced, circulated, practiced,
and accumulated socially, writings based on that knowledge are not easy to comprehend.
As this difficulty can only be overcome through cooperation and solidarity as social
engagement, I encourage readers to join this cause.”
This Public Health Interest Group focuses on promoting shared knowledge and discussion
on essential public health issues among doctors. However, as Prof Kim stated, more
doctors and healthcare workers should join the citizenry movement to gradually change the
world. Following this sentiment, this team hopes to encourage health professionals to form
groups that focus on important issues for community health. This momentum can lead to
collective activities with community members, politicians, and government officials. Public
engagement is needed more than ever: this is a call for action to our colleagues in the
Republic of Korea and the world.
References
1) Kim C-Y. Further conceptualizing of ‘publicness’ in health and health care in South Korea. Public Health
Affairs. 2017;1:65-77. Korean
2) Cha S. South Korean doctors strike over plan to boost medical student numbers. Reuters. 2020 [cited
2021 Feb 23].
3) Min HS, Park Y, Kim C-Y. Recognition of the concept of publicness in healthcare: a content analysis of
Korean newspapers. J Korean Med Sci. 2017;32:393-400.
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April 2021
JUNIOR DOCTORS’ ACTIVITIES Page 57
Although the book content is challenging to analyze and
understand, due to unfamiliar concepts from medical training,
the Public Health Interest Group offers an opportunity to
engage with other doctors on valuable academic exercises.
Since digital health is a process that is currently shaping the future, it must be continuously
evaluated, especially as technology continues to advance at such a quick pace. It must
ensure adequate security protocols are followed and monitored to increase patients’ safety.
As a virtual process, patients should have the same amount of confidentiality, respect, and
treatment, when compared to a face-to-face setting.
Initiation of a New World Medical Association (WMA) Working Group
In November 2020, Dr Joe Heyman (Chair, WMA Associate Members), distributed the
WMA call for the development of a Working Group to review the WMA Statement on
Guiding Principles for the Use of Telehealth for the Provision of Health Care to the Junior
Doctors Network (JDN) membership (1). This email represented a fantastic opportunity for
interested junior doctors to embark on this digital health journey.
In December 2020, the eHealth Task Force became the newest Working Group, under the
leadership of Dr Prof Kun Zheng, Chair of the Chinese Medical Association. Other
members included WMA Associate Members from the Israeli, Malaysian, Uruguayan, and
Finnish Medical Associations, Dr Ankush Bansal (WMA Associate Members lead), and
myself.
Junior Doctors Network Newsletter
Issue 21
April 2021
The First Junior Doctors Network’s eHealth Working Group
JUNIOR DOCTORS’ ACTIVITIES
Lisa María González López, MD
General Physician
Primary Health Center 30 de Mayo
Santo Domingo, Dominican Republic
Ankush Bansal, MD FACP FACPM SFHM
Voluntary Clinical Assistant Professor of Medicine
Florida International University
Miami, Florida, USA
Page 58
Digital health is a broad term that refers to the use of
information and communication technologies in medicine
and other health care related professions to manage
illnesses and health risks and promote wellness (1).
Agenda for WMA Discussion
At the conclusion of the WMA meeting, the unanimous decision was to merge these three
policies. Ms Malke Borow (Director, Division of Law and Policy, Israeli Medical Association)
and I volunteered to prepare the first draft before sending it to the eHealth Task Force
colleagues. Coincidentally, since the Medical Technology Working Group, under the Israeli
Medical Association’s leadership, had similar objectives as the eHealth Task Force, the
WMA Associate Members section decided to merge both entities into the eHealth and
Medical Technology Task Force.
Memorable Course of Discussion
Over the past three months, the eHealth and Medical Technology Task Force has
continued to revise the WMA Statement. They considered the comments provided by other
Medical Associations in the original document. Task Force team members, who represent
diverse countries like Australia, India, Kuwait, Palestine, and Romania, have contributed
their expertise from medicine, public health, and digital health and demonstrated
enthusiasm for continued learning on these topics.
The team coordinated Zoom meetings to brainstorm on these tasks, which allowed them to
share diverse perspectives, appreciate critical analyses, and ultimately build professional
relationships. Currently, Ms Borow and I are working on a second draft so that the eHealth
and Medical Technology Task Force team members can collectively review the content
prior to submission to the WMA.
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Table 1. Categories and definitions of digital health (2-4).
The eHealth Task Force reviewed the
document prepared by the WMA’s Socio-
Medical Affairs Committee (SMAC). This
document compiled the comments to the
WMA Statement of 15 National Medical
Associations and Associate Members,
including China, France, Germany, New
Zealand, and the United States. The
eHealth Task Force led the discussion to
consider the merging of three policies
(telehealth, mobile health, and
telemedicine) into one or developing
three different policies (Table 1).
Values and Future of eHealth and Medical Technology Task Force
In the eHealth and Medical Technology Task Force, team members evaluated the
efficiency, potential improvements, probable issues encountered in ethical matters, and
actions that could enhance electronic and digital health quality. Since members supported
effective and high-quality communication between patients and their healthcare providers,
they have attempted to be as concise and straightforward as possible in the WMA
Statement. They provided a clear definition of digital health technology and clarified other
terms – telehealth, mobile health, and telemedicine – that are often poorly understood by
the scientific and general community.
Since patient-centered healthcare is a key component of digital health, healthcare providers
should share the potential risks and implications with patients regarding privacy concerns,
such as technological failures, unauthorized access, patient data and confidentiality
breaches, and possible secondary use of data. This Task Force aims to ensure that
patients feel protected and taken care of during their routine healthcare visits as well as
during crises (e.g. pandemic, wars, natural disasters) that can infringe on their well-being.
To better understand the challenges facing patient security protocols, the Task Force looks
forward to developing new projects that focus on patient data security and records policies.
References
1) Ronquillo Y, Meyers A, Korvek SJ. Digital health. StatPearls. 2020 [cited 2021 Mar 16].
2) World Health Association. Telehealth. 2020 [cited 2021 Mar 14].
3) World Medical Association. WMA Statement on Mobile Health. 2017 [cited 2021 Mar 14].
4) World Medical Association. WMA Statement on the Ethics of Telemedicine. 2020 [cited 2021 Mar 14].
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As the Task Force continues to revise the WMA Statement,
team members seek to strengthen security protocols while
discussing medical ethics involved in privacy laws.
Global surgery is an emerging field in global health, which aims to enhance access to
timely, affordable, and safe surgery for all citizens. Although global surgery has not yet
been formally included as an advocacy domain in previous advocacy efforts of the World
Medical Association (WMA), working group members believed that it was time that the
Junior Doctors Network (JDN) and WMA highlight the importance of surgery and
anesthesia care as a part of universal health coverage and health systems strengthening
efforts around the world.
After founding the Global Surgery Working Group, JDN members collectively discussed the
need to raise awareness of the importance of surgery and anesthesia care through the
development of a WMA resolution on Access to Surgery and Anesthesia Care. This
proposed activity was described at the monthly JDN teleconference meetings and received
support by the JDN Management Team to proceed with the next steps of the plan. This
article describes the four steps − searching the literature, writing the draft resolution,
seeking informal feedback, and requesting formal feedback − completed by the JDN Global
Surgery Working Group members to develop the WMA resolution on Access to Surgery
and Anesthesia Care.
Junior Doctors Network Newsletter
Issue 21
April 2021
Introducing Policy at the World Medical Association:
The Global Surgery Experience
Manon Pigeolet, MD MSc
Harvard T.H. Chan School of Public Health
Boston, Massachusetts, USA
Global surgery is an emerging field in global health, which aims
to enhance access to timely, affordable, and safe surgery for all
citizens.
To address these efforts, JDN members formed the Global
Surgery Working Group in February 2019.
INTERNATIONAL CONFERENCES Page 61
Searching the Literature
JDN members conducted a literature review to become familiarized with the emerging
topics of Global Surgery, such as current knowledge, attitudes, and practices surrounding
the delivery and accessibility of global surgery and anesthesia care. Then, they reviewed
policy briefs on the topics of access to surgery and anesthesia care by other international
organizations, such as the report from The Lancet Commission on Global Surgery and the
World Health Assembly Resolution 68.15 on Strengthening Emergency and Essential
Surgical Care and Anaesthesia as a Component of Universal Health Coverage. Finally,
JDN members conducted an in-depth search within existing WMA resolutions, policies, and
declarations in order to identify existing content on surgery or anesthesia care.
Writing the Draft Resolution
By understanding the current views on access to surgery and anesthesia care in the global
health arena, we proceeded to prepare the resolution. As a team, we identified common
goals and ideas as well as accountable individuals and organizations for the
implementation. We prepared and circulated the draft resolution within the working group to
obtain feedback by members and confirm that the content truly reflected the vision for
global surgery and anesthesia care. Once we reached group consensus, we integrated the
final revisions and prepared the document in the official format of a resolution.
Seeking Informal Feedback
As we wanted to seek informal feedback from WMA leadership on our draft resolution, Dr
Chukwuma Oraegbunam (JDN Chair, 2018−2019) discussed the elements of the resolution
with Dr Otmar Kloiber (WMA Secretary General). As such, WMA leadership agreed with
the draft resolution and next steps to formally propose the resolution to the WMA audience.
WMA leadership offered two options: 1) introduce the resolution through the WMA
Associate Members group which would be sent to the WMA General Assembly; or 2)
collaborate with a National Member Association (NMA) that can introduce the policy to the
WMA Council or the WMA General Assembly (GA). Since we did not have contacts with an
NMA who would potentially be interested in supporting this policy, we decided to introduce
the policy through the WMA Associate Members’ meeting.
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April 2021
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Requesting Formal Feedback
At the WMA Associate Members’ meeting, which preceded the WMA GA (October 2019) in
the Republic of Georgia, members voted to support the policy and its formal presentation at
the GA. Subsequently, the document was forwarded to the WMA General Assembly, where
it was reviewed by the NMAs who chose to have it re-circulated for further comments. The
document was eventually sent back and forth several times between the NMAs and the
WMA General Assembly and Council for feedback, voting, and re-circulation. The final
version was completed with support from Dr Lwando Maki (JDN Medical Ethics Officer,
2018−2021) and Dr Yassen Tcholakov (JDN Chair, 2020-2021), who both helped
incorporate the recommended edits provided by NMAs. The final version was submitted to
the WMA in January 2021. This revised document still contained the central ideas and
beliefs described in the initial version. Finally, the WMA Council proposed the policy for
adoption at the virtual WMA Council Meeting (April 2021), where NMAs voted on its
adoption.
However, now that we have finally reached the end of the tunnel and can celebrate another
JDN-driven WMA resolution, this process does not feel intimidating anymore. On behalf of
the JDN Global Surgery Working Group, we hope that this narrative offers insight into the
internal proceedings of the WMA and can serve as a framework for JDN-driven policies and
future collaborations.
Junior Doctors Network Newsletter
Issue 21
April 2021
INTERNATIONAL CONFERENCES
In early 2019, this entire process resembled the adventures
of Alice in Wonderland and seemed to be a lengthy and
laborious process.
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