JDN_18NL_April2020

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 18
April 2020
ISSN (print) 2415-1122
ISSN (online) 2312-220X
Junior Doctors Leadership 2019−2020
Junior Doctors Network Newsletter
Issue 18
April 2020
Dr Audrey Fontaine
France
Dr Yassen Tcholakov
Canada
Dr Julie Bacqué
France
Dr Christian Kraef
Germany
Dr Uchechukwu
Arum
Nigeria
Dr Lwando Maki
South Africa
Dr Helena Chapman
Dominican Republic
Dr Lyndah Kemunto
Kenya
Dr Maki Okamoto
Japan
Dr Chukwuma
Oraegbunam
Nigeria
CHAIR
DEPUTY
CHAIR
SECRETARY
SOCIO-MEDICAL
AFFAIRS
OFFICER
EDUCATION
DIRECTOR
MEDICAL
ETHICS
OFFICER
MEMBERSHIP
DIRECTOR
PUBLICATIONS
DIRECTOR
COMMUNICATIONS
DIRECTOR
IMMEDIATE
PAST
CHAIR
Page 2
Dr Mariam Parwaiz
New Zealand
Dr Nneka Okafor
Nigeria
Dr Vandrome Nakundi
Kakonga
Democratic Republic
of Congo
Dr Ricardo Correa
United States
Dr Victor Animasahun
Nigeria
Junior Doctors Network Newsletter
Issue 18
April 2020
Editorial Team 2019−2020
Page 3
Table of Contents
TEAM OF OFFICIALS’ CONTRIBUTIONS
06 Words from the Chair
By Dr Audrey FONTAINE (France)
07 Words from the Communications Chair
By Dr Maki OKAMOTO (Japan)
08 Words from the Publications Director
By Dr Helena CHAPMAN (Dominican Republic)
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS
09 Public Health Doctors in the Republic of Korea Lead COVID-19 Response Efforts
By Dr Sejin CHOI (Republic of Korea), Dr Hangyeol LEE (Republic of Korea), Dr Taeyoung
KIM (Republic of Korea), Dr Kyeongdo JEONG (Republic of Korea), and Dr Junghyun CHO
(Republic of Korea)
13 Greek Junior Doctors: Perspectives of Pursuing a Career in Medicine and the
Brain Drain Phenomenon
By Dr Konstantinos RODITIS (Greece), Dr Konstantinos LOUIS (Greece), and Dr
Evangelia SAMARA (Greece)
17 Current Challenges of Diabetes in Low-income Countries: Focus on Sub-Saharan
Africa
By Dr Vandrome NAKUNDI KAKONGA (Democratic Republic of the Congo)
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES
20 Role of Junior Doctors’ Groups in Trainee-led Research Collaborations
By Dr Oladimeji ADEBAYO (Nigeria)
23 Does Medical Internship Training in Korea Serve its Purpose?
By Dr Yujin SONG (Republic of Korea) and Dr Jihoo LEE (Republic of Korea)
28 An Overview of the Mental Health Burden in Malaysia
By Dr Shaeraine RAAJ (Ireland), Dr Myelone THARMASELAN (Malaysia), and Dr Sujesha
NAVANATHAN (Ireland)
Junior Doctors Network Newsletter
Issue 18
April 2020
Page 4
Table of Contents
JUNIOR DOCTORS’ ACTIVITIES
31 COVID-19 Pandemic in the Republic of Korea: Role of Junior Doctors
By Dr Jaehyeon JANG (Republic of Korea) and Dr Sei NA (Republic of Korea)
35 Providing Mentorship to Encourage Scientific Publications: Academic Workshop
in the Dominican Republic
By Dr Helena CHAPMAN (Dominican Republic)
39 International Universal Health Care Day: Interviews with Japan’s Key Leaders
By Dr Kazuhiro ABE (Japan)
INTERNATIONAL CONFERENCES
43 World Health Organization: 146th Session of the Executive Board
By Dr Paula REGES (Brazil) and Dr Audrey FONTAINE (France)
47 Prince Mahidol Award Conference 2020: Universal Health Care Forum 2020
By Dr Lyndah KEMUNTO (Kenya), Dr Audrey FONTAINE (France), Dr Christian KRAEF
(Germany), and Dr Jihoo LEE (Republic of Korea)
WORKING GROUPS
51 Climate Change Working Group Update
By Dr Yassen TCHOLAKOV (Canada)
Junior Doctors Network Newsletter
Issue 18
April 2020
Page 5
I am enthusiastic to share this April 2020 issue of the Junior Doctors Network (JDN)
Newsletter with junior doctors across the world! This high-quality resource provides
opportunities for junior doctors to share their global health activities and leadership in their
countries and region.
Under the World Medical Association (WMA)’s continuous support and tutelage, we have
become a strong voice for junior doctors around the world. The JDN serves as a platform
where junior doctors can share their professional experiences, discuss perspectives and
practices, and develop more in-depth understanding of global health issues.
Over the last decade, our network has expanded, offering leadership activities within
diverse JDN working group activities and at national and international conferences and
meetings. JDN members have shared their expertise in WMA activities, where they work
within the Associate Member groups, comment on WMA policies, and collaborate with the
WMA Secretariat on emerging health topics. They also ensure external representation at
conferences (e.g. Prince Mahidol Award Conference) and meetings (e.g. World Health
Organization Executive Board) as well as connect with other health professional groups.
Now more than ever, the JDN serves as a crucial asset for COVID-19 response efforts.
JDN members continue to communicate via email and virtual platforms like Slack,
WhatsApp, and GoToMeeting, in order to express support and share information of clinical
practices. As junior doctors, we must be protect our physical and mental health as we
manage excessive workloads and potential knowledge gaps in workplace responsibilities.
Therefore, I would like to thank you for your strong commitment and encourage you to
prioritize your health and well-being.
Looking forward to hearing from you on these virtual platforms! We look forward to seeing
you in Spain in October!
Enjoy your reading,
Audrey
Junior Doctors Network Newsletter
Issue 18
April 2020
Words from the Chair
TEAM OF OFFICIALS’ CONTRIBUTIONS
Audrey Fontaine, MD
Chair (2019−2020)
Junior Doctors Network
World Medical Association
Dear colleagues from around the world,
Page 6
It is my pleasure to welcome you to the 18th issue of the Junior Doctors Network (JDN)
Newsletter.
Supported by the World Medical Association (WMA), the JDN provides an international
platform, where JDN members share their passion and enthusiasm to enhance medical
practices and support global health initiatives. In October 2020, the JDN will be celebrating
the 10th year anniversary, where the JDN has expanded membership and broadened the
scope of activities and working groups. JDN members have shared their leadership through
the delivery of policy statements at WMA and World Health Assembly (WHA) meetings,
coordination of monthly JDN meetings, and preparation of biannual JDN Newsletters.
These activities offer insight into junior doctors’ scientific perspectives, allow exchanges of
encountered challenges in the clinical or community setting, and foster ongoing
collaborations.
Thanks to our wonderful JDN Publications Team, led by Dr Helena Chapman, for preparing
this outstanding 18th issue of the JDN Newsletter. We hope that these high-quality articles
by JDN members will stimulate your inspiration and provoke discussions among your
colleagues.
We look forward to your active participation in our JDN activities!
Sincerely,
Maki
Junior Doctors Network Newsletter
Issue 18
April 2020
Words from the Communications Director
Maki Okamoto, MD
Communications Director (2019−2020)
Junior Doctors Network
World Medical Association
Dear colleagues,
TEAM OF OFFICIALS’ CONTRIBUTIONS Page 7
Figure 1. List of JDN social media resources.
To learn more information about JDN
activities and updates, please visit
the new JDN social media accounts
(Figure 1).
Junior Doctors Network Newsletter
Issue 18
April 2020
Words from the Publications Director
Dear JDN colleagues,
On behalf of the Publications Team (2019-2020) of the Junior Doctors Network (JDN), we
are honored to present and share the 18th issue of the JDN Newsletter to junior doctors
across the world.
As we have entered the new 2020 decade, we aim to leverage our JDN momentum to go
beyond our previous accomplishments. Over the past four months, we have published the
17th issue of the JDN Newsletter, marking the first collaboration with the Medical Ethics
Working Group. This JDN Newsletter Special Edition issue, published in March 2020,
provided perspectives on diverse medical ethics topics from junior doctors from Dominican
Republic, France, India, Korea, Mexico, and South Africa.
Now, we share the 18th issue of the JDN Newsletter, which includes articles from junior
doctors from Brazil, Canada, Dominican Republic, France, Germany, Greece, Ireland,
Japan, Malaysia, Nigeria, and Republic of Korea. These reports disseminate updates on
JDN activities, scientific perspectives on global topics, and reflections on community health
experiences.
The JDN Newsletter represents an indispensable international platform for the global
community of junior doctors. Junior doctors can prepare articles that highlight their global
health activities, inspire other junior doctors across the world, and strengthen
communication between World Medical Association (WMA) and JDN members. This open
dialogue can foster collaborations among junior doctors, which can lead to improved
approaches to understand risks that directly influence health and well-being of all
community members.
We wish to recognize the enthusiasm and dedicated efforts of all editors of the JDN
Publications Team 2019-2020 as we finalized this 18th issue. We appreciate the continued
support of the JDN Management Team and WMA leadership for the dissemination of this
important junior doctors’ resource. We hope that you enjoy learning from junior doctors’
experiences in this 18th issue!
Together in health,
Helena
Helena Chapman, MD MPH PhD
Publications Director (2019−2020)
Junior Doctors Network
World Medical Association
TEAM OF OFFICIALS’ CONTRIBUTIONS Page 8
In the Republic of Korea, four cases of the coronavirus disease 2019 (COVID-19) were
confirmed on January 27, 2020, and additional cases were reported over the following
three weeks. On February 21, 2020, a significant COVID-19 outbreak occurred in the
southeastern metropolitan city of Daegu, causing a surge in confirmed cases. The Ministry
Junior Doctors Network Newsletter
Issue 18
April 2020
Public Health Doctors in the Republic of Korea Lead
COVID-19 Response Efforts
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 9
Sejin Choi, MD
Public Health Doctor
Vice President, Korean Association of
Public Health Doctors
Seoul, Republic of Korea
Hangyeol Lee, MD
Public Health Doctor
Former Director of Public Relations,
Korean Association of Public Health
Doctors
Seoul, Republic of Korea
Taeyoung Kim, MD
Public Health Doctor
Former Director of Education, Korean
Association of Public Health Doctors
Seoul, Republic of Korea
Kyeongdo Jeong, MD
Public Health Doctor
Former Vice President, Korean
Association of Public Health Doctors
Seoul, Republic of Korea
Junghyun Cho, MD
Public Health Doctor
Former President, Korean Association
of Public Health Doctors
Seoul, Republic of Korea
of Health promptly applied strict containment and mitigation strategies across the country,
which were informed by lessons learned during the Middle East Respiratory Syndrome
(MERS) outbreak in 2015. One month after this national action, daily reports of new
confirmed cases fell below 100, and continue to fall below 50 (1). By April 18, 2020, there
were 10,653 confirmed COVID-19 cases and 232 deaths, with an estimated mortality rate
of 2.2% (1).
As the scientific community continues to learn more about viral transmission, global citizens
are interested in regular updates regarding the development of rapid diagnostic methods,
immune response, and call to action for essential workers. Hence, without junior doctors in
the Republic of Korea, especially the network of public health doctors (PHDs), these
national response efforts would have significant limitations.
Role of Public Health Doctors
PHDs are public officials engaging in public health practices of communities and public
institutions, in lieu of the three-year mandatory service required of all Korean male doctors.
Junior Doctors Network Newsletter
Issue 18
April 2020
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 10
These successful rapid response and quarantine efforts of
the COVID-19 outbreak, coordinated by the Republic of
Korea, have received global attention.
Photo 1. An overworked Public Health
Doctor at the quarantine office.
Credit: Dr Seungho Yang.
Of the PHDs, an estimated 60% just completed medical
school, 20% finished their internship year, and 20%
became PHDs immediately after their medical residency.
They are junior doctors – or doctors within 10 years of
their medical graduation – around 20 to 30 years old,
serving as invaluable human resources in the public
sector of the Korean healthcare system.
During the COVID-19 outbreak, PHDs have been working
across all levels of the national quarantine system.
Although the majority of PHDs practice at local healthcare
centers, they concurrently work at screening centers
where patients with suspected COVID-19 infections are
evaluated (Photo 1). Some PHDs work as Epidemic
Intelligence Service (EIS) officers at airports, seaports,
local governments, and the central quarantine
headquarter at the Korea Centers for Disease Control (KCDC). Hence, the national
quarantine system relies on PHDs, considering that 229 (42%) of the 548 screening
centers nationwide have been established in healthcare centers, run by more than 2,000
PHDs, and that nearly all EIS officers in local governments are PHDs (2).
Role of the Korean Association of Public Health Doctors
While the tremendous effort of PHDs should be recognized, the role that the Korean
Association of Public Health Doctors (KAPHD) played as a network of junior doctors may
have implications for other countries. Although not every country has a reserve force of
doctors dedicated to public service like PHDs, every country can support a national
network of junior doctors, which can benefit both doctors and patients.
In efforts to support the COVID-19 response efforts, KAPHD has actively supported PHDs,
nurses, and paramedics in five specific actions. First, with initial widespread confusion
about the coordination of logistics and protocol for infection prevention and control
practices, KAPHD prepared manuals on operational guidelines for screening centers and
epidemiologic investigations and disseminated videos on how to obtain a nasopharyngeal
swab specimen and appropriately use personal protective equipment (PPE). These
KAPHD resources supported PHDs as they strengthened their infection control practices,
maximized speed and efficiency of conducting diagnostic tests, and educated patients on
accurate healthcare information.
Second, KAPHD invested efforts to ensure the health, safety, and well-being of PHDs.
Continuous and close communications were made with government and congressmen of
the National Assembly to confirm that PPEs were provided to PHDs without any shortage
or delay. KAPHD received donations, purchased protective masks, face shields, and
disposable gloves, and distributed these resources to every PHD. These collective actions
resulted in no reported COVID-19 cases among PHDs.
Third, communication channels with leaders and policy makers of the government and
National Assembly were not a novel development in light of the COVID-19 pandemic. Over
the past years, KAPHD had established relationships with the Korean Medical Association
and participating fora with political parties, by presenting evidence-based reports and
findings on emerging healthcare issues to regional governments. These efforts stemmed
from the lessons learned during the previous outbreaks of severe acute respiratory
syndrome (SARS) in 2002, swine flu in 2009, and MERS in 2015, when PHDs were not
supported and respected in their clinical roles on the frontline.
Junior Doctors Network Newsletter
Issue 18
April 2020
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 11
Fourth, KAPHD organized and facilitated communication among PHDs through the
organizational website as well as mobile group chats. These communication channels have
been crucial to effectively and quickly solve problems and meet the needs of PHDs as they
work across different clinical capacities and locations related to the COVID-19 response
efforts.
Fifth, KAPHD has disseminated educational resources to enhance public awareness about
COVID-19 as an important mitigation strategy. KAPHD created YouTube videos and
posters, encouraging community members to use protective masks, practice social
distancing, and support widespread efforts to curb COVID-19 transmission. They also
collaborated with healthcare start-up companies and influential YouTuber stars to expand
the dissemination of these educational resources.
Importance of Junior Doctors’ Leadership
Since approximately 90% of PHDs form part of the KAPHD, this strong network of junior
doctors in the Republic of Korea has demonstrated significant leadership efforts to reduce
COVID-19 transmission across the country. Although the COVID-19 pandemic has not
ended yet, now is the time to strengthen this network of junior doctors, prepare for the next
pandemic, and build a sustainable healthcare system. As junior doctors, we should have an
active role in community health efforts and ensure that we contribute our perspectives on
major health policy topics to health leaders and other decision-makers.
Through a global coalition, national networks of junior doctors can share administrative,
epidemiologic, and clinical experiences and resources. As recommended by the World
Medical Association, the wider community should be “alert to the threat of emerging
disease outbreaks and ready to respond with a global strategy” (3).
References
1) Central Disaster Management Headquarters; Central Disease Control Headquarters. Coronavirus
disease-19: Republic of Korea. 2020 [cited 2020 Apr 18]. Korean.
2) Central Disaster Management Headquarters; Central Disease Control Headquarters. Status of public
relief hospitals. 2020 [cited 2020 Feb 25]. Korean.
3) World Medical Association. WMA statement on health emergencies communication and coordination.
2017 [cited 2020 Apr 18].
Junior Doctors Network Newsletter
Issue 18
April 2020
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 12
Korean PHDs learned an important lesson from the COVID-
19 response efforts: Junior doctors need to proactively stand
up as national and international leaders and promote prompt
and appropriate interventions that protect community health.
The fundamental choice of an individual to become a doctor consists of a continuous
struggle that combines long hours of studying, furious competition with classmates and
colleagues, exhausting working hours, challenging workplaces, high levels of stress, sleep
deprivation, and frequent poor work-life balance.
In recent years, the rising number of physicians and their unequal distribution over the
various geographic regions and medical specialties, as well as the brain drain phenomenon
during the Greek economic crisis (2009-2019), has become a major concern for health
policy in Greece (1). The process of choosing the right profession, as well as following the
correct career path, has puzzled various scientific fields (e.g. economists, psychologists,
sociologists). This has resulted in the development of numerous theories, such as the
theory of characteristics and factors, chance theory, economic theories, social learning
theories, evolution theories, sociological theories, and the theory of career development, as
referred by Brown et al. (2).
Junior Doctors Network Newsletter
Issue 18
April 2020
Greek Junior Doctors: Perspectives of Pursuing a
Career in Medicine and the Brain Drain Phenomenon
Konstantinos Roditis, MD MSc
Vascular Surgery Resident
“Korgialeneio-Benakeio” Hellenic Red Cross
General Hospital
Athens, Greece
Junior Doctors’ Network-Hellas (JDN-Hellas)
Konstantinos Louis, MD PhD
Consultant, 3rd Department of Obstetrics-
Gynaecology
“Attikon” University Hospital
Medical School, National Kapodistrian University
Athens, Greece
Junior Doctors’ Network-Hellas (JDN-Hellas)
Evangelia Samara, MD
Consultant, Department of Anaesthesiology
“Tzaneio” General Hospital
Piraeus, Greece
Junior Doctors’ Network-Hellas (JDN-Hellas)
Pursuing a medical career in Greece has never been an easy
task for medical students and junior doctors.
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 13
Junior Doctors’ Network-Hellas (JDN-Hellas) has recently presented the mid-term results of
a nationwide study, initiated in 2015, focusing on junior doctors and medical students. A
junior doctor was defined as an individual who graduated from medical school within the
last 15 years.
To date, this study has included a total of 112 respondents, comprising of 46% male and
54% female, who were between 18-44 years old. Of the sample, 49% were resident
hospital doctors, 23% were recently specialized doctors, 8% were medical graduates
awaiting their residency program, 2% were rural service doctors, and 18% were medical
students.
The first objective was to examine the views and perceptions of junior doctors and medical
students regarding their selection of medicine as their career. About one-third (30%) of
respondents were very satisfied with choosing medicine as a career path, almost half
(48%) were satisfied, 6% were neutral, 12% were dissatisfied, 2.7% were very dissatisfied,
and 0.6% were rethinking their career choice. After specialization, the majority (85%) of
respondents said that they would practice medicine as clinicians, 4% would work as
managers, 7% as researchers, 1% in a different profession, 1% in public health, and 1% in
medical education.
The second objective was to describe the views and perceptions of junior doctors and
medical students regarding their future career in medicine within the next 15 years. A total
of 32% of respondents believed that they would be ready to work in their own private
practice, 21% would be ready to work as specialists at a public or private hospital, 36%
would prefer to practice medicine with a group of doctors, 10% would prefer additional
supervision, and 1% would definitely need additional supervision. Of those who planned to
work in Greece after specialization, about half (52%) of respondents stated that they would
choose Attica (greater Athens metropolitan area), 24% Central Macedonia (Thessaloniki
metropolitan area), 10% Western Greece, 8% South Aegean, 3% Northern Aegean, and
3% Eastern Macedonia-Thrace.
Junior Doctors Network Newsletter
Issue 18
April 2020
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 14
This study aimed to find and present the current and future
views and perspectives of young medical professionals in
regards to choosing medicine as their future career (3).
Study findings showed that 44% of participants would prefer to work in the public sector,
whereas 56% would prefer to work in the private sector. Factors that determined their
future choice of workplace included salary, professional standards, workplace quality,
workload, size (e.g. city, town, village), access to special equipment, collaboration with
competent colleagues, and access to “hard” or demanding patient cases (Figure 1).
Additionally, workload and work-life balance were conceived differently by junior doctors.
Study findings illustrated that more than 50% of respondents believed that the workload of
internal medicine, surgery, and anesthesiology residents was considered heavy, while 43%
believed that general practice residents faced a more reasonable workload. Work-life
balance ratios also varied among different specialties (Figure 2).
Finally, the majority (72%) of participants stated that they were willing to leave Greece and
work abroad as junior specialists, with 34% of them choosing the United Kingdom, 20%
Germany, 12% Sweden, 8% the United States, 6% France, and 20% another country in
Europe, Asia, and Oceania.
Junior Doctors Network Newsletter
Issue 18
April 2020
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 15
Figure 1. Factors influencing how junior doctors choose their
future workplace. Source: Louis, 2018.
Figure 2. Medical residents responded about
their perception of work-life balance.
Source: Louis, 2018.
Based on study findings and other recent studies (4,5), researchers have identified that
Greece is currently experiencing a massive brain drain phenomenon. This phenomenon
can be described when thousands of young generations of medical professionals decide to
leave the country, after finishing their specialization, to live and work abroad, mainly to
western and northern European countries, where salaries are higher, living costs are
reasonable, and work-life balance is better than back home (6). The Greek State,
unfortunately, has not taken concrete nor effective measures to counteract this massive
loss of new health specialists. This has led to poor working conditions in hospitals and
health centers, rising rates of violence and harassment against medical professionals, and
deterioration in the quality of health services offered to the population, especially in
underserved areas.
As health leaders, physicians can identify gaps in health care service delivery that require
future interventions and join forces with decision-makers towards the common goal of
achieving universal health coverage in Greece.
References
1) Pehlivanidou A, Souliotis K, Kalafati M, Belali T, Tsamadias J, Giannakas F, Tountas J. Criteria that affect
the selection of the field of medical specialization in Greece. Arch Hell Med. 2008;25:167-176.
2) Brown D. Summary comparison and critique of major theories. In: Brown D, Brooks L (eds). Career
choice and development. San Francisco, CA: Jossey-Bass; 1984. pp.210-238.
3) Louis K. Career in medicine: views and expectations of junior doctors in Greece of 2018. Oral
communication presented at the 44th Annual Panhellenic Medical Congress; 2018 May 12; Athens,
Greece.
4) Roditis K, Samara E, Louis K. A survey to assess job satisfaction among junior doctors in Greece.
Scientific Chronicles. 2019;24:72-96.
5) Chatziprodromidou IP, Emmanouilides C, Yfanti F, Ganas A, Roupas T, Varsamidis K, Apostolou TM.
Brain drain: the Greek phenomenon. Int Res J. Public Environ Health. 2017;4:289-293.
6) Hope K. Greece brain drain hampers recovery from economic crisis. Financial Times. 2018 Aug 16 [cited
2020 Feb 17].
Junior Doctors Network Newsletter
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April 2020
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 16
As a call to action, Greek health authorities must support
medical education and training programs, which can encourage
physicians to practice in public and private sectors across
Greek communities.
Diabetes is considered to be one of the fastest growing health challenges of this century.
Global statistics have reported that the estimated number of adults (aged 20-79) living with
diabetes has increased from 151 million in 2000, 285 million in 2009, and 463 million in
2019 (1). The prevalence of diabetes in adults is highest in high-income countries (10.4%)
and middle-income countries (9.5%), when compared to low-income countries (4%) (1). As
the prevalence of diabetes is expected to increase in all countries over the next 25 years,
middle-income countries are projected to experience the largest disease burden (2).
Sub-Saharan Africa (SSA) had the lowest age-adjusted prevalence of diabetes (4.7%) in
2019, which was attributed to lower levels of urbanization as well as lower rates of being
overweight and obese (2). Additionally, this low prevalence of diabetes may be due to a
high proportion of adults with undiagnosed diabetes (66.8%), associated with delaying
medical care for appropriate diagnosis (1). For example, in the Democratic Republic of the
Congo, rural citizens often seek medical care at traditional healers, which can hinder
prompt medical evaluation, diagnosis, and management to prevent long-term
complications.
First, the nutrition transition refers to evidence that the structure of dietary intake and
prevalence of obesity have been changing rapidly over the past 15 years (3). Second, the
epidemiological transition describes the high prevalence of infectious diseases that shifts to
chronic and degenerative diseases. These transitions are associated with the adoption of
urban-industrial lifestyles, characterized by a diet with a high intake of meat, sugar
sweetened beverages, partially hydrogenated fats, and a lower intake of fiber, fruits, and
vegetables (3,4).
Junior Doctors Network Newsletter
Issue 18
April 2020
Current Challenges of Diabetes in Low-income Countries:
Focus on Sub-Saharan Africa
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 17
Vandrome Nakundi Kakonga, MD
Primary Health Care Physician
Saint Paul Health Facility
Uvira, Democratic Republic of the Congo
The developing world continues to experience two societal
transitions.
Example: Democratic Republic of the Congo
The Saint Paul Health Facility, located in the eastern town of Uvira, created the diabetic
service in January 2000. To date, this service has registered a total of 3,743 patients who
reside in three different administrative zones. Each year, clinic staff provide follow-up to
more than 1,780 patients and register 15 new cases each month. Of the total clinic
population, 65% of patients have long-term complications of diabetes such as retinopathy,
nephropathy, peripheral neuropathy, and diabetic foot. These debilitating health
complications, which reduce quality of life and can lead to premature death, are linked to
two challenges in this population. First, health care workers utilize blood glucose levels (via
glucometer), rather than glycated hemoglobin (HbA1c) levels, to diagnose and monitor
diabetes in patients. Second, health facilities lack necessary equipment to detect early
signs of potential diabetes complications.
However, little progress has been reported, due to weak health care infrastructure and
budget, poor working conditions for health care workers, and lack of health care coverage
for diabetes care. In fact, diabetes care requires out-of-pocket expenditure by patients,
which affects the economic stability of citizens.
For World Diabetes Day 2019, health care workers and medical students at the Saint Paul
Health Facility collaborated to coordinate diabetes screenings for the Uvira community
(Photos 1-2). After screening a total of 460 community members, they diagnosed 9% with
impaired tolerance glucose and 15% with diabetes. Among the 15% diagnosed with
diabetes, 59% had undiagnosed diabetes. The prevalence of impaired tolerance glucose
and undiagnosed diabetes matches the prevalence estimates (9% and 59.7%, respectively)
in Africa, reported by the International Diabetes Federation in 2019 (1,2).
Junior Doctors Network Newsletter
Issue 18
April 2020
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 18
Over the last 20 years, there have been widespread regional
efforts to reduce the burden of diabetes and related
complications and improve quality of life.
Moving forward, strong leadership by health leaders is essential to achieve universal health
care for all patients, especially for diabetes patients. Primary health care physicians – and
especially junior doctors in SSA – can encourage community members to change their
lifestyle behaviors through proper nutrition and increased physical activity. These collective
efforts can offer prompt and appropriate patient care for acute conditions as well as prevent
potential long-term complications.
Dr Dario Rahelić, Chair of the International Diabetes Federation’s Young Leaders in
Diabetes Programme, from 2016 to 2019, stated: “We cannot give to others without being
affected positively ourselves. And this is the secret of giving: when we make the world
better for others, you make the world better for ourselves.”
References
1) Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes
prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes
Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019;157:107843.
2) International Diabetes Federation. IDF Diabetes Atlas, 9th edition. Brussels: IDF; 2019.
3) Popkin BM. Global nutrition dynamics: the world is shifting rapidly toward a diet linked with
noncommunicable diseases. Am J Clin Nutr. 2006;84:289-298.
4) Crush J, Frayne B, McLachlan M. Urban Food Security Series No. 7: Rapid urbanization and the nutrition
transition in southern Africa. Kingston and Cape Town: African Food Security Urban Network; 2011.
Junior Doctors Network Newsletter
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April 2020
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS Page 19
Photo 2. Medical students educated patients about
diabetes on World Diabetes Day 2019.
Credit: Dr Billy Nguza.
Photo 1. Dr Vandrome Nakundi and medical
students coordinated diabetes screening for the
Uvira community on World Diabetes Day 2019.
Credit: Joel Kapuku.
Junior doctors can provide a powerful voice to raise
awareness for the importance of diabetes prevention and
education and dispel myths.
Trainee-led research collaboration refers to when trainees, resident doctors, early career
doctors or junior doctors lead, design, and implement research and then disseminate their
study findings (1, 2). These studies can be multicentred and may be audits, cohort studies,
randomised clinical trials, systematic reviews, and metanalyses.
This concept was pioneered by surgical trainees at the West Midlands Research
Collaborative in the United Kingdom. This model is now widespread and well entrenched in
the United Kingdom, with over 30 trainee-led research projects in different specialties.
Other countries, such as Canada and the United States, have also developed these
trainee-led research collaborations. In Nigeria, the first was established in 2018, which
pioneered the “Challenges of Residency Training, and Early Career Doctors (ECDs) in
Nigeria” (CHARTING) study (3,4).
Interestingly, these collaborations are initiated and driven by the enthusiasm of trainees
themselves. It is necessary to distinguish trainee research collaborations from trainee-led
research collaborations. The first trainee research collaboration was reported to be a two-
year study of measles, conducted in 1986 by general practitioner trainees, which was
initiated and coordinated by the Essex faculty of the Royal College of General Practitioners
(5). This project demonstrated the capacities, competence, and enthusiasm of junior
doctors to organise themselves to undertake large-scale and rigorous research studies.
The success of such arrangement driven from faculty may have prompted the first reported
trainee-led research collaboration of multicentred studies in 2007 by West Midlands
Research Collaborative.
Junior Doctors Network Newsletter
Issue 18
April 2020
Role of Junior Doctors’ Groups in Trainee-led Research
Collaborations
The junior doctor/trainees’ group serves as a robust platform to
galvanise interests and provide the necessary support for this
initiative (6).
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 20
Oladimeji Adebayo, MB.BS
University College Hospital
Ibadan, Nigeria
The group can initiate the formation of these research collaborations, such as the Research
Collaboration Network in Nigeria, which was prompted by the Nigerian Association of
Resident Doctors (NARD) (3). They serve as veritable source of funding and logistics
support, especially in many low- and middle-income countries, where there is paucity of
research grant systems. The meetings of such bodies are inherent opportunities for such
collaborations to evolve while also providing networking opportunities.
Even in countries where theses or dissertations are necessary criteria for completion of
residency training programmes, joining such academic collaborations can enrich
participants’ research skills and capacities. Furthermore, in other programmes that require
previous expertise, these collaborations provide the necessary knowledge and skills for
junior doctors to excel at required research tasks. These capacities are not limited to study
design, implementation, analysis, and dissemination of findings, but they also involve the
application of governance skills, particularly in large national, multidisciplinary studies. They
have the potential to strengthen data integration from multiple sites, while generating robust
contributions to the scientific knowledge base (2).
Aside from the United Kingdom, where the model was initiated and reached national
recognition by professional associations, it has not yet become a common practice in other
countries. It is therefore imperative for junior doctors’ groups in these areas to serve as a
veritable source of support, raising awareness and bulwark of advocacy for these research
collaborations (6). These trainee groups can serve as leaders to promote the accruable
benefits of these initiatives and encourage the application of this model as a global
framework for research collaborations in other countries (6).
Junior Doctors Network Newsletter
Issue 18
April 2020
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 21
Although this model of promoting research competence among
junior doctors offers significant benefits for academic learning, it
appears to be poorly utilised globally.
The benefits of these collaborations are enormous to the extent
that junior doctors are encouraged to engage and further
develop their research skills.
References
1) Bartlett D, Pinkney T, Futaba K, Whisker L, Dowswell G. Trainee led research collaboratives: pioneers in
the new research landscape. BMJ. 2012;345:e5084.
2) Kasivisvanathan V, Cashman S, Cumberbatch M, Lamb B, Nambiar A, Shah T, Emberton M. Pushing the
boundaries of urological research with trainee-led collaboration in the BURST Research Collaborative.
Urology News. 2016 [cited 2020 Jan 20].
3) Adebayo O, Oluwaseyi O, Olaopa O, Kpuduwei S, Oluwafemi E, Omotayo FF, et al. Trainees
collaboratively investigating early career doctors’ themes: a NARD initiative in Nigeria. Nigerian Journal of
Medicine. 2019;28:93-97.
4) Kanmodi K, Ekundayo O, Adebayo O, Efuntoye O, Ogunsuji O, Ibiyo M, et al. Challenges of residency
training and early career doctors in Nigeria study (CHARTING Study): a protocol paper. Nigerian Journal
of Medicine. 2019;28:198-205.
5) Timmins DJ, McFarlane SH, Butler NS. Facilitating a trainee collaborative study. JR Coll Gen Pract.
1989;39:423-424.
6) Dowswell G, Bartlett DC, Futaba K, Whisker L, Pinkney TD. How to set up and manage a trainee-led
research collaborative. BMC Med Educ. 2014;14:94.
Junior Doctors Network Newsletter
Issue 18
April 2020
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 22
The medical environment in Korea is highly specialist-centered. The Post-Graduate
Medical Education (PGME) course in Korea includes one year of internship and three to
four years of residency, depending on the selected residency program. In 2013, the Korean
Medical Association conducted a survey that identified that more than 90% of Korean
physicians had completed the PGME course and were certified as specialist physicians (1).
This percentage far outweighs the average reported by the Organization for Economic Co-
operation and Development (OECD), and continuously rises each year. In other words,
most junior physicians in Korea experience peer pressure throughout the internship training
course, motivating them to pursue a medical specialty.
Junior Doctors Network Newsletter
Issue 18
April 2020
Does Medical Internship Training in Korea Serve its Purpose?
Yujin Song, MD
Intern, National Medical Center
Executive Member, Korean Intern Resident Association
Seoul, Republic of Korea
Jihoo Lee, MD
Internal Medicine Resident, Seoul National University
Director, Korean Intern Resident Association
Seoul, Republic of Korea
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 23
Figure 1. KMA/KIRA survey of trainee physicians on
perceptions if they receive appropriate education during
training. Credit: KMA/KIRA and Kim et al., 2017.
Despite the importance of this PGME
phase, internships of junior physicians
in Korea have been notoriously known
for their clinical training with
inadequate organization of curriculum
content. The main responsibilities are
often restricted to manual chores that
rarely serve an educational purpose,
including patient care related to
dressing changes and transfer from
one location to another. In 2017, the
KMA’s Medical Policy Research
Institute conducted a survey that
reported that more than 61% of
interns showed disapproval when
receiving an adequate education
during their internship (Figure 1) (2).
Although hospital leadership carelessly made a mistake in coordinating the faulty internship
schedule, these interns had to complete extra training hours on their own expense in order
to receive academic credit. After this unfortunate event, the MOHW and KIRA sent official
documents to teaching hospitals to request adherence to the official intern training
regulations.
However, again in 2019, more than 60% of the 110 interns at Seoul National University
Hospital experienced this same ordeal as these nine interns. The Training Environment
Evaluation Board of Korea and the MOHW are currently investigating the situation to
decide upon the exact penalty for the hospital. Subsequently, authorities also identified
other major training hospitals that violated the official internship training regulations of
required departments (3). The degree in which these major training hospitals failed to
adhere to the intern training regulations differed from one another. Nevertheless, it was
shocking that both hospitals and interns in these hospitals did not know whether they were
adhering to established regulations for internship training.
Junior Doctors Network Newsletter
Issue 18
April 2020
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 24
Figure 2. KMA/KIRA survey of trainee physicians
on perceptions if curricula are well organized.
Credit: KMA/KIRA and Kim et al., 2017.
In 2018, the Korean Intern Resident Association
(KIRA) administered a survey that showed that
only 29% of interns considered their internship
curriculum well-organized to build upon their
medical expertise (Figure 2).
Unfortunately, although interns can experience
inadequate training, they can also feel neglected
by the hospital leadership that should protect
them. In 2018, nine interns at Ewha Woman’s
University Mokdong Hospital were informed that
they were not qualified to receive accreditation for
their internship since they could not complete
required internship training in four departments –
internal medicine, general surgery, ob-gyn, and
pediatrics – set by the Ministry of Health and
Welfare (MOHW).
Junior Doctors Network Newsletter
Issue 18
April 2020
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 25
Photo 2. KIRA hosted a scientific session for PGME
medical training at the Medical Education Conference
2019. Credit: KIRA.
Photo 1. KIRA held an open forum to discuss a better
PGME environment for junior doctors with one
Congress member, 2018. Credit: KIRA.
From 2010, KIRA has been involved in
various efforts to improve the quality of
PGME for junior physicians in their
internship and residency training. One of
these efforts was a joint research
publication on the policy of medical
education for junior physicians. In the
national audit of 2018, KIRA held an open
forum to discuss approaches to form a
better PGME environment for junior
physicians with one Congress member.
This forum discussion led to the publication
of policy recommendations for improved
PGME (Photo 1). These recommendations
stressed the ambiguity of the internship
training curriculum, where guidelines do not
mention objective measures to evaluate
clinical skills during training.
To stress the importance of PGME in
Korea, KIRA hosted the scientific session
called, Medical Training in PGME, at the
annual Medical Education Conference
2019 in Korea. From junior physicians’
perspectives, KIRA identified specific
challenges of PGME and proposed several
alternatives to the large audience of health
leaders, including MOHW, the Korean
Hospital Association, and the Korean
Academy of Medical Science. One
proposed element was to reduce interns’
chores irrelevant to education and allow
their participation in the medical decision-
making process, which would strengthen
their internship training (Photo 2).
Unfortunately, despite all KIRA’s proactive endeavors, there have been few advances to
date. It is still unclear even what interns should pursue due to the discordant stance
between stakeholders. The Korean Academy of Medical Science, which has the
responsibility to monitor PGME progress, has insisted on abolishing the internship training
in order to strengthen resident education and nurture highly specialized physicians (4).
Training hospitals, however, oppose this action as they argue that the abolition of the
internship training would increase the shortage of clinicians and associated workloads. As
this discord among interested parties continues, the current internship training of junior
physicians appears to resemble a ship sailing through a foggy sea with no specific
destination.
These national guidelines for PGME are essential to develop junior physicians who are
prepared to identify and manage future emerging threats. For example, in the United
States, the Accreditation Council for Graduate Medical Education set basic standards
called, Common Program Requirements, that require interns to develop certain skills,
knowledge, and attitudes to provide patient-centered care. In turn, each residency program
developed five-level milestones, where junior physicians can observe their objective
progress from intern to specialist physician..
On the other hand, some training hospitals argue that they have limited resources to cover
the financial costs to teach and train junior physicians. Many countries, including United
States, United Kingdom, Canada, and Australia, are providing government funding to invest
in the curriculum development of junior physicians’ training programs, which can lower the
financial burden for individual hospitals. For example, the Australian government has
coordinated public hospitals to provide internship training programs. General practitioners
receive financial aid from the federal government in the city where they plan to work.
Furthermore, the budget has been allocated to improve the quality of the training
environment as well as inspect and supervise the training curricula.
Junior Doctors Network Newsletter
Issue 18
April 2020
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 26
As Korean junior doctors, we believe that the internship training
in Korea should be strictly evaluated and modified in order to
offer high-quality clinical training for junior physicians.
In reality, the current PGME in Korea has fallen behind the real world. Junior physicians,
who work on the daily frontlines of medicine, deserve better training, education, and
mentorship from their health institution and the Korean government.
References
1) Ministry of Health and Welfare (Republic of Korea). Health and welfare statistical year-book 2019.
Republic of Korea: Ministry of Health and Welfare; 2019. Korean.
2) Kim MK, Moon WR, Key DH, Lee SH, Jo YD, Nam GH, Ahn CH. A survey on training and working
conditions of residents in 2017. Republic of Korea: Research Institute for Healthcare Policy; 2017.
Korean.
3) Junior Doctors Network of Korea. Administrative measures for medical interns in severance: Samsung
Seoul Medical Center is being delayed…results are expected in February. 2020 [cited 2020 Feb 23].
Korean.
4) Wang GC, Kim DH, Kim SH, Park WB, Ahn DS, Yu GH, Lee YS, Lee H, Lim IS, Jang YS. A study on
reformation of post-graduate medical education system in Korea. Republic of Korea: Research Institute
for Healthcare Policy; 2011. Korean.
Junior Doctors Network Newsletter
Issue 18
April 2020
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 27
As we hope for upcoming changes, junior physicians are
health leaders who must vocalize their recommendations that
strengthen clinical training for optimal health care service
delivery in the future.
The South-East Asian country of Malaysia has significant cultural diversity with a rich
cultural heritage. According to the Malaysia Department of Statistics, the total population
has grown from 28.5 in 2010 to 32.6 million people in 2020, with 29.4 million (90.2%)
citizens and 3.2 million (9.8%) non-citizens. The majority (69.3%) of the population are
Malays, with the remaining population as Chinese (22.8%), Indians (6.9%) or minor ethnic
groups (1%).
In 2016, the Ministry of Health (MOH) reported that the prevalence of mental health
disorders among adults was 29.2% and 12.1% among children (1). These findings indicate
a three-fold increase in mental health cases among adults, when compared to 10.6% from
1996 (MOH 2015). The highest prevalence of mental health disorders was identified in the
rural areas, Sabah and WP Labuan (42.9%), followed by the capital, Kuala Lumpur (39.8%)
(1). This difference may be attributed to rural areas within the Malaysian states which face
some challenges when seeking psychiatric evaluations (2).
Junior Doctors Network Newsletter
Issue 18
April 2020
An Overview of the Mental Health Burden in Malaysia
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 28
Shaeraine Raaj, MD MCPsychI MRCPsych
Psychiatrist and Clinical Lecturer
Phoenix Care Centre
University College Dublin School of Medicine
Dublin, Ireland
Myelone Tharmaselan, MD MBA MA
Ministry of Health
Malaysia
Sujesha Navanathan, MD
Psychiatrist Registrar
Department of Psychiatry, Royal College of
Surgeons
Dublin, Ireland
Over the past 20 years, the prevalence of mental disorders, such
as depressive and anxiety disorders, has increased significantly
in Malaysia, where one in three Malaysians has experienced a
mental health disorder (1).
Mental health disorders were found to have no significant association with ethnicity (1).
Suicidal behaviour was found to be associated with interpersonal conflicts, and the annual
suicide rate in Malaysia is approximately 6 to 8 suicides per 100,000 population (3).
Furthermore, since adults from low-income families had a higher prevalence of mental
health disorders when compared to high-income families, poverty remains a complex
phenomenon with wide-ranging implications for individual and family well-being (4).
In the neighbouring country of Singapore, study findings showed an increased lifetime
prevalence of mental health disorders in Singapore from 12% in 2010 to 13.9% in 2016 (5).
These findings suggest that Malaysia is experiencing a dramatic increase in the prevalence
of mental disorders, when compared to Singapore.
The Malaysian Mental Health Act was enacted on September 6, 2001, by the Parliament in
Malaysia (ACT 615), but was adopted into operation in 2010, following the enforcement of
the Mental Health Regulations 2010 (6).
It also incorporated informed consent, which refers to the provision of voluntary consent by
patients to undergo surgery or electroconvulsive therapy. In clinical cases where no
informed consent can be provided due to patients’ impairment or loss of capacity, then
informed consent can be provided by a close relative or two psychiatrists upon medical
evaluation.
The mental health burden in Malaysia incorporates three main challenges. First, lack of
awareness and misconceptions about mental health disorders can serve as a barrier
towards access to prompt and appropriate treatment (6). Second, due to the lack of
understanding and insight on mental illness, most Malaysians tend to intentionally avoid
medical treatment and seek religious practitioners or shamans (7). Third, there is a limited
number of psychiatrists and psychologists to meet the population’s demands.
Junior Doctors Network Newsletter
Issue 18
April 2020
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 29
The Act provided a structured framework in relation to mental
disorders and made provisions for the admission, detention,
assessment, treatment, and protection of persons with
mental health disorders.
Psycho-education and positive peer support groups can reduce stigma and improve
adherence to mental health treatment. Health education can incorporate supportive mental
health messages on the television, radio, billboards, and virtual platforms. The Ministry of
Health should review and allocate further funding for mental health community programs
and strengthen clinical education and training for psychiatrists and psychologists in
Malaysia. This national support can provide health care services for at-need communities
and take forward steps to meet the World Health Organization’s recommendation of one
psychiatrist for 10,000 people.
In summary, the number of mental health cases is poised to significantly increase in the
coming years as Malaysia, which continues to transition from an upper-middle income to a
high-income country. Notably, Malaysia will most likely face multiple challenges regarding
the lack of awareness, misconception, and stigma of mental health disorders. Coupled with
limited funding and number of trained psychiatrists, these potential barriers can negatively
impact the delivery of mental health services to the Malaysian population. Hence, the
Malaysian government and various stakeholders should address this essential population
health topic and develop preventive strategies and effective health programs to improve the
mental health and well-being of Malaysians.
References
1) Ministry of Health (Malaysia). National Health and Morbidity Survey 2015. Volume II: non-communicable
diseases, risk factors and other health problems. Kuala Lumpur: Ministry of Health Malaysia; 2015.
2) Crabtree S, Chong G. Standing at the crossroads: mental health in Malaysia since in-dependence. In A.
Haque (ed.): Mental health in Malaysia: issues and concerns. Kuala Lumpur: University Malaysia Press;
2000.
3) Armitage CJ, Panagioti M, Abdul Rahim W, Rowe R, O’Connor RC. Completed suicides and self-harm in
Malaysia: a systematic review. General Hospital Psychiatry. 2015;37:153-165.
4) Das J, Do Q-T, Friedman J, McKenzie D, Scott K. Mental health and poverty in developing countries:
revisiting the relationship. Soc Sci Med. 2007;65:467-480.
5) Subramaniam M, Abdin E, Vaingankar JA, Shafie S, Chua BY, Sambasivam R, et al. Tracking the mental
health of a nation: prevalence and correlates of mental disorders in the second Singapore mental health
study. Epidemiol Psychiatr Sci. 2019;29:e29.
6) Khan NN, Yahya B, Abu Bakar AK, Ho RC. Malaysian mental health law. BJPsych International.
2015;12:40-42.
7) Chong ST, Mohamad MS, Er AC. The mental health development in Malaysia: history, current issue and
future development. Asian Social Science. 2013;9:1-8.
Junior Doctors Network Newsletter
Issue 18
April 2020
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES Page 30
To address these challenges, the Ministry of Health contributes a
major role in increasing awareness by organising and delivering
mental health awareness campaigns in rural and urban areas.
In December 2019, Wuhan, the capital of Hubei province, China, became the center of an
outbreak of pneumonia of an unknown cause, which raised attention within China and
across the world. On January 7, 2020, scientists isolated a novel coronavirus from patients
in Wuhan (1). This virus had been rapidly disseminating across the border of China, mainly
through air travel to adjacent countries. On January 19, 2020, a febrile Chinese traveler
arrived at the Incheon International Airport quarantine and was diagnosed with this novel
coronavirus.
In spite of the strengthening quarantine and surveillance measures from neighboring
countries, the novel coronavirus indiscriminately landed in other geographic regions. On
January 30, 2020, as confirmed novel coronavirus cases skyrocketed, fear and concern
resulted with the growing threat of a pandemic.
On February 11, 2020, after consultation and collaboration with the World Organisation for
Animal Health (OIE) and the Food and Agriculture Organization (FAO), the WHO named
the disease COVID-19, short for ‘coronavirus disease 2019’ (2). On February 21, 2020, the
WHO added the detection of COVID-19 in the surveillance for severe acute respiratory
infections (SARI). One week later, the WHO had increased the assessment of the risk of
spread and impact of COVID-19 to a high global level. As of March 5, 2020, 93,090
confirmed cases were reported in over 74 countries (2).
Junior Doctors Network Newsletter
Issue 18
April 2020
COVID-19 pandemic in the Republic of Korea:
Role of Junior Doctors
JUNIOR DOCTORS’ ACTIVITIES Page 31
The World Health Organization (WHO) declared this outbreak
to be a public health emergency of international concern,
under the International Health Regulations (IHR 2005).
Jaehyeon Jang, MD Msc
Public Health Physician, Anseong Public Health
Center
Director, Korean Intern and Resident Association
Anseong, Republic of Korea
Sei Na, MD
General Practitioner
Member, Korean Intern and Resident Association
Seoul, Republic of Korea
Reflecting from the previous Middle East Respiratory Syndrome (MERS) outbreak in 2015,
there were 186 confirmed cases and 36 deaths in total in the Republic of Korea (3). An
ineffective screening system for suspected MERS patients and an inability to isolate
patients in a negative pressure room attributed to this mortality rate. After the eradication of
MERS, health authorities took forward steps to prepare the country for emerging threats.
First, they increased the number of negative pressure rooms from fewer than 100 units in
2015 to 1,225 units in 2019. Second, they established a hotline to facilitate public inquiries
about clinical symptoms in a methodically organized reporting system.
In one instance, one woman had attended a large-scale religious gathering and developed
respiratory symptoms, which was confirmed as the 31st COVID-19 case in the Republic of
Korea. Subsequently, aggressive local transmission spurred in the metropolitan city of
Daegu, and the Republic of Korea entered a new phase of COVID-19 prevention and
control measures. The number of cases increased rapidly from 31 to 4,812 in only two
weeks. Medical resources and personal protective equipment (e.g. N95 masks, Hazmat
Junior Doctors Network Newsletter
Issue 18
April 2020
JUNIOR DOCTORS’ ACTIVITIES Page 32
Despite these dedicated efforts and advancements, the
Republic of Korea has encountered the COVID-19 outbreak to
be a significant challenge for population health.
If COVID-19 was confirmed, patients were
transported directly to a negative pressure room,
via a route that minimizes contact between patients
and susceptible individuals (Photo 1). Following
the recommendation of Dr Moran Ki (National
Graduate School of Cancer Science and Policy,
Korea), some local governments implemented
drive-through testing stations, where individuals
with respiratory symptoms could drive to a neutral
spot to receive the diagnostic test for COVID-19.
This drive-through approach aimed to limit the
exposure and potential COVID-19 transmission to
health care workers (Photo 1). Photo 1. Drive-through site for COVID-19
testing in Sejeong Province, Republic of
Korea. Credit: Jaehyeong Lee, ASDK.
Junior Doctors Network Newsletter
Issue 18
April 2020
JUNIOR DOCTORS’ ACTIVITIES Page 33
Figure 1. Comparison of trends of confirmed COVID-19
cases (cumulative) of the world, China, and South
Korea. Illustrated by KIRA, 2020. Source: WHO, 2020.
suits) were in short supplies, and the
general population was fearful of being
unprotected and susceptible to viral
transmission. This new phase placed
enormous pressure on the Korean society
and national health system (Figure 1).
To support national surveillance and control
measures, Korean junior doctors are
actively working in screening centers and
clinical care of COVID-19 patients. One
survey conducted by the Korean Intern
Resident Association (KIRA) revealed that a
significant number of hospital surveillance
and treatment programs depended on junior
doctors’ contribution (Figure 2). Notably,
junior doctors, comprised of medical interns
and residents, contributed to 50% of the
established 98 screening centers. Aside
from their regularly assigned shifts, they
contributed to additional shifts by extending
their regular schedules, performing overtime
shifts, or being available on-call during off-
duty time).
As the scenario enters greater urgency,
more junior doctors are assigned to
screening programs and clinical care. KIRA
officially acknowledged and encouraged
junior doctors’ voluntary cooperation during
this outbreak (4). In addition, KIRA
requested the withdrawal of ‘Electronic
Medical Record (EMR) shutdown’ (e.g. ban
for logging into EMR system beyond their
working hours) to maximize junior doctors’
clinical practices and minimize record errors
during epidemiologic investigations.
Figure 2. KIRA Survey of junior doctors on clinical
responsibilities at COVID-19 screening centers during
regular shifts and additional shifts (extending regular
shift, overtime shift, on-call hours during off-duty time).
Survey by KIRA, 2020.
As junior doctors continue to gain expertise and refine clinical skills, they contribute
significant leadership in the hospital and community settings. Public Health Doctors
(PHDs), one subgroup of junior doctors, are responsible for managing local screening
centers and providing clinical care to local community members. They conduct
epidemiologic investigations for real-time COVID-19 surveillance and stress the importance
of quarantine. When the Daegu outbreak occurred, representing 90% of COVID-19 cases,
hundreds of PHDs were transferred to this metropolitan city to aid other health care
workers.
Unfortunately, despite the selfless service of junior doctors to reduce COVID-19
transmission in the Republic of Korea, health authorities are not providing appropriate
measures for health care worker protection. The Korean government has hastily released
new versions of protocols frequently that may have fatal long-term consequences for health
care workers. Junior doctors are working extra hours with no hazard pay, facing potential
exposure to COVID-19 infection, and experiencing burnout and fatigue.
The Republic of Korea continues to combat COVID-19 transmission across local
communities, but the number of cases has increased and transmission has not slowed (5).
As junior doctors, to curb the soaring level of COVID-19 transmission, we must prioritize
our collective efforts to combat the COVID-19 outbreak in our countries, as a pressing
issue over other non-emergency health topics. Working in health care teams, junior doctors
have the tremendous opportunity to empower our colleagues and collaborate on all
required duties to combat this global pandemic.
References
1) Wang C, Horby PW, Hayden F, Gao GF. A novel coronavirus outbreak of global health concern. Lancet.
2020;395:470-473.
2) World Health Organization. Novel Coronavirus (2019-nCoV): Situation reports – 49. 2020 [cited 2020 Mar
9].
3) Choi JW, Kim KH, Moon JM, Kim MS. Public health crisis response and establishment of a crisis
communication system in South Korea: lessons learned from the MERS outbreak. Journal of the Korean
Medical Association. 2015;58:624-634. Korean.
4) Jihyeon P. Problems of ‘Electronic Medical Records Shutdown Program’ among the COVID-19 epidemics
in Korea. Doctor’s News (Korea ed.). 2020 [cited 2020 Mar 5].
5) Lovelace Jr B. Top CDC official tells Congress coronavirus almost qualifies as a global pandemic. CNBC
News. 2020 [cited 2020 Mar 5].
Junior Doctors Network Newsletter
Issue 18
April 2020
JUNIOR DOCTORS’ ACTIVITIES Page 34
This account serves as evidence that all Korean junior
doctors have provided expertise, time, and selfless duty to
mitigate risk and curb COVID-19 community transmission.
Scientific inquiry sets the essential framework to identify programmatic or research gaps,
develop timely solutions, and implement appropriate interventions to achieve overall
objectives. Global health threats – such as air pollution, antimicrobial resistance, increased
prevalence of noncommunicable diseases, vector-borne disease transmission, weak health
system infrastructure, and zoonotic disease spillover – continue to challenge scientists and
practitioners in their clinical and community initiatives. Junior doctors should understand the
scientific background of these threats in order to conduct appropriate medical evaluations,
identify risks for vulnerable populations, and provide evidence-based recommendations for
management strategies. They serve as frontline leaders to improve disease surveillance
programs and strengthen public health preparedness and response measures in their local
community and nation.
As junior doctors are familiar with the expertise required throughout their clinical training,
they can stress the importance of professional development skills like scientific writing.
These scientific publications, based on critical inquiry and analysis, are products that will
facilitate shared knowledge among health professionals to diverse audiences. Medical
curricula, however, have traditionally emphasized acquiring scientific knowledge and skill-
based competencies to excel on standardized medical exams. Hence, the following
example highlights the valuable contribution of junior doctors who participate in professional
development workshops that provide insight and mentorship to medical students on
relevant career skills.
Junior Doctors Network Newsletter
Issue 18
April 2020
Providing Mentorship to Encourage Scientific Publications:
Academic Workshop in the Dominican Republic
JUNIOR DOCTORS’ ACTIVITIES Page 35
Helena Chapman, MD MPH PhD
Publications Director (2019−2020)
Junior Doctors Network
World Medical Association
“To raise new questions, new possibilities, to regard old
problems from a new angle, requires creative imagination and
marks real advance in science”
− Albert Einstein
Workshop: Key Skills in Preparing Scientific Publications
Supported by the Executive Board and the Standing Committee on Medical Education
(SCOME) of the Organización Dominicana de Estudiantes de Medicina (ODEM),
recognized as the International Federation of Medical Students’ Associations (IFMSA) for
the Dominican Republic, ODEM members organized a two-hour academic workshop for
medical students in September 2019. The event aimed to provide an overview of the writing
process and offer key strategies to prepare a letter to an editor. Adapted from the
successful workshop conducted in February 2019, the agenda was prepared by the
president, Ms. Genesis Familia Tiburcio (Universidad Nacional Pedro Henriquez Ureña,
UNPHU), and the vice-president of internal affairs, Ms. Mariand Méndez (Universidad
Autónoma de Santo Domingo, UASD) (1). Held at UNPHU School of Medicine, an
estimated 50 participants attended the event, representing seven medical schools from the
cities of Santo Domingo, Santiago, and San Pedro de Macorís (Photos 1-2).
In the workshop seminar, Dr Helena Chapman (Universidad Iberoamericana, UNIBE)
emphasized the essential skills of critical analysis, technical knowledge, and scientific
writing for a medical journal. She provided an introduction of plagiarism, examples of
bibliographic citation styles, elements of the writing process, and sections of scientific
manuscripts. Then, she advised medical students to contribute their innovative lens toward
the evaluation of a scientific topic through a letter to an editor. Using two published letters
to editors, she reviewed the step-by-step process of critical analysis and strategies to
organize content. Finally, she described the relevant content of the accompanying cover
letter and title page for manuscript submission.
Junior Doctors Network Newsletter
Issue 18
April 2020
JUNIOR DOCTORS’ ACTIVITIES Page 36
Photo 2. ODEM logo.
Credit: ODEM.
Photo 1. ODEM members who participated in the academic workshop.
Credit: ODEM.
Panel: ODEM Members Share Experiences in Scientific Publications
Following this seminar, four ODEM members shared their personal experiences and
lessons learned related to the development of their letters for selected medical journals
(Photo 3). These ODEM members had attended the previous academic workshop in
February 2019, participated in the four-month practicum from March to June 2019, and
submitted their letters to medical journals.
Two ODEM members expressed enthusiasm related to their first publication in a medical
journal. They shared challenges of time management with academic schedules,
acknowledged acquiring critical analytical and writing skills, and described their contribution
to advance scientific inquiry. Mr Julio Otaño Rivas (UNPHU) presented his letter to the
editor titled, Developing Empathy in Medical Students, published in The Clinical Teacher
journal. Ms Lilian Teresa Pimentel (Universidad OyM) published her letter to the editor
titled, Educating Well-rounded Physicians for the 21st Century, in the MEDICC Review
journal.
At the workshop closing, Dr Chapman encouraged ODEM members to seek opportunities
to expand their scientific knowledge and apply to the field of scientific communication. She
offered a gratuitous virtual four-month practicum to ODEM members, describing the strict
schedule of weekly assignments coupled with personalized mentorship throughout the
development of the letter to an editor.
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Issue 18
April 2020
JUNIOR DOCTORS’ ACTIVITIES Page 37
Photo 3. Ms Rosario Penelope del Rosario, Ms
Cristina Melenciano, Ms. Maria Fernanda Cedeno, Dr
Helena Chapman, Ms Genesis Familia, Mr Julio
Otaño, and Ms Lilian Teresa Pimentel (left to right).
Credit: ODEM.
Two ODEM members emphasized the
value in the learning process as they
shared experiences where their letters to
editors were rejected during the editorial
process. Ms Maria Fernanda Cedeño
(UNIBE) described the editorial
recommendation to adapt the content of her
letter on enhancing emotional intelligence to
the longer format of an editorial article. Ms
Penélope del Rosario and Ms Cristina
Melenciano (UASD) presented the editorial
decision to seek an alternative journal for
their letter resubmission on enhanced
training in palliative care.
By identifying gaps in medical education – including key moments to apply medical
knowledge to practice – junior doctors can continue to showcase the value of global health
leadership and contribution to medical education.
Reference
1) Chapman HJ. Innovative workshop: developing critical inquiry in the Dominican Republic. JDN
Newsletter. 2019:0:24-26.
Junior Doctors Network Newsletter
Issue 18
April 2020
JUNIOR DOCTORS’ ACTIVITIES Page 38
As community health leaders, junior doctors can seek direct
interactions with medical students and provide mentorship,
offer opportunities for innovative brainstorming and critical
analysis, and foster professional networks.
In 2017, the United Nations (UN) General Assembly officially recognized the importance of
Universal Health Coverage (UHC) and established International UHC Day on December
12th.
In September 2019, UN Member States agreed to a political declaration on UHC and
confirmed their commitment to achieving UHC by 2030 (1). Understanding this global
priority, leaders identified upcoming challenges, including the lack of political leadership
and limited essential resources to affirm sustainable and quality health provisions for UHC.
They agreed that subsequent efforts would require continued dialogue focusing on
problem-solving approaches to achieve established goals. As such, they promoted the
theme, Keep the Promise, for UHC Day in 2019 (2).
Several members of the Japan Medical Association’s Junior Doctors Network (JMA-JDN)
participated in the advocacy efforts for UHC Day in 2019. They served as members of the
UHC Youth Network, which was composed of young medical doctors, nurses, and students
who have supported shared viewpoints for UHC since 2017. This article aims to share the
experiences of JMA-JDN in their advocacy activities that promote achieving UHC by 2030.
Junior Doctors Network Newsletter
Issue 18
April 2020
International Universal Health Care Day:
Interviews with Japan’s Key Leaders
JUNIOR DOCTORS’ ACTIVITIES Page 39
This resolution provides a global platform for UHC advocates
to promote the added value of UHC for national health systems
by highlighting the need for robust and resilient health systems
and sharing personal narratives of global citizens.
Kazuhiro Abe, MD PhD
Department of Public Health
Graduate School of Medicine
University of Tokyo
Tokyo, Japan
Like other countries, Japan health leaders have encountered many challenges in the
implementation of UHC. Japan’s post-World War II experiences may provide some clues to
how Japan and other countries can achieve UHC by 2030. Thus, JMA-JDN members
interviewed eight individuals who have served in various leadership positions (e.g.
politicians, administrators, health providers, academic professors, members of civil society
organizations) and were aware of the specific details of Japan’s history on UHC (Photo 1).
Members asked participants about how Japan had developed the universal health
insurance system, added national health provisions, and improved sustainability of the
health system. These interviews were filmed, and members developed short videos on the
YouTube channel of the UHC Youth Network (3,4).
Key Points from Interviews with Japan’s Key Leaders
Prof Kenji Shimazaki, professor at the National Graduate Institute for Policy Studies and
past administrative officer of Japan’s Ministry of Health, Labour, and Welfare, explained the
necessary five components to develop UHC in countries. To simplify this concept, he used
the comparison of a jet plane. The five components included economic growth (powerful
engine), spirit of social solidarity (vast wings), strong leadership by politicians (excellent
pilots), government officers or researchers (excellent pilots or mechanics), and the basic
infrastructure for administrative finance (long runways). His political analysis showed that
the most influential factor for Japan to develop UHC was economic growth from the 1960s
to the 1970s, led by the expanding phase of demographics and stable world politics. He
highlighted that all low-, middle-, and high-income nations face different challenges in
implementing UHC, including concurrent threats like managing health service delivery for
acute and chronic conditions while experiencing an aging society and economic disparities.
Prof Keizo Takemi, a member of the House of Councilors and a Goodwill Ambassador for
UHC, and Prof Yasushi Katsuma, a professor at Waseda University, mentioned that since
the 1990s, many Japanese citizens who were involved in policy-making have realized that
UHC is a key element of human security. They said that the concept of UHC helps multiple
stakeholders, such as health and finance ministers, to collaborate on national plans to
achieve UHC by 2030.
Dr Yoshitake Yokokura, President of the Japan Medical Association and the past president
of the World Medical Association, mentioned that the sense of security that people can
receive medical care when they become ill had driven Japan’s rapid growth after World
War II. He stressed that there is an interactive relationship between social security and the
economy. Economic growth supports the financial base of social security, while the
development of social security supports the Japanese economy by producing employment
inducement effects.
Junior Doctors Network Newsletter
Issue 18
April 2020
JUNIOR DOCTORS’ ACTIVITIES Page 40
Ms Sumie Ishii, a chairperson of the Japanese Organization for International Cooperation in
Family Planning, emphasized the importance of trained community workers to connect
public health operators with the community. She said that this was important since almost
all low- and middle-income countries have established national health strategies and
policies including UHC.
Mr Masaki Inaba, Chair of Japan Civil Society Organization Network on Global Health,
discussed the combined importance of medical care, social security, and social welfare.
Ms Tomoko Fukuda, Regional Director of East, South East Asia, and Oceania Region of
the International Planned Parenthood Federation, mentioned the three roles of civil society
organizations and the importance of sexual and reproductive health and rights to achieve
UHC.
Mr Miyavi, a guitarist and goodwill ambassador of the UN High Commissioner for
Refugees, shared his experiences visiting refugee camps and living in the United States
and Japan and discussed the importance of access to health care services without financial
strain.
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Issue 18
April 2020
JUNIOR DOCTORS’ ACTIVITIES Page 41
Photo 1. Key leaders interviewed for the UHC Day 2019. Credit: UHC Youth Network.
Through these interviews, JMA-JDN members learned key points that were shared by key
experts who support Japan’s UHC from various leadership positions in Japan. Their
narratives highlighted personal experiences that form part of the history of the health care
system, which is unpublished in course textbooks. JMA-JDN members hope that the
content shared on the YouTube channel of the UHC Youth Network will provide insight to
other countries that aim to achieve UHC.
References
1) United Nations. Political declaration of the high-level meeting on universal health coverage. 2019 [cited
2020 Feb 16].
2) UHC 2030. International Universal Health Coverage Day 2019 campaign report. 2019 [cited 2020 Feb 16].
3) UHC Youth Network. UHC Day 2019 – lesson and message from Japanese experience. 2019 [cited 2020
Feb 16].
4) UHC 2030. Global campaign on UHC Day 2019. 2019 [cited 2020 Feb 16].
Junior Doctors Network Newsletter
Issue 18
April 2020
JUNIOR DOCTORS’ ACTIVITIES Page 42
These activities offer additional opportunities for junior doctors
to learn essential knowledge and skills from health experts,
which are infrequently provided in required clinical and
research responsibilities.
The 146th session of the Executive Board (EB146) took place at the World Health
Organization (WHO) headquarters in Geneva, Switzerland, from February 3-8, 2020. This
meeting provided the opportunity for global health leaders to address various elements on
the established Programme of Work (1). Notably, coronavirus disease 2019 (COVID-19)
was of particular interest in the discussion, especially as the WHO recognized COVID-19
as a Public Health Emergency of International Concern on January 30, 2020.
Junior Doctors Network Newsletter
Issue 18
April 2020
World Health Organization: 146th Session of the Executive Board
INTERNATIONAL CONFERENCES Page 43
Paula Reges, MD
National Institute of Infectious Diseases
Evandro Chagas – Fiocruz
Rio de Janeiro, Brazil.
Audrey Fontaine, MD
Chair (2019−2020)
Junior Doctors Network
World Medical Association
Figure 1. Statements submitted to the WHO
Executive Board 146th session, February 2020.
Source: WHO EB 2020.
The EB146 was an opportunity to present
WHO updates, providing reports of previous
activities and actions, sharing challenges, and
collecting inputs and perspectives from
member states, civil society organizations, and
non-state actors (NSAs). This event facilitated
professional networking and engagement
between leaders of the World Medical
Association (WMA) and the 14 delegates of the
Junior Doctors Network (JDN).
Professional engagement was achieved by
hosting side meetings, facilitating open
discussions, and delivering policy statements.
JDN delegates participated in writing WMA
public statements on eight different agenda
items (Figure 1).
WMA-JDN members presented brief responses on the WMA public statements, including:
1) Primary Health Care (PHC) as a cornerstone to achieve Universal Health Coverage
(UHC); 2) WHO reform involvement of non-State actors, representing the WHO
Professions Alliance; and 3) Data and Innovation, with a global strategy on digital health
advocating for ethical values and strengthened governance (Photos 1-4).
Junior Doctors Network Newsletter
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April 2020
INTERNATIONAL CONFERENCES Page 44
Photo 1. WMA-JDN delegate, Dr Christian Kraef,
delivered a statement on Primary Health Care.
Credit: WHO EB146.
Photo 2. WMA-JDN delegate, Dr Yassen Tcholakov,
delivered a statement on WHO reform involvement of
non-State actors. Credit: WHO EB146.
Photo 3. WMA-JDN delegate, Dr Paula Reges,
delivered a statement on Data and innovation.
Credit: WHO EB146.
Photo 4. WMA-JDN delegation, Dr Sead Zeynel, Dr
Karan Parikh, Dr Paula Reges, Dr Nyambura Muroki,
Dr Audrey Fontaine, Dr Christian Kraef, Dr Mike
Kalmus Eliasz, Dr Caline Mattar, and Dr Yassen
Tcholakov (left to right) at the WHO Hall.
Credit: WHO EB146.
PHC continues to be highlighted as a core instrument necessary for the achievement of
UHC. Member states were urged to invest greatly in PHC, increase the affordability and
accessibility of health services, and build resilient health systems.
The report on the political declaration for prevention and control of noncommunicable
diseases provided various cost-effective, population-based, and individual-level
interventions for mental health and well-being that Member states can utilize to develop
national policies. Notably, to tackle the growing global health concern of premature deaths
attributed to air pollution, Member states requested that WHO leaders provide detailed
statistics on significant risk factors and morbidity and mortality rates and develop
recommendations for national action plans to mitigate risk.
Regarding the WHO governance reform processes, leaders emphasized the need to
enhance interactions and consultations between NSAs and WHO leaders. In the WHO
report in 2019, Web Consultation with Non-State Actors on their Involvement in WHO
Governance, recommendations included: 1) organizing NSAs into constituencies (e.g.
groups that represent similar interests); 2) limiting the number of statements delivered; and
3) creating an alternative forum where NSAs, Member states, and the WHO Secretariat
could discuss issues outside the governing body meetings (2). Due to the paucity of details
on these respective reforms, the consensus was for the WHO Secretariat to prepare a new
proposal on the modalities of engagements with NSAs for the 148th session of the
Executive Board (EB148) in January 2021.
Throughout the EB146, continued updates were provided on the SARS-Cov2 and COVID-
19 transmission, coupled with an open platform for questions. The WHO Director-General,
Dr Tedros Adhanom Ghebreyesus, and the WHO team on Health Emergencies stressed
the importance of health literacy and strengthening all health systems in light of this
outbreak.
Junior Doctors Network Newsletter
Issue 18
April 2020
INTERNATIONAL CONFERENCES Page 45
To achieve UHC, a need for enhanced intersectional
collaboration between all relevant stakeholders was emphasized.
Furthermore, the epidemic of information, known as an infodemic, was discussed as being
one of the largest threats to successful mitigation of this outbreak. With this overabundance
of correct and incorrect information, citizens are challenged to find trustworthy sources and
reliable guidance about COVID-19 transmission, thus spreading panic and despair.
By the closing ceremony of the EB146, the common sentiment was that the 73rd World
Health Assembly in May 2020 would incorporate an agenda that would highlight global
health priorities as well as the current COVID-19 concerns related to disease control. This
agenda would offer side meetings and open discussions for all delegates and facilitate
decision-making among WHO leaders and Member states.
References:
1) World Health Organization. Executive Board, 146th Session: programme of work. 2020 [cited 2020 Feb
28].
2) World Health Organization. Web consultation with non-State actors on their involvement in WHO
governance. 2019 [cited 2020 Feb 28].
Junior Doctors Network Newsletter
Issue 18
April 2020
INTERNATIONAL CONFERENCES Page 46
“This outbreak is a test of solidarity – political, financial and
scientific. We need to come together to fight a common enemy
that does not respect borders, ensure that we have the
resources necessary to bring this outbreak to an end and
bring our best science to the forefront to find shared answers
to shared problems.”
− Dr Tedros Adhanom Ghebreyesus (WHO Director-General)
The Prince Mahidol Award Conference (PMAC) is an annual global health conference that
focuses on policy-related health issues. Since 2008, this annual event has been co-hosted
by the Prince Mahidol Award Foundation and numerous international organizations such as
the World Health Organization (WHO) and the World Bank. PMAC 2020, recognized as the
Universal Health Coverage (UHC) Forum 2020, was held from January 28 to February 2,
2020, in Bangkok, Thailand.
Using the theme, Accelerating Progress Towards UHC, the conference aimed to present
evidence-based science and advance discussion on UHC goals, including challenges
related to national implementation and sustainability. More than 1,150 participants from 75
Junior Doctors Network Newsletter
Issue 18
April 2020
Prince Mahidol Award Conference 2020:
Universal Health Care Forum 2020
INTERNATIONAL CONFERENCES Page 47
Lyndah Kemunto, MBChB
Membership Director (2019−2020)
Junior Doctors Network
World Medical Association
Audrey Fontaine, MD
Chair (2019−2020)
Junior Doctors Network
World Medical Association
Christian Kraef, MD
Socio-Medical Affairs Officer (2019−2020)
Junior Doctors Network
World Medical Association
Jihoo Lee, MD
Internal Medicine Resident, Seoul National University
Director, Korean Intern Resident Association
Seoul, Republic of Korea
Figure 1. Themes of the plenary sessions at the Prince
Mahidol Award Conference 2020.
Countries attended PMAC 2020, including
four members of the Junior Doctors
Network (JDN) of the World Medical
Association. The JDN delegation, who
received an extended invitation from the
JDN of Thailand (JDN-Thai), formed part
of the conference rapporteur team and
prepared session summaries.
Pre-Conference Activities
At PMAC 2020, pre-conference activities included 55 side meetings and seven field visits to
health institutions. Side meetings set the stage for the main conference, with academic
sessions that focused on UHC presentations and discussions on Health for All and the
global goal of Leaving No One Behind. The dialogue cast light on diverse health issues
affecting youth, women and children, immigrants, and other vulnerable groups.
Representatives from several countries shared their experiences and lessons learned when
establishing UHC in their health systems.
Since the meeting was held in Thailand, a country that achieved UHC in 2002, participants
were able to directly observe and experience various elements of UHC in practice. They
visited seven institutions and learned about their health service delivery such as health
promotion and prevention activities, diagnosis and treatment measures, rehabilitation
medicine, and palliative care for vulnerable groups including the elderly, disabled persons,
prisoners, women, and children.
Participants had the opportunity to visit a public hospital and prison. First,
Pahonpolpayuhasena Hospital is a public hospital that provides One Day Surgery (ODS)
services (e.g. hernia repairs). Since this hospital recently adopted a strategy to be a centre
of excellence for ODS, health authorities have expanded the number of surgeries included
in the ODS package. Participants learned about these innovative cost-effective ODS
services that offer high-quality health care services, minimize duration of hospital admission
time, and reduce national health expenditure. Second, Samutprakan Central Prison was
originally built in 1937, but due to overcrowding conditions, a new prison was built in
another location and completed in 2001. During this visit, participants observed how Thai
leaders have dedicated efforts to implement health care coverage across all prisons and
improve prisoners’ quality of life.
Junior Doctors Network Newsletter
Issue 18
April 2020
INTERNATIONAL CONFERENCES Page 48
Session topics also included disease-specific topics, new
medical technologies, artificial intelligence, priority setting,
and UHC financing strategies.
Conference Agenda
The conference proceedings were opened by Her Royal Highness Princess Maha Charki
Sirirndhon of Thailand. Keynote speakers included Ban Ki-moon (deputy chair of The
Elders), Her Royal Highness Dina Mired of Jordan, and Prof Ralf Bartnschlager and Prof
David Mabey (2020 Prince Mahidol Awards Laureates). The laureates were awarded for
their research on Hepatitis C virus and Chlamydia trachomatis infection, respectively.
In the keynote address, Ban Ki-moon (former Secretary-General of the United Nations)
stressed the inadequate and uneven global progress towards UHC. Referencing statistics
from the latest WHO and World Bank reports on UHC, he revealed that although with
improved health coverage, rising levels of out-of-pocket health spending leads to
catastrophic financial challenges for households. Thus, he encouraged political leaders to
prioritize UHC through public financing, asserting that UHC is a political choice.
Then, Her Royal Highness Dina Mired made a strong call for commitment towards UHC.
She shared three essential pre-requisites for UHC: political goodwill, comprehensive
services and transformation health reforms, and strategic health leadership. She
emphasized the need to coordinate the health workforce at the centre of UHC through
empowering and promoting the right to health for all. As a renowned non-communicable
disease advocate, she underscored the significance of innovative health financing from sin
taxes of selected products like alcohol and tobacco.
First, robust leadership and governance were identified as key drivers to achieve UHC, as
the political economy requires transparency, trust, and confidence from all stakeholders.
Participants appeared to agree that health is a fundamental human right and that UHC
remains an ambitious yet critical goal toward achieving the targets of the Sustainable
Development Goals. Second, collaborative efforts for health financing would require social
solidarity, public and private sector involvement, and other innovative financing models.
Publicly financed UHC seemed to be the most progressive and sustainable model for
countries to achieve UHC. Low- and middle-income countries are urged to increase
domestic funding for health and reduce reliance on donor funding to make UHC more
sustainable.
Junior Doctors Network Newsletter
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April 2020
INTERNATIONAL CONFERENCES Page 49
Over the course of the conference, advanced discussions
highlighted the need for high-quality and comprehensive UHC
with appropriate health financing.
In conclusion, the PMAC 2020 provided an open platform for international health leaders to
discuss various elements of UHC. Throughout the conference sessions, the participation of
physicians and other health professionals appeared to be insufficient, despite their vital role
in UHC service delivery. Over the next few years, the WMA-JDN hopes to continue their
active participation and engagement in the discussion of these health-related agendas and
other emerging topics.
Acknowledgments: The WMA-JDN delegation would like to thank the PMAC 2020
organizing committee and JDN-Thai members for the kind invitation to actively participate
in these fascinating discussions.
Junior Doctors Network Newsletter
Issue 18
April 2020
INTERNATIONAL CONFERENCES Page 50
By encouraging physicians to openly share their expertise and
lessons learned in the clinical and community settings, the
voices of physicians in the field will be heard around the world.
Photo 1. Dr Jihoo Lee, Dr Christian Kraef, Dr
Audrey Fontaine, and Dr Lyndah Kemunto (left to
right) represent the JDN delegation at PMAC 2020.
Credit: PMAC 2020.
Photo 2. PMAC 2020 attendees participate in
conference activities. Credit: PMAC 2020.
The Junior Doctors Network (JDN) Climate Change Working Group was founded by junior
doctors in 2015, motivated by their knowledge and prior experiences of the impact of
climate change on population health. Junior doctors were enthusiastic to contribute input to
the World Medical Association (WMA) leadership on climate change and health at the
United Nations Framework Convention on Climate Change during the negotiations of the
Paris Agreement in 2015.
Since 2015, the working group has contributed to several WMA accomplishments. Among
them, JDN members have coordinated numerous WMA delegations to participate in
international meetings addressing climate change and formed strong alliances with other
organizations working in this field. They aimed to better understand how the health sector
influences international climate negotiations. Additionally, the working group has led the
revision of the WMA Climate Change and Health resolution, adopted in October 2017. This
resolution united junior doctors from across the world to contribute on formal manuscripts
for the World Medical Journal. For example, the collaborative manuscript focusing on the
role of physicians in social movements against climate change was published in the
December 2019 issue (1).
This year, JDN members are enthusiastic to coordinate additional activities for the Working
Group. The WHO-Civil Society Working Group on Climate Change will soon seek to
broaden its reach and involve more individuals. The areas of work, which are yet to be
finalized, will likely include advocacy for nationally determined contributions, work towards
green healthcare systems, and expansion of climate change education in health
professionals’ curriculum (2). Each element will have a strategy that is openly co-
constructed to encourage more JDN member involvement.
Junior Doctors Network Newsletter
Issue 18
April 2020
Climate Change Working Group Update
WORKING GROUPS Page 51
Junior doctors recognized the unique position of health
professionals in developing a positive narrative capable of
influencing climate change policy.
Yassen Tcholakov, MD
Deputy Chair (2019-2020)
Climate Change Working Group Lead (2019-2020)
Junior Doctors Network
World Medical Association
The WMA Council Meeting, which was to be held in April 2020 in Porto, Portugal, aimed to
discuss two new policies related to the environment and climate change. Although this
meeting has been cancelled, due to the coronavirus pandemic, the Working Group plans to
continue to advance these two policies for the next WMA Council Meeting. First, the
Turkish Medical Association planned to present the resolution, Protecting the Future
Generation’s Right to Live in a Healthy Environment, for adoption by the WMA. This
resolution involves numerous concepts related to planetary boundaries, defines the term
ecocide as “a serious loss, damage or destruction of ecosystems, and includes climate and
cultural damage”, and calls upon governments to amend the Rome Statute of International
Criminal Court in order to recognize Ecocide alongside Genocide, War Crimes, and Crimes
Against Humanity. Second, members aimed to establish Green Guidelines for WMA
meetings as a formal discussion point. Since this policy incorporates how the WMA can
improve practices held at meetings that can reduce the overall environmental impact, it has
the potential to encourage concrete actions that support other policies and serves as an
example for other global organizations.
As we begin a new decade, we must reflect on the status of the world and recognize the
impact of the current novel coronavirus pandemic. As a classic infectious disease, viral
transmission has shown the fragility of the globalized world as well as significant global
health challenges in emergency preparedness and response measures to protect
population health. Global environmental changes, whether by anthropogenic and man-
made sources, should be observed and analyzed, documenting important links to human
health.
One part of this complex answer incorporates the need to strengthen risk communication
skills among the climate change and health community. Although the climate impact of the
coronavirus is difficult to predict at the present time, a second question persists: will the
crashing economy lead to reduced global emissions or will challenges exist for the adoption
of renewable technologies? Only time will tell.
References
1) Briand A-S, McGushin A, Pétrin-Desrosiers C, Aglan A, Tcholakov Y. The role of physicians in fighting
climate change. World Medical Journal. 2019;65:46-49.
2) Tcholakov Y, Howard C, Beagley J, Miller J, Armstrong F, Omrani OE. Nationally determined
contributions and health: briefing for the health community. Geneva: World Health Organization and
Global Climate and Health Alliance; 2019.
Junior Doctors Network Newsletter
Issue 18
April 2020
WORKING GROUPS Page 52
One key reflection remains: why is our response to climate change
vastly different that our response to the coronavirus pandemic?