upJDN Newsletter Issue 25

Junior Doctors Network Newsletter
Issue 25
November 2022
Published by the Junior Doctors Network of the World Medical Association
Junior Doctors Network Newsletter
Issue 25
November 2022
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.
ISSN (print) 2415-1122
ISSN (online) 2312-220X
Junior Doctors Network Newsletter
Issue 25
November 2022
Junior Doctors Leadership 2021-22
Junior Doctors Network Newsletter
Issue 25
November 2022
2
Dr Andi Khomeini
Takdir
(Indonesia)
Publications Director
Junior Doctors Network Newsletter
Issue 25
November 2022
Editorial Team 2021-22
Junior Doctors Network Newsletter
Issue 25
November 2022
Andi Khomeini Takdir Yassen Tcholakov
Lwando Maki Jeazul Ponce
Lekha Rathod Iretomiwa Adeleye
Giacomo Crotti Manu Pradeep
Evo Esievoadje
3
Junior Doctors Network Newsletter
Issue 25
November 2022
Table of Contents
TEAM OF OFFICIALS’ CONTRIBUTIONS
01 Words from JDN Management Team
By JDN Management Team
02 Words from the Publications Team and Director
By Publications Team 2021-22 and Andi Khomeini Takdir
WORKING GROUP UPDATES
03 Medical Ethics working group
By Lwando Maki and Shiv Joshi
04 WHO working group
By Laura Kalkman
05 Climate Change working group
By Yassen Tcholakov, Lekha Rathod, Laura Jung
06 Pandemic working group
By Wenzhen Zuo and Marie-Claire Wangari
4
Junior Doctors Network Newsletter
Issue 25
November 2022
Table of Contents
JUNIOR DOCTORS’ ACTIVITIES
07 Brief Review of the context of the Act for the Improvement of Training Conditions
and Status of Medical Residents in Korea: Focusing on Working Hours and On-duty
Allowance
By Minku Kang and Seungwon Cho
JUNIOR DOCTORS’ SCIENTIFIC PERSPECTIVES
08 WHA75 WMA Intervention Writing: Human Resource for Health
By Wunna Tun et al
09 A One Health approach to tackling Antimicrobial Resistance
Mabel Ortiz De Leo and Deborah Sateler
JUNIOR DOCTORS’ COMMUNITY REFLECTIONS
10 What does legalization of cannabis mean for Malawi?
By Parth K. Patel and Sahiba S.Maniar
11 A Bangladeshi doctor’s experience of a medical camp for flood victims
By Lisanul Hasan
12 Multitudinous Trainee Doctors have been slaughtered mercilessly and arrested
by Myanmar Military since Military Coup
By Wunna Tun
5
Junior Doctors Network Newsletter
Issue 25
November 2022
We are writing to you towards the end of the 2021-2022 JDN term. This year was
an important transition year; we resumed in-person meetings after 2 years of only
virtual activities. However, this did not stop us from reverting to comfortable old
habits—we worked on making activities hybrid to make the best of the strides
achieved during the pandemic. This was not without challenges; yet we hope that it
will ensure that members from all regions of the world have a greater capacity to
continue engaging.
The fully hybrid JDN Meeting in Paris in April 2022 allowed a greater number of
participants to actively participate and a greater diversity of countries to be
represented! The JDN organized the first hybrid delegation to an external event
providing opportunities for members to remotely engage in critical global health
advocacy during the 75th World Health Assembly.
Internally, the management team made progress on many important issues for the
JDN: finalizing a new streamlined membership registration process, holding regular
information sessions for new members, updating the JDN website, creating the first
JDN handover manuals, and setting up a brand-new JDN archiving system for
important documents.
As we close this term, many new exciting areas of engagement are upcoming for
the JDN. The previously inactive Pandemic and the Antimicrobial Resistance
Working Groups restarted their work this year. While the JDN Climate Change and
Health Working Group made important contributions to the JDN over many years it
will now be closed but work in this area will not stop as a new Planetary Health
Working Group will build on it. With the opening of the LGBTQI+ Working Group,
we hope to create a new space for members to discuss equity and representation
for both healthcare workers as well as patients identifying with different genders
and orientations. We encourage you to look at the working group reports on page
8-13 and contact the respective working group chair/s to join one that aligns with
your interests.
The 2021-22 Management Team wishes the best of luck to the incoming
management team, will support them as they start working and will also continue to
remain available to JDN members for guidance.
Yassen Tcholakov,
on behalf of the JDN Management Team 2021-2022
01 Words from the Management Team
6
Junior Doctors Network Newsletter
Issue 25
November 2022
Dear JDN,
We present to you the newsletter of 2021-22 after a very long delay. We apologize
for the delay and hope that we have done justice to your trust in us. This newsletter
is a culmination of the team’s hard work over the last six months.
Thank you!
Publications Team of JDN WMA 2021-2022
__________________________________________________________________
It has been an honor to be together with the JDN-WMA management team for the
2021-2022 period. It has also been a pleasure to collaborate with the JDN-WMA
publication team for the same period, until finally being able to present this
newsletter to all of you.
In this newsletter we try to read and listen to articles that come from various
countries and are written by junior doctors from various scientific backgrounds.
There are many kind, positive, and constructive messages that our colleagues are
trying to convey. Hopefully, these messages will be an inspiration for the struggle to
move forward and continue to grow for junior doctors in other parts of the world.
This newsletter is the result of the work of friends from the JDN-WMA publication
team for the period 2021-2022. Hopefully good things can be continued in the
future, and for things that have not been as expected, then I as Director of
Publications express my deepest apologies from the bottom of my heart.
Best regards and hope for a good health for everyone.
Andi Khomeini Takdir
Director of Publication of JDN WMA 2021-2022
02 Words from the Publications Team and Director
7
Junior Doctors Network Newsletter
Issue 25
November 2022
Dr. Lwando Maki MBCHB(UCT)
Deputy Chair, WMA JDN Management Team
Cape Town, South Africa
Dr. Shiv Joshi, MBBS, MD
Medical Ethics Officer, WMA JDN Management Team
Department of Community Medicine, Jawaharlal Nehru Medical College,
DMIMS (Deemed to be University)
Sawangi (Meghe), Wardha, Maharashtra, India
Executive Summary
Medical ethics are integral to global health and the medical profession. Health
professionals have encouraged discussions on Medical Ethics topics such as clinical
competencies and responsibilities, human and animal research, patient confidentiality, and
end-of-life care. Junior doctors should be active leaders, encouraging global health
workforce dialogue on these diverse themes. JDN formed the Medical Ethics Working
Group on 22 June 2019 with the aim to strengthen a global network where JDN members
can share information, resources, and activities on Medical Ethics. It continues to develop
Medical Ethics activities and encourage Junior Doctors’ participation in policy analysis,
policy review, and research. The working group fosters collaborations that lead to Junior
Doctors exchanging clinical and community experiences in Medical Ethics.
Recent Activity Report
Medical Ethics in War
Junior doctors are affected by conflict environments and need medical ethics to face
scenarios requiring complex decisions. The JDN Medical Ethics working group hosted a
panel on Medical Ethics in War at the JDN Spring Hybrid Meeting during the WMA Council
Session in Paris on April 6, 2022. Dr. Lwando Maki chaired with Dr. Wunna Tun and Dr.
Shiv Joshi as moderators for the panel discussion at the office of French Medical Council.
Junior doctors from all WMA regions and JDN partners attended.
03 Medical Ethics working group
8
Junior Doctors Network Newsletter
Issue 25
November 2022
Launching of sister working group: The LGBTQIA+ Working Group
Junior Doctors Network emphasises non-discrimination, non-prejudice, and inclusion. This
sister working group will create a global network for junior doctors interested in LGBTQIA+
issues to share and distribute professional development activities such as meetings,
conferences, and workshops. The working group will conduct high-quality research and
publish it in journals devoted to current and emerging LGBTQIA+ issues. The working
group will commemorate international and regional diversity days, as well as advocate for
LGBTQIA+ people at global health events and meetings.
WMA Policy
Members of the working group reviewed WMA policy for contribution to JDN submissions.
2023 Plans:
• Social media campaign on medical ethics during war from medical ethics media sub-
group
• Case discussion and Hot Seat series called ‘EthiScan.’ From working chairs
• Third edition for the Medical Ethics Special Edition from medical ethics papers sub-
group
• Delegation to UNESCO Bioethics Conference from Medical Ethics Health deep dive
sub-group
• “Beyond the comfort Zone”: Arts and Ethics project from Medical Ethics Alive sub-
group
If you are interested in Medical Ethics and would like to participate with other JDN
colleagues in numerous activities, please contact the co-chairs of the JDN Medical Ethics
Working Group (dr.lwando.maki@gmail.com and drshivjoshi93@gmail.com) . The Medical
Ethics Work Group is the largest working group in JDN and has a vibrant and diverse
membership, where members represent the majority of World Health Organization regions
as well as various medical and surgical specialties.
Stay connected, and let your voice reach the world!
03 Medical Ethics working group
9
Junior Doctors Network Newsletter
Issue 25
November 2022
Laura C. Kalkman, MD
Chair, WHO Activities Working Group (2021-22), Junior Doctors Network, World Medical
Association
The JDN Working Group on WHO Activities was established in September 2021
and was active for the first time the past year. The main goals of the working group
on WHO activities are to streamline the participation of the JDN in WHO-related
activities to build capacity among junior doctors and foster meaningful participation
of young doctors in the global health arena. The Working Group on WHO activities
aims to inspire more junior doctors to engage in global health and high-level global
health diplomacy, involve them in relevant policy issues and add to the JDN by
reflecting the opinion and interests of junior doctors.
To this end, the working group has organized capacity-building events for
members. These include the intervention writing workshop, where members
learned how to write an official statement representing the vision of WMA on WHO
policies. Workshop members could participate in writing these actual documents for
the WHO Executive Board Meeting and World Health Assembly during the
workshop. The Working group members also envisioned an advocacy strategy
around global health themes, including Universal Health Coverage, the social
determinants of health and the COVID-19 pandemic. Moreover, the best advocacy
practices of youth-led organizations in the field of global health were shared during
an online webinar. The Working Group also initiated watch parties for important
WHO meetings and shared updates of these events with JDN members.
After an evaluation, the Working Group decided to continue its work in the
upcoming year and hopes to closely collaborate with other working groups on
creating advocacy activities and organize projects and publications to foster active
participation of junior doctors in WHO-related activities.
04 WHO working group
10
Junior Doctors Network Newsletter
Issue 25
November 2022
Yassen Tcholakov, MD MSc MIH
Chairperson of the WMA JDN
Chairperson of the JDN Climate Change Working Group
Public Health and Preventive Medicine Physician
Montreal, Canada
Lekha Rathod, MBBS MScIH
Incoming Chairperson of the JDN Planetary Health Working Group
Research Assistant, Julius Global Health, UMC Utrecht, The Netherlands
Member, Planetary Health Alliance
Mumbai, India
Laura Jung, MD MSc Public Health
Incoming Co-Chairperson of the JDN Planetary Health Working Group
Infectious Disease Resident
Board Member of the German Alliance on Climate Change and Health
Leipzig, Germany
The JDN Climate Change Working Group was formed in 2015 to organize JDN work and
increase the WMA’s capacity to engage in international climate change policy. It brought
together JDN members who had a variety of prior experiences in the field and who were
motivated by the desire to make the voice of doctors heard in the climate negotiations. In
the following years, the group contributed to the planning, organizing and coordinating
advocacy related to negotiations of what would become the Paris Agreement. The JDN
was back then one of the very few health groups which assiduously followed those
negotiations. Recognizing the unique position of health professionals in developing a
positive narrative capable of influencing climate change policy, and the unique experience
of many JDN members in the field, the working group served as a platform where JDN
members got together to collaboratively write articles, conduct advocacy, relevant
research, and contribute to WMA Policy including importantly the latest revision of the
WMA Declaration on Climate Change and Health.
05 The Climate Change and Health Working Group Last Report!
Time for Planetary Health to take the Stage
11
Junior Doctors Network Newsletter
Issue 25
November 2022
For the last few years, the Working Group has been functioning in ad-hoc mode, only
taking on tasks when opportunities present themselves. Nevertheless, this year, the
working group chair was approached by members interested in restarting work in this area.
Discussions eventually led to the proposal of a new JDN Working Group on Planetary
Health, which was created at the same time as the closure of the previous Climate Change
and Health Working Group. The new planetary health working group recognizes that
climate change is just one of several planetary boundaries that have been overstepped by
humanity. This more holistic perspective gives us the opportunity to better react to the
global environmental degradation, which is becoming increasingly apparent, and its impact
on human health and wellbeing. The answer offered by planetary health focuses on
transdisciplinary action on a policy as well as on the community level. The new working
group, therefore, aims to bring together health professionals who can act as change agents
for a healthy future. It furthermore plans to engage the whole JDN network, building on the
member’s experiences with health impacts and local solutions to the planetary crisis.
This article is the last sign-off of Yassen Tcholakov as the Chair of the Climate Change
Working group, but he will nevertheless work closely with the newly formed Planetary
Heath WG to ensure the success of this transitional period and this new start under the
leadership of co-chairs Lekha Rathod and Laura Jung. If you are interested in contributing
in any way, please reach out to them.
05 The Climate Change and Health Working Group Last Report!
Time for Planetary Health to take the Stage
12
Junior Doctors Network Newsletter
Issue 25
November 2022
Wenzhen (Jen) Zuo, MD
Chairperson of the JDN COVID-19 / Pandemic Working Group
Canada
Marie-Claire (MC) Wangari, MD
Co-chairperson of the JDN COVID-19 / Pandemic Working Group
Kenya
Introduction
The Pandemic Working Group is a newly re-activated working group since January 2022
from the ad-hoc “COVID-19 working group”, created at the beginning of this pandemic. It
was re-started at the height of the Omicron wave, to offer a space for junior doctors around
the world to share their experiences from their respective countries and to keep ourselves
informed about realities that are facing each other. We have shared stories while working
with colleagues around the world and have collected these stories via a google form.
These are pending to be published over a social media campaign later this autumn.
The current aim of the working group is to review developments in the public health arena
on matters pertaining to health emergencies of concern e.g., COVID-19 and monkeypox
and appraise solutions being tabled with an aim to add the voice of junior doctors
worldwide in these efforts.
In terms of accomplished activities, the working group has participated in following all the
discussions around the New Pandemic Treaty that is being negotiated at the World Health
Organisation (WHO). We took part in the first and second meetings of the
Intergovernmental Negotiating Body (INB) of WHO as representatives from the WMA. We
presented at the last April’s council meeting of WMA in Paris a session on “Vaccine
inequity and hesitancy”. We also had an advocacy strategic planning session last July,
which set the foundation of our advocacy strategic planning for the next two years for the
Pandemic Instrument.
What’s up-coming next: projects and opportunities to look out for
• Comments from the WG about the zero draft of the Pandemic New Instrument – early
September 2022
• Advocacy toolkit being drafted in collaboration with UAEM – October 2022
• WMA GA in Berlin: WG session at the pre-GA JDN’s autumn bi-annual meeting
• Publication of pandemic stories on social media
• Third INB meeting in Dec – online streaming early December
If you are interested to join us, please write to wenzhen.zuo@gmail.com
06 COVID-19 / Pandemic working group
13
Junior Doctors Network Newsletter
Issue 25
November 2022
Minku Kang *, MD
Korean Intern Resident Association, Seoul, Korea
Department of Preventive Medicine, Korea University College of Medicine,
Seoul, Korea
Department of Public Health, Korea University Graduate School,
Seoul, Korea
Seungwon Cho *, MD
Korean Intern Resident Association, Seoul, Korea
Department of Psychiatry, Hanyang University Medical Center, Seoul, Korea
Department of Health Policy and Management,
Graduate School of Public Health, Hanyang University, Seoul, Korea
*Both authors contributed equally to this work
Figure 1 Korean medical residents protesting unfair 100-hour work weeks. 2012. Source:
http://www.bosa.co.kr/news/articleView.html?idxno=2051728
07 Brief Review of the context of the Act for the Improvement of Training
Conditions and Status of Medical Residents in Korea: Focusing on
Working Hours and On-duty Allowance
14
Junior Doctors Network Newsletter
Issue 25
November 2022
Medical residents in Korea maintain a dual status of being both workers and trainees. In
2015, the Act for the Improvement of Training Conditions and Status of Medical Residents
(the Medical Resident Act, 전공의법(Korean)) was legislated by the South Korean
government.(1)
Before the legislation, Korean medical residents worked an average of nearly 90 hours a
week(2). Many of them experienced physical, verbal, and sexual violence in the workplace
(2, 3). As a result, medical residents reported significantly higher levels of musculoskeletal
symptoms and deteriorated mental health as compared to the general population (2, 3).
In 2014, a medical resident won a case concerning the payment of the on-duty allowance
was not enough considering the Labour Standards Act1. (Daejeon High Court 2014. 11. 26,
judgment 2013 Na 11186). In many training hospitals in Korea at the time, it was
customary to pay wages comprehensively without any extra pay for overtime or holiday
work and only ten to twenty dollars for night duty. The court ruled that medical residents
should also be paid an on-the-job allowance under the Labour Standards Act which sets
out the minimum standards for any employment.
This litigation concerning the on-duty allowance and studies(2, 3) concerning the
impractical working hours led to the introduction of the Medical Resident Act. After the
introduction of the Medical Resident Act, the working hours of the medical residents
decreased considerably. According to the ‘2021 Resident Study’ conducted by the Korean
Intern Medical Association (KIRA), medical residents work about 77 hours on average per
week.(4, 5) Although the average working hours of medical residents increased slightly in
2021 than in 2020 due to the influence of COVID-19, it is clear that the working hours are
gradually decreasing considering the five-year trend.(5) Despite the clear improvement,
medical residents are still not fully protected by the Labour Standards Act.
1The Labour Standards Act is a national act which prescribes minimal standards for terms and
conditions of employment including wages, working hours, holidays, and leave. Overtime work,
night work and holiday work must be paid 50% more than the ordinary wage. The maximum weekly
working hours is 52 hours and employers must grant a daily rest period of at least 11 hours.
07 Brief Review of the context of the Act for the Improvement of Training
Conditions and Status of Medical Residents in Korea: Focusing on
Working Hours and On-duty Allowance
15
Junior Doctors Network Newsletter
Issue 25
November 2022
Long Working Hours
The current act regulates that the working hours cannot exceed more than 80 hours per
week for an average of four weeks. Contrary to the original intention of reducing the
working hours of the medical residents, this provision had the effect of stipulating the
working hours of the medical residents to be practically 80 hours. Another problem is that
the act permits 36 hours of non-stop work up to three times a week.
Absence of Additional Wage Calculation Standards
Medical residents face unpaid overtime, night, and holiday work due to the absence of
additional wage calculation standards. Medical residents are not subject to the provisions
of the Labour Standards Act regarding working hours and holidays due to the adoption of
the comprehensive wage system.(6) According to the ‘COVID-19-related Resident Survey’
conducted by the KIRA, 59% of respondents reported that they did not receive even the
minimum allowance for approximately two years after the outbreak of COVID-19.(5)
The Necessity of the Medical Resident Act Reform
Medical residents are still enduring long working hours and 36 hours of continuous work. It
is necessary to revise the Medical Resident Act, which presupposes fundamental labour
rights under the Labour Standards Act.(7) The primary goal is to reduce medical residents’
working hours and to reduce the upper limit of the continuous 36 hours of work.
It is also essential to introduce a procedure for negotiating contracts with the possibility of
reducing working hours and improving on-duty allowance through the trade union.(6) There
is a need for revision to guarantee payment of disaster allowances when working overtime,
at nighttime, on holidays, or working in disaster situations such as COVID-19.(6) Through
the related discussions, the hope is that the employment contract will be made based on
equal and reasonable negotiations between employers and medical residents and will
protect the rights and interests of medical residents in accordance with those stipulated in
the Labour Standards Act.
07 Brief Review of the context of the Act for the Improvement of Training
Conditions and Status of Medical Residents in Korea: Focusing on
Working Hours and On-duty Allowance
16
Junior Doctors Network Newsletter
Issue 25
November 2022
References
1. Act on the Improvement of Training Conditions and Status of Medical Residents.
[Available from:
https://elaw.klri.re.kr/eng_mobile/ganadaDetail.do?hseq=40274&type=abc&key=ACT%
20FOR%20THE%20IMPROVEMENT%20OF%20TRAINING%20CONDITIONS%20AN
D%20STATUS%20OF%20MEDICAL%20RESIDENTS&param=A].
2. Kim S, Kim S, Kim J. Working condition, health and perceived patient safety among
doctors in training: 2014 Korean Intern and Resident survey. Health and Social Welfare
Review. 2015;35(2):584-607.
3. Kim S. The working condition and patient safety of the medical resident: training that
was too painful was not training. Journal of the Korean Medical Association.
2016;59(2):82-
4. Sohn S, Seo Y, Jeong Y, Lee S, Lee J, Lee KJ. Changes in the working conditions and
learning environment of medical residents after the enactment of the Medical Resident
Act in Korea in 2015: a national 4-year longitudinal study. Journal of educational
evaluation for health professions. 2021;18.
5. COVID-19-related Resident Survey Seoul: Korean Intern Resident Association, 2022;
[updated 9 Feb 2022. Available
from:http://youngmd.org/155/?idx=10214730&bmode=view.
6. Kim I. Problems and improvement plans of the current medical residents training
system. Medical Policy Forum. 2012;10(1):102-7.
7. Kang M. ‘Seven years after the Medical Resident Act. time to reform the act considering
‘labour rights’ Seoul: Medical Times; [updated 14 Feb 2022. Available from:
https://www.medicaltimes.com/Main/News/NewsView.html?ID=1145732].
07 Brief Review of the context of the Act for the Improvement of Training
Conditions and Status of Medical Residents in Korea: Focusing on
Working Hours and On-duty Allowance
17
Junior Doctors Network Newsletter
Issue 25
November 2022
08 WHA75 WMA Intervention Writing: Human Resource for Health
Wunna Tun, MBBS, MD
Secretary, JDN, World Medical Association
Myanmar
Minku Kang, MD
Department of Preventive Medicine, Korea University College of
Medicine, Seoul, Korea
President, Korean Intern Resident Association (KIRA)
Seoul, Korea
Ian Pereira, MD
Radiation Oncology,
Queen’s University
Kingston, Canada
Iretomiwa Adeleye, MBBS
Cantonment Medical Center, Headquarters Training & Doctrine
Command Nigerian Army (HQ TRADOC NA)
Medical Women’s Association of Nigeria (MWAN)
Lagos, Nigeria
Pablo Estrella Porter, MD, MPHc
Hospital Clínico Universitario de Valencia
Valencia, Spain
Lekha Rathod, MBBS MScIH
Research Assistant, Julius Global Health, UMC
Utrecht, Netherlands & Mumbai, India
Balkiss Abdelmoula, MD, MPH
Family Medicine Specialist, University of Sfax
Tunisia
Khatia Otarashvili, MD, MH
Ph.D. Student in Public Health, Ilia State University
Tbilisi, Georgia
18
Junior Doctors Network Newsletter
Issue 25
November 2022
The 75th World Health Assembly (WHA) in May 2022 spanned over a week in the Palais
des Nation, Geneva, Switzerland (1). The main theme was ‘Health for Peace and Peace
for Health’ focusing on four Pillars. The Human Resources for Health (HRH) agenda falls
under Pillar 1: a target for more than one billion people benefitting from universal health
coverage (UHC).
In 2016, the 69th WHA adopted resolution 69.19 to develop the WHO Global Strategy on
Human Resources for Health: Workforce 2030. This provided policy options for the
Member States on health workforce education, regulation, retention, skill optimization, and
other workforce needs. The concept of this is to develop workforce optimization policies, to
stimulate investments in the health labor market that are responsive to population needs,
to build institutional capacity and partnerships and to develop data for monitoring and
accountability that are applicable in a variety of socioeconomic and regional contexts. (3).
In May 2021, the 74th WHA adopted resolution 74.14 on protecting, safeguarding and
investing in the healthcare workforce to develop a clear set of actions, a 2022–2030
agenda and an implementation mechanism to be presented to the 75th WHA in 2022 for
accelerating investments in healthcare worker education, skills, jobs, safeguarding and
protection. Core objectives across key sectors based on key principles were described (4).
Part of this was the development of the “global healthcare worker compact”, a document
that aimed to provide the Member States, stakeholders and other relevant organizations
with technical guidance on how to protect healthcare workers and safeguard their rights
and to promote and ensure decent work, free from racial and all other forms of
discrimination and a safe and enabling practice environment (5). The Compact had four
domains: 1) preventing harm, 2) providing support, 3) inclusivity, and 4) safeguarding the
rights of healthcare workers with a suggestion they could be operationalized through
Workforce 2030 (3). None of these policies suggests what is legally binding to protect the
safety of the health workforce. This leaves the human rights of the health workforce up to
dangerous interpretation.
The World Medical Association (WMA) holds an official observer status with the World
Health Organization (WHO). JDN is part of the Associate Members of the WMA and
contributes to drafting its intervention statements for the WHA (2).
08 WHA75 WMA Intervention Writing: Human Resource for Health
19
Junior Doctors Network Newsletter
Issue 25
November 2022
There were a total of 10 JDN members working on HRH policy at the WHA, which was the
largest JDN engagement for writing interventions at the WHA. Membership was open to all
JDN members; this team included Wunna, Balkiss, Pablo, Flora, Minku, Nikolai, Khatia,
Ian, Lekha, Iretomiwa, and Imtia who provided their enormous contributions to the HRH
policy draft. JDN Management team members Yassen, Wenzhen, and JDN WHO WG
chair Laura provided crucial support. The team used a collaborative model giving all
members an opportunity to provide initial input, followed by multiple rounds of refinement of
the statements and an opportunity for all members to suggest changes. The working
documents of the group including a detailed background, discussion, comments and
references were stored separately for future use. The team met virtually on 2 occasions
and each meeting lasted approximately 120 minutes. These meetings were used to edit
the draft and share different perspectives among members from our diverse backgrounds
through collaborative discussion. The team discussed the topic in a shared document and
exchanged several emails over the queries and comments.
The JDN HRH draft team decided to stress exploring legally binding mechanisms to
protect the safety of the health workforce in this WMA intervention.
The team prepared 2 versions of their intervention, one is 140 words and another is 300
words in case these statements would be used for further constituency statements. The
JDN draft of this statement was further revised and improved by the WMA secretariat.
Ultimately, the WMA statement was accepted as a constituency statement together with
International Pharmaceutical Federation, International Pharmaceutical Students’
Federation, FDI World Dental Federation, World Confederation for Physical Therapy,
March of Dimes, and the International League of Dermatological Societies (6). All of the
constituency members agreed about the importance of a legally binding mechanism to
protect HRH. The final statement can be read below.
The Health Workforce HWF is the core of health systems. The shortage of health
personnel will grow with the pandemic exacerbating that problem. Due to increased
educational inequities, future professionals have either ceased studying or received
substandard education, adding to the shortfall and widening skills-gaps. The governance of
HRH issues is increasingly complex and WHO plays a central role to increase coherence.
The delivery of high-quality health services depends on environments that support decent
work conditions. Throughout the pandemic, healthcare personnel have worked long hours,
faced unwarrantable violence and worsened mental health in high-pressure environments.
Under-investment has resulted in the deterioration of working conditions. The protection
and performance of the HWF requires legally binding strategies to guarantee the safety of
health personnel especially in high-risk settings.
08 WHA75 WMA Intervention Writing: Human Resource for Health
20
Junior Doctors Network Newsletter
Issue 25
November 2022
States should mobilize investments to retain healthcare professionals in the profession and
in their country by providing the support they need to meet their goals. These retention
strategies include protection, resourcing, training, career development and fair
remuneration. Member states (MS) must implement the international code for recruitment
of HWF.
MS must improve the safety and sustainability of the HWF through accountability and
instruments that enable data-driven decision-making by exploring legally binding
mechanisms to uphold workforce rights, including all equity-seeking groups and to provide
methods to analyze data to minimize institutional barriers and biases. The four domains of
the Global health and care worker compact: preventing harm; providing support; inclusivity;
and safeguarding rights, must be addressed by MS.
Professionals in training and early career are often used as replacement or sent into the
harshest working conditions. It is critical that they are not exploited and be put into
dangerous situations.
It remains to be seen if future WHO and the Member States meetings will work to
strengthen legal protections for healthcare workers. In the meantime, JDN members can
continue advocating for improved working conditions and provide support for each other so
that we can achieve these improvements, together with patients and our health systems, in
solidarity.
References
1. WHA75 (2022). Available at: https://apps.who.int/gb/e/e_WHA75.html (Accessed: July
10, 2022).
2. About us (no date). Available at: https://www.wma.net/junior-doctors/about-us/
(Accessed: July 10, 2022).
3. Human resources for health (2022). Available at:
https://apps.who.int/gb/ebwha/pdf_files/WHA75/A75_15-en.pdf (Accessed: July 10,
2022).
4. Seventy-fifth world health assembly (2022). Available at:
https://apps.who.int/gb/ebwha/pdf_files/WHA75/A75_12-en.pdf (Accessed: July 10,
2022).
5. Human resources for health (2022b). Available at:
https://apps.who.int/gb/ebwha/pdf_files/WHA75/A75_13-en.pdf (Accessed: July 10,
2022).
6. 75 th World Health Assembly -2022 Constituency statement on agenda item 15. Human
resources for health (2022). Available at: https://www.wma.net/wp-
content/uploads/2022/05/WHA75-HPs-constituency-statement-on-HRH-1.pdf
(Accessed: July 10, 2022).
08 WHA75 WMA Intervention Writing: Human Resource for Health
21
Junior Doctors Network Newsletter
Issue 25
November 2022
Mabel Johana Ortiz de Leo MD, MBA, MSc in Antimicrobial Resistance
Veracruz, Mexico
Deborah Sateler DVM, BSc Environmental Public Health
Science Advisor
One Health Scientific Solutions
St. Albert, Canada
Overview
Antimicrobials are widely used across industries, in the environment, veterinary, and
human health sectors. These are life-saving drugs and essential agents against infectious
diseases. However, their effectiveness has been seriously compromised because of the
increasing number of resistance genes in most bacteria, fungi and parasites causing
human disease (1). This is a worldwide challenge known as Antimicrobial Resistance
(AMR), and it has become a global threat to public health systems in recent decades. The
interconnection between human and animal habitats in their shared environment
contributes to antimicrobial resistant organisms’ emergence, evolution, and spreading (2);
thus, fighting AMR requires a One Health approach.
The misuse of antimicrobials has increased recently because in some countries, these
remain unregulated, available without a prescription, and relatively cheap to acquire.
Additionally, complicated social, political, and microbiological dynamics undermine
competent AMR stewardship in human medicine, especially in low and middle-income
countries. The consequences of infection with resistant organisms are concerning and
contribute to extended hospital stays and increased mortality; the proliferation of
antimicrobial-resistant microorganisms compromises the protection of current and future
patients undergoing surgery, chemotherapy, or any other medical procedure (3).
The burden
According to the Review in Antimicrobial Resistance by the UK government, it is expected
that by 2050, drug-resistant infectious diseases will cause 10 million deaths each year (4).
The global prevalence of AMR is vast and has been estimated in a recent report from
Murray CJL et al. in 2019 (5). In predictive statistical models, an estimated 4.95 million
deaths were associated with bacterial AMR, including 1.27 million deaths directly
attributable to bacterial AMR. In addition, the six death leading pathogens associated with
resistance were Escherichia coli, followed by Staphylococcus aureus, Klebsiella
pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas
aeruginosa. This report has been the most comprehensive, with data from systematic
literature reviews, hospitals, and surveillance systems from 204 countries.
09 A One Health approach to tackling Antimicrobial Resistance
22
Junior Doctors Network Newsletter
Issue 25
November 2022
Types of antimicrobial resistance
The spread of resistant strains in bacteria is facilitated via several vectors such as humans,
animals, and the environment (6). Clinically significant resistance genes can cross habitat
boundaries from environmental microorganisms to human pathogens. The pathogens
(bacteria) that face antimicrobial selection pressure enhance their fitness by acquiring and
expressing resistance genes, then sharing them with other bacteria through gene over-
expression and silencing, phase variation, or horizontal gene transfer (7).
Levels of resistance can be widely different among related bacterial groups. Susceptibility
and resistance are usually measured through the minimum inhibitory concentration (MIC),
defined as the minimal concentration of a drug that will inhibit the growth of bacteria. This
concept is used to classify the types of AMR in bacteria as natural or acquired (8) (9).
1. Natural Resistance
Natural resistance may be intrinsic (always expressed) or induced (the genes are naturally
in the bacteria but only expressed to resistance levels after exposure to an antibiotic). The
most prevailing intrinsic resistance mechanisms in bacteria are:
a. Reduced permeability of the outer membrane
b. Efflux Pumps
Examples of bacteria and their intrinsic resistance to antibiotics are: E. coli (intrinsic
resistance to macrolides) and gram negatives (intrinsic resistance to glycopeptides and
lipopeptides)
2. Acquired Resistance
Acquiring genetic material that confers resistance to bacteria is possible through the
following (8, 9):
a. Transformation
b. Transposition
c. Conjugation
d. Mutations
e. Bacteriophage-borne transmission (rare)
f. Plasmid-mediated transmission of resistance genes (most common
acquisition route of extraneous genetic material
Mechanisms of antimicrobial resistance
The main categories of antimicrobial resistance mechanisms in bacteria are (Figure 1):
1. Limiting uptake of a drug (Natural), including antimicrobials.
2. Inactivation of a drug (Natural/Acquired) by affecting its chemical mechanisms.
3. Modification of a drug target (Acquired) to build resistance.
4. Active drug efflux (Natural/Acquired) to eject toxic substances.
09 A One Health approach to tackling Antimicrobial Resistance
23
Junior Doctors Network Newsletter
Issue 25
November 2022
Figure 1: Antimicrobial Resistance Mechanisms.
Image credits: Kosmidis S, 2015.
The microbiome of humans, animals, plants, water and soils are interconnected within the
bacterial pangenome1, including their antimicrobial-resistant genes (ARGs) that can flow
between them without restrictions (6). This mobile resistome2 can transmit ARGs from
person to person and into the environment. Additionally, the exposure to pathogens has
been exacerbated through the rapid growth, expansion, and international travel of human
populations, leading to more people living in close contact with wild and domestic animals,
both livestock and pets. This scenario facilitates the spread of existing or known (endemic)
and new or emerging zoonotic diseases.
Antimicrobial resistance under the One Health lens
The multifactorial nature of the AMR as a global health threat requires a transdisciplinary
effort, where multiple sectors, disciplines, and communities at different levels of society are
involved. This perspective is what is promoted by the One Health concept, a term officially
launched in 2004 within “The Manhattan Principles” at a Wildlife Conservation Society’s
meeting. The document focused on providing recommendations for a more holistic
approach to Health considering the, back then, recent outbreaks of severe acute
respiratory disease (SARS), highly pathogenic avian influenza H5N1, and Ebola between
2003 and 2004 (10).
09 A One Health approach to tackling Antimicrobial Resistance
24
Junior Doctors Network Newsletter
Issue 25
November 2022
Currently, the most recent definition of the One Health approach has been provided by the
One Health High-Level Expert Panel (OHHLEP) and supported by the Quadripartite (WHO-
WOAH-FAO-UNEP) in 2021. It states that One Health should be an integrated and unifying
approach that aims to balance and sustainably optimize the Health of people, animals, and
ecosystems. It recognizes that the health of humans, domestic and wild animals, plants,
and the general environment (including ecosystems) are closely linked and interdependent
(11).
Implementing the One Health approach strengthens the collaboration between sectors and
disciplines, which contributes to protecting Health and addressing health challenges such
as the emergence of infectious diseases and antimicrobial resistance. Additionally, this
approach allows tackling the full spectrum of disease control by linking the Health of
humans, animals, plants, and the environment. As previously mentioned, these are
interrelated and impact antimicrobial resistant organisms’ emergence, evolution and
spreading (Figure 2). A remarkable characteristic of One Health is its applicability at any
level of society (community, national, regional and global) to promote the prioritization of
research and interventions (11).
Fig. 2: One Health approach and AMR. Representation of the interrelatedness between human
activities and the environment and its elements.
Image Credits: Dr Mabel Ortiz De Leo
Health care professionals are fundamental to combat AMR and other public health issues
such as the emergence of zoonotic diseases (e.g., COVID-19 and Monkeypox); adopting a
One Health approach represents an excellent opportunity to promote the well-being of
individuals, their communities, and ecosystems.
09 A One Health approach to tackling Antimicrobial Resistance
25
Junior Doctors Network Newsletter
Issue 25
November 2022
References
1. Gil-Gil T, Laborda P, Sanz-García F, Hernando-Amado S, Blanco P, Martínez JL.
Antimicrobial resistance: A multifaceted problem with multipronged solutions.
Microbiologyopen. 2019;8(11):1–4.
2. One Health [Internet]. [cited 2021 Feb 21]. Available from: https://www.who.int/news-
room/q-a-detail/one-health
3. Ferri M, Ranucci E, Romagnoli P, Giaccone V. Antimicrobial resistance: A global
emerging threat to public health systems. Crit Rev Food Sci Nutr [Internet].
2017;57(13):2857–76. Available from:
http://dx.doi.org/10.1080/10408398.2015.1077192
4. Stone NRH, Rhodes J, Fisher MC, Mfinanga S, Kivuyo S, Rugemalila J, et al. Dynamic
ploidy changes drive fluconazole resistance in human cryptococcal meningitis. J Clin
Invest [Internet]. 2019;129(3):999–1014. Available from:
https://doi.org/10.1172/JCI124516
5. Murray CJL, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al.
Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. The
Lancet. 2022;399(10325):629–55.
6. Sun Q, Wang Y, Hulth A, Xiao Y, Nilsson LE, Li X, et al. Study protocol for One Health
data collections, analyses and intervention of the Sino-Swedish integrated multisectoral
partnership for antibiotic resistance containment (IMPACT). BMJ Open. 2018;8(1).
7. McEwen SA, Collignon PJ. Antimicrobial Resistance: a One Health Perspective.
Antimicrob Resist Bact from Livest Companion Anim. 2018;521–47.
8. Roy PH. Genetic mechanisms of transfer of drug resistance. Antimicrobial Drug
Resistance. 2009;53–64.
9. C Reygaert W. An overview of the antimicrobial resistance mechanisms of bacteria.
AIMS Microbiology. 2018;4(3):482–501.
10.One Health Basics, Centers for Disease Control and Prevention [Internet]. [cited 2022
June 10]. Available from: https://www.cdc.gov/onehealth/basics/index.html
11.Joint Tripartite (FAO, OIE, WHO) and UNEP Statement [Internet]. [cited 2022 August
23]. Available from: https://www.who.int/news/item/01-12-2021-tripartite-and-unep-
support-ohhlep-s-definition-of-one-health
09 A One Health approach to tackling Antimicrobial Resistance
26
Junior Doctors Network Newsletter
Issue 25
November 2022
Dr. Parth K. Patel
Dr. Sahiba S. Maniar
The Malawian Cannabis, affectionately known as Malawi Gold (aka Chamba), is
internationally known in Africa and Internationally (1). Rated as an elite cannabis strain in
the world by a World Bank report, it remains one of the most potent psychoactive
substances with the least tested impurities (2). Following years of parliamentary motions
and endless debates, in February 2020, a bill was passed by the August House to
decriminalize Cannabis for medicinal and industrial purposes (3). This development
structured by the Cannabis Regulatory Authority of Malawi (CRAM), allows commercial
cultivation and processing of Cannabis, yet it falls short of decriminalizing its recreational
use (1).
Examining the cannabis plant through botanical lenses highlights the usefulness of every
part of the plant, releasing it from the sole intoxication purposes. The seeds are high in
omega-6 fatty acids (GLA) and ten essential amino acids. They can be consumed whole or
used to produce various food products, including hemp oil, hemp milk, hemp cheese, and
hemp-based protein powder. The stalks of the plant are the most industrially relevant. They
are used for diverse purposes, such as in plastic composites (hemp fiberglass and flax are
used to create parts for Mercedes, BMW, and Jaguar); clothing (hemp fiber is stronger and
softer than cotton); building materials (non-toxic and considered a carbon-sink widely used
for insulation and roofing); wood-based products (papers and tissues); ropes made of
twisted hemp fibers; biofuel (Hemp ethanol). The leaves have a strong medicinal use for
CBD oil (an anti-proliferative agent with analgesic, anti-inflammatory, and anti-anxiolytic
effects), predominantly as an adjunct therapy. The flowers are rich in resin and widely used
to produce creams, lotions, and shampoos (4).
Furthermore, it is crucial to consider the huge economic benefits for Malawi of
decriminalizing Cannabis, given its status as a Low-Middle Income Country (LMIC). Malawi
has been heavily reliant and a major producer of tobacco globally. However, with the
increasing regulations against tobacco use globally, revenues collected through the
markets are dipping lower every season, strangulating economic growth further (5). With
strong compliance to the rigorous international standards, Malawi may benefit from a
switch to large-scale cannabis production as an exciting revenue earner for the
Government, creating massive avenues for the overall progress of the country. Taxes
collected could be channeled back into numerous services like roads, transport, education,
and healthcare facilities (6).
10 What does legalization of cannabis mean for Malawi?
27
Junior Doctors Network Newsletter
Issue 25
November 2022
Such additional income levels could indirectly mitigate challenges faced in the public health
sector as well as provide the avenue to the long-awaited and widespread spoken-about
universal health coverage.
Controversial research studies have claimed that the effects of Cannabis used in
recreational circumstances are generated through the main psychoactive ingredient called
tetrahydrocannabinol (THC) and cannabidiol (CBD), which acts on specific cannabinoid or
CB1 receptors (7). THC has strong psychoactive effects, making the user’ high’, whereas
CBD has an anti-psychoactive effect that moderates the effects of THC (8). Extensive
pharmacological analysis suggests that THC has analgesic, anti-inflammatory, antioxidant,
and antiemetic properties. In contrast, CBD exhibits the potential to treat epilepsy,
schizophrenia, type 2 diabetes, inflammatory bowel disease, and drug dependency. These
advantages cannot be ignored while discussing a drug of paramount importance (9).
Despite all this, most countries globally, through innumerable debates, discussions, and
forums, have maintained their stance firmly against the adoption and introduction of
Cannabis for medicinal purposes due to the lack of safety data.
The CRAM has a fee of US$10,000 to acquire a license to cultivate Cannabis, claimed a
prohibitively high amount for Malawian farmers (5). CRAM has further outlined basic
regulations for industrial vs medicinal cannabis production (10). The pressing question
regarding the safe usage of medicinal Cannabis for consumers in large and unregulated
quantities remains unanswered. Further amplified, technical prerequisites to produce the
therapeutic form of this drug do not certainly address quality control measures –
uncontrolled contamination, inadequate biochemical processing, as well as disagreements
on the most suitable and accurate analytical methods present a challenge not only to
consumers but also manufacturers and regulators.
Without a well-defined guideline on when to prescribe Cannabis for medicinal purposes,
physicians are at a colossal risk of disciplinary action by regulators in any direct or indirect
adverse events. The unavailability of a rigorous framework to mitigate problems arising out
of this law should be viewed as an opening for physicians to actively engage stakeholders
in advocating for safe production and minimal usage of these unsupervised therapeutic
agents, ensuring non-maleficence and enhancing the health of the population at large.
10 What does legalization of cannabis mean for Malawi?
28
Junior Doctors Network Newsletter
Issue 25
November 2022
References
1. https://www.reuters.com/article/malawi-cannabis-idUSL8N2IA4VV
2. https://web.archive.org/web/2012011213023
3. http://www.bnltimes.com/index.php?option=com_content&view=article&id=2877:malawi
s-chamba-valued-at-k1-4-billion&catid=42:national&Itemid=401
4. https://www.theguardian.com/global-development/2020/feb/28/malawi-legalises-
cannabis-amid-hopes-of-fresh-economic-growth
5. https://www.malawihemp.org/article/hemp-101
6. https://www.africanews.com/2022/05/01/malawi-looks-to-cannabis-for-profits-amid-
declining-tobacco-demand//
7. https://www.ica-malawi.org/faqs
8. https://www.nps.org.au/australian-prescriber/articles/prescribing-medicinal-cannabis
9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7023045/
10.https://www.ncbi.nlm.nih.gov/books/NBK423845/
11.http://www.daes.gov.mw/pictures/1633614115GUIDELINES%20FOR%20THE%20CAN
NABIS%20INDUSTRY%20IN%20MALAWI.pdf
10 What does legalization of cannabis mean for Malawi?
29
Junior Doctors Network Newsletter
Issue 25
November 2022
By Lisanul Hasan, MBBS
Honorary Medical Officer, Department of Psychiatry,
Dhaka Medical College & Hospital Community Activities
Dhaka, Bangladesh
A monsoon flood incapacitated the Greater Sylhet region of Bangladesh for almost a
month. Many say the region has not seen such a massive flood in the last 50 years. A
huge number of people are suffering while they take shelter in temporary shelters.
According to Sylhet district administration, 37176 people were staying at 439 shelters as of
1st July 2022. Over 40 thousand houses were destroyed, leaving almost 3 million people
homeless. There is an ongoing humanitarian crisis due to food, potable water, clothing,
and medicine shortage (1).
Many professional bodies, philanthropists, and social media influencers are trying to
provide help in the form of food, medicine, and other necessities. We had a chance to
participate in such an initiative recently. We travelled almost 350 kilometres away from the
capital city – attempting to reach the most vulnerable and hard-to-reach people. Although I
had volunteered in several other medical camps for flood victims during my student days,
this was the first time I participated as a medical doctor. Furthermore, I happened to be the
senior team leader of a medical team. It was an initiative of several organizations, and our
team executed the medical camp as part of the whole relief initiative. We had three doctors
and a final-year medical student from Sylhet (Picture 1).
11 Greater Sylhet Floods: A Bangladeshi doctor’s experience of a
medical camp for flood victims
30
Junior Doctors Network Newsletter
Issue 25
November 2022
Figure 1: Relief and medical team on the rooftop of our boat. Credit : Moin Uddin Ahsan Tushar.
Many regions of Greater Sylhet remain submerged during monsoon, and the residents
have adapted to the yearly water-logging. People built their houses to remain above water
during the rainy season. However, mother nature has not been so kind this year and
flooded all the low-lying areas. It took us 18 hours to reach our destination. There were
barely any dry lands to set up our relief and medical camps. We went to distribute as much
relief as possible from our boat as most of the houses were like isolated islands.
Figure 2: Doctors consulting patients on a boat. Credit: Moin Uddin Ahsan Tushar
11 Greater Sylhet Floods: A Bangladeshi doctor’s experience of a
medical camp for flood victims
31
Junior Doctors Network Newsletter
Issue 25
November 2022
We brought surplus medicine for common conditions during floods such as diarrhoea,
common cold, abdominal ache, skin infections, traumatic injuries etc. (Figure 2). However,
people were more eager to acquire food as they were starving. Currently, the government
and the military are trying to distribute relief but are stretched too thin. We observed a lack
of coordination that left many areas of the flood-affected land without any aid. Our team of
junior doctors and a final-year medical student – a local volunteer – tried to distribute as
much medicine as possible and disseminate essential health education.
Although our initiative satisfied us momentarily, it also showed us how inadequate our
efforts were. People needed continuous medical support, unlike our one-day camp. A
comprehensive disaster management plan that includes coordination among all the
relevant organizations is of utmost importance in situations like this. Although Bangladesh
is a riverine country with floods of various intensities almost every year, this flood reminded
us of the necessity to work harder and do better for the people in terms of disaster
management. It is recommended to incorporate non-governmental organizations and
volunteers in our disaster management plan more carefully than ever to avoid more
humanitarian crises.
In conclusion, we realize that such medical and relief camps are part of our civic duty, but
those need to be executed under centralized coordination, preferably by the government,
so that most people receive the aid they urgently require.
Reference
1. Sylhet Flood: Over 37,000 people still living in shelters. Dhaka Tribune [Internet]. 2022
July Available from: https://www.dhakatribune.com/bangladesh/2022/07/01/sylhet-flood-
over-37000-people-still-living-in-shelters ]
11 Greater Sylhet Floods: A Bangladeshi doctor’s experience of a
medical camp for flood victims
32
Junior Doctors Network Newsletter
Issue 25
November 2022
Wunna Tun, MBBS, Msc, MD
Secretary, JDN
Myanmar
It has been 700 days since Myanmar’s military coup. On the eve of February 1, 2021,
Myanmar military ousted the democratically elected Myanmar government officials and
State Counsellor Aung San Suu Kyi. Since then, tens of thousands of junior doctors have
walked away from military-run hospitals and institution to join civil disobedience movement
(CDM) against the military junta. (1). There were 80-100 percent of healthcare
professionals in each region in Myanmar have engaged in CDM which become the largest
doctors’ protest in the history of world (2).
Myanmar junior doctors continue to take care of patient in secretly with the aid of well-
wishers in compliance with the international code of medical ethics and the physician’s
pledge (3). Myanmar army and security forces systematically assaulted, detained, and
murdered medical personnel for no apparent reason. The World Medical Association
(WMA) criticized the detention and harassment of physicians by Myanmar army and
security forces while they were treating patients in Myanmar in the statement issued in
third week of February 2021 (4).
Although these WMA statement and other international concern on headline on world
media, the military increased their force to jail and torture doctors more frequently and
brutally, but junior doctors continued to care for patients in secret risking their own life for
patients (1).
During the WMA Council Meeting in April 2021, the WMA released a strong expression of
solidarity for the people of Myanmar and medical workers in Myanmar (5). Myanmar’s
military ignored these declarations, believing that they could not be used to take action to
military (6). Myanmar military increase their crime against humanity and abducted family
members of junior doctors and force junior doctors to surrender. Even junior doctors
surrender their life with family members, Myanmar military killed mercilessly over family
members in front of junior doctors. Representatives from NMA from across the world
attended the WMA Virtual Annual Meeting in October 2021 and endorsed the WMA Policy
Statement to support physicians in Myanmar (7).
Tens of thousands of Myanmar junior doctors and medical personnel were injured,
imprisoned, humiliated, and massacred since military coup, and their families were
kidnapped and slaughtered. Recently in July 2022, trainee doctors who are travelling to
carry out their medical training was slaughtered mercilessly by Myanmar Military (8).
12 Multitudinous Trainee Doctors have been slaughtered mercilessly
and arrested by Myanmar Military since Military Coup
33
Junior Doctors Network Newsletter
Issue 25
November 2022
The WMA and other UN, NGO, and international leaders’ statements have not stopped the
military’s atrocities. The international community is impotent to protect Myanmar and has
taken no legal action to confront these hallmarks of military war crimes against Myanmar’s
doctors and humanity.
The World has two parallel dimensions. In one realm, medical students and trainee
physicians are peacefully learning, caring for patients, and traveling to medical
conferences. The leaders and people of that universe are praying and releasing
statements and debating issues for Myanmar, Ukraine, Tigray, Syria, and other countries.
Support without action is useless for people in another alternate dimension. In a parallel
universe in Myanmar, there are service health disruptions, the killing of junior doctors, their
families, and friends, air bombing attacks on healthcare centers with fighter planes, the
burning down of innocent people’s homes, and a food security problem.
I am urging the WMA, NMA, JDN, member states and other international organizations to
work together to bring Myanmar’s military and security forces to the International Criminal
Court and arrest them immediately in order to prevent junior doctors from being
slaughtered mercilessly and arrested by the Myanmar military.
Statements and other forms of support are meaningless without action, and all Myanmar
Junior Doctors will no longer honor these statements and other forms of support, urging for
the above-mentioned actions before the JDN Biannual Meeting in October 2022.
References
1. Radio Free Asia. 2022. Junta-Run Public Hospitals Rejecting Even Myanmar’s Sickest
COVID-19 Patients. [Accessed 27 April 2022] Available at:
https://www.rfa.org/english/news/myanmar/hospitals- 07292021170330.html
2. Devex, 2022. [online] Available at: [Accessed 27 April 2022].
3. Parsa-Parsi RW. The Revised Declaration of Geneva: A Modern-Day Physician’s
Pledge. JAMA. 2017;318(20):1971–1972. doi:10.1001/jama.2017.16230
4. WMA – The World Medical Association-Harassment and arrest of doctors in Myanmar
condemned by physician leaders Wma.net. 2022 [cited 27 April 2022].
5. Available from: https://www.wma.net/news-post/harassment-and-arrest-of-doctors-in-
myanmar-condemned-by-physician-leaders/
12 Multitudinous Trainee Doctors have been slaughtered mercilessly
and arrested by Myanmar Military since Military Coup
34
Junior Doctors Network Newsletter
Issue 25
November 2022
6. Wallen B, Zoramsanga I. From trainee doctor to guerrilla warrior: How Myanmar’s youth
are preparing for civil war [Internet]. The Telegraph. 2022 [cited 27 April 2022].
Available from: https://www.telegraph.co.uk/world-news/2021/08/13/trainee-doctor-
guerrilla-warrior-myanmars-youth-preparing-civil/
7. WMA – The World Medical Association-WMA General Assembly [Internet]. Wma.net.
2022 [cited 27 April 2022]. Available from: https://www.wma.net/news-post/wma-
general-assembly-7
8. Hagan, R., Reuters (2022) Teenage trainee doctors ‘slaughtered’ in Myanmar amid
mounting reports of atrocities, mirror. Available at: https://www.mirror.co.uk/news/world-
news/teenage-trainee-doctors-slaughtered-myanmar-27424198 (Accessed: July 10,
2022).
12 Multitudinous Trainee Doctors have been slaughtered mercilessly
and arrested by Myanmar Military since Military Coup
35