April 2015

Volume 41 Number 3
April 2015
An International Forum for Family Doctors
World Organization of Family Doctors
From the President: Lessons from Latin America
Del Presidente: Lecciones desde América Latina
From the CEO's desk: Young Doctors and Family Doctor Day
Policy Bite: The role of primary care in the ageing population
Fragmentos de política (marzo 15):
World Family Doctor Day - May 19 is our day to celebrate
One word for family medicine on Family Doctor Day
Rural Round-up: networking with rural colleagues around the world 12
Occupational health feature: Depressive patients, work is relevant
Exposure to radiation through medical imaging
Regional news
Speakers for WONCA Europe in Istanbul in October
Countdown to WONCA Africa conference
WONCA History - WONCA Asia Pacific returns to Taipei
Young Doctors' News
WONCA Chief Executive Officer
Dr Garth Manning
WONCA World Secretariat
World Organization of Family Doctors
12A-05 Chartered Square Building,
152 North Sathon Road,
Silom, Bangrak, Bangkok 10500, THAILAND
Phone: +66 2 637 9010
Fax: +66 2 637 9011
Email: [email protected]
Executive Member at Large &
Honorary Treasurer
Dr Donald Li (Hong Kong, China)
Executive Member at Large
Dr Karen Flegg (Australia)
Regional President, WONCA Africa
Dr Matie Obazee (Nigeria)
Spanish Society creates new social network profiles
semFYC apuesta por una nueva estrategia digital
Chloé Perdrix writes: Vietnam and Laos
EQuiP Meeting in Switzerland, 24-25 April
Asia Pacific research conference 2015
Email: [email protected]
Twitter @WONCApresident
LinkedIn WONCA president
Facebook Michael Kidd - WONCA president
Executive Member at Large &
WHO Liaison Person
Dr Luisa Pettigrew (United Kingdom)
Caribbean College of Family Physicians conference report
Featured Doctor
A/Prof Per KALLESTRUP: Denmark
Prof Mehmet UNGAN: Turkey
Faculty of Health Sciences, Flinders University
GPO Box 2100, Adelaide SA 5001, Australia
Tel: +61 8 8201 3909
Fax: +61 8 8201 3905
Mob: +61 414 573 065
Prof Amanda Howe (United Kingdom)
VdGM award to Per Kallestrup
Health Systems and Young Family Doctors - VdGM Forum 2015
Proud to call myself a Vasco da Gamian.
Rajakumar movement for young doctors- photos from Taiwan
Member Organizations
WONCA President
Prof Michael Kidd AM
Regional President, WONCA Asia Pacific
Prof Jungkwon Lee (South Korea)
Regional President, WONCA East Mediterranean
Dr Mohammed Tarawneh (Jordan)
Regional President, WONCA Europe
Prof Job FM Metsemakers (Netherlands)
Regional President, WONCA IberoamericanaCIMF
A/Prof Inez Padula (Brazil)
Regional President, WONCA North America
Prof Ruth Wilson (Canada)
Regional President, WONCA South Asia
Prof Pratap Prasad (Nepal)
Young Doctor Representative
Dr Raman Kumar (India)
Editor, WONCA News & Editorial Office
Dr Karen M Flegg
PO Box 6023
Griffith ACT 2603 Australia
Email [email protected]
Volume 41 Number 3
April 2015
From the President: Lessons from Latin America
I was in Montevideo, with 1600 other family
doctors from 26 nations, attending the 4th
WONCA Iberoamericana Congress on Family and
Community Medicine hosted by the Uruguayan
Society of Family Medicine (Sociedad Uruguaya
de Medicina Familiar y Comunitaria) and led by
the wonderful Jacqueline Ponzo. The theme of the
congress was “quality and equity in health care”
which is very appropriate given the focus of
WONCA’s current global work on strengthening
primary care to ensure universal health coverage.
Photo: Panel of presidents of WONCA’s
Iberoamericana Region: (from left to right, Julio
Ceitlin, Javier Dominguez del Olmo, Adolfo
Rubinstein, Liliana Arias, Maria Inez Padula
The Waynakay Movement is the organization for
young family doctors in WONCA’s Iberoamericana
region (covering the Spanish and Portuguese
speaking nations of the Americas, as well as
Spain and Portugal). "Waynakay" means "youth"
in the Quechua language of the Andes in the
western part of South America. WONCA’s
Waynakay Movement is led by enthusiastic young
family doctors including Andrea de Angulo from
Colombia, Rodolfo Deusdará from Brazil and
Virginia Cardozo from Uruguay. In March I had the
opportunity to meet with many members of the
Waynakay Movement at an energy-charged
meeting in Montevideo in Uruguay. I learned about
some of the challenges facing those training to
become family doctors in many countries of the
region, and their aspirations for their future
WONCA’s Iberoamericana regional organisation
was founded in 1981 by Argentine family medicine
pioneer, Julio Ceitlin. The organization brought
together societies and colleges of family medicine
in the countries of the region and in 1996 was
named the Confederacion Iberoamericana de
Medicina Familiar (CIMF). In 2004 CIMF joined
WONCA and brought the countries of South
America and Central America into the WONCA
family and made WONCA the truly global
organization that it is today.
WONCA’s Iberoamericana Region now includes
20 countries, from Mexico, Cuba, Puerto Rico and
Dominican Republic in the north, through Central
America and South America, to Uruguay,
Argentina and Chile in the south, plus Portugal
and Spain, and includes over
600 million people.
Photo: WONCA president with members of the
WONCA Waynakay Movement
One of the highlights of the
Montevideo meeting was a panel
with several CIMF presidents,
including Julio Ceitlin (now 90
years old), Javier Dominguez del
Olmo from Mexico (2000-2004),
Adolfo Rubinstein from Argentina
(2004-2010), Liliana Arias from
Colombia (2010-2013) and Maria
Inez Padula Anderson from
Brazil (2013-2018). These family
Volume 41 Number 3
medicine leaders, past and present, engaged with
colleagues in discussing the challenges facing
family medicine in many countries and the
opportunities to strengthen primary care and
ensure universal health coverage for all people of
the region.
April 2015
development of this strategy and has been leading
a consultation process that has involved hundreds
of family doctors from around the world.
This new global strategy from the WHO aims to
provide a “compelling vision of a future in which all
people have access to health services”. The
strategy calls for reorienting health care systems
to prioritize primary and community care services
and includes reference to the important role of
family doctors in countries like Brazil. The interim
WHO report contains 10 quotes; four from
patients and carers, two from health care
managers, and four from family doctors. This
recognition of the importance of the contributions
of family medicine to people-centred and
integrated health services is very welcome. Here
are some of the extracts:
Photo: Palacio Salvo
in Plaza
Square) located
between Ciudad
Vieja (Old City) and
WONCA is playing
our part in
supporting quality
and equity in global
health, and we have
set ourselves three
main challenges.
First, we are
committed to better understand the strength of
each of our member organisations in each region,
and to expand WONCA’s influence by supporting
the development of new member organisations in
more low- and middle-income nations, including all
nations of Central America and South America, to
ensure that all people have access to high quality
family medicine.
“I really value the long term relationship I have
with many patients. I also know their families and
the community well.” Female family doctor from
the WHO Western Pacific Region.
“We need more support from the government to
adopt more family medicine and to increase the
budget for primary health care.” Female family
doctor from the WHO Eastern Mediterranean
“What I value the most in my work is good
relationships with the people the nurses and I care
for. We have a post-conflict multi-ethnic
population. Once as bad enemies they now sit in
my waiting room together and talk and understand
each other.” Male family doctor from the WHO
Europe Region.
WONCA’s second challenge, recognizing the
importance of the next generation of family
doctors, is actioned through our commitment to
supporting the next generation of family doctors
especially through the development of young
family doctor movements in all seven regions of
the world, and through the appointment of a young
family doctor to represent the world’s young family
doctors on the WONCA executive.
“Politicians need to understand that primary care
is the backbone of any health system and getting
it right will lead to cost benefits, healthier
populations and public faith in the system.” Male
family doctor from the WHO Region of the
WONCA’s third challenge is our commitment to
strengthen WONCA’s work with the World Health
Organization (WHO) at global and regional levels
to expand the role of family medicine in
strengthening primary health care in all countries
and supporting universal health coverage, and to
ensure that each country has a well-trained and
supported family medicine workforce.
There is hope for global health as the world wakes
up to the importance of strengthening primary care
and the important role we play as family doctors in
ensuring universal health coverage and high
quality care.
Family medicine has the power to play a
transformative role in the shaping of all societies,
as we are seeing in the countries of Central
America and South America. I hope you all have
the opportunity to see this for yourself as a
participant in our 2016 WONCA World Conference
in Brazil.
Our work with the World Health Organization
becomes stronger and stronger thanks to the
leadership of our WONCA liaison person with the
WHO, Maria-Luisa Pettigrew. In March the WHO
released two interim reports on its new Global
Strategy on People-Centred and Integrated Health
Services. WONCA is contributing to the
Volume 41 Number 3
Photo: WONCA president
succumbs to peer
pressure from a group of
young doctors and has
his first taste of mate, a
traditional South
American caffeine-rich
infused hot herbal drink,
served in a leather-clad
gourd and sipped through
a metal straw
April 2015
World Organization of Family Doctors (WONCA)
Prof Kidd’s keynote speech on Quality and Equity
and Global Family Medicine: perspectives from
Latin America, delivered at the 4th WONCA
Iberoamericana Congress on Family and
Community Medicine, can be found here.
Michael Kidd
Del Presidente: Lecciones desde América Latina
Foto: Comité de presidentes de la Región
Iberoamericana de WONCA: (de izquierda a
derecha, Julio Ceitlin, Javier Domínguez del
Olmo, Adolfo Rubinstein, Liliana Arias y Maria
Inez Padula Anderson).
Estuve en Montevideo con otros 1.600 médicos
de familia de 26 países, para asistir al Cuarto
Congreso WONCA Iberoamérica de Medicina
Familiar y Comunitaria, organizado por la
Sociedad Uruguaya de Medicina Familiar y
Comunitaria, y liderado por la maravillosa
Jacqueline Ponzo. El tema del congreso fue La
calidad y la equidad en la atención de la salud,
que es muy apropiado, dado el enfoque de la
corriente de trabajo global de WONCA en el
fortalecimiento de la atención primaria para
garantizar la cobertura universal de salud.
El Movimiento Waynakay es la organización de
jóvenes médicos de familia en la región de
WONCA Iberoamericana, que cubre los países de
habla hispana y portuguesa de América, así como
España y Portugal. Waynakay significa “juventud”
en el idioma quechua de los Andes, en la parte
occidental de América del Sur. El Movimiento
Waynakay de WONCA está dirigido por jóvenes
médicos de familia entusiastas, entre ellos,
Andrea de Angulo, de Colombia, Rodolfo
Deusdará, de Brasil y Virginia Cardozo, de
Uruguay. En marzo, tuve la oportunidad de
reunirme con muchos miembros del Movimiento
Waynakay en una reunión cargada de buena
energía en Montevideo, Uruguay. Aprendí acerca
de algunos de los desafíos que afrontan estos
médicos en formación para convertirse en
médicos de familia en muchos países de la
región, y sus aspiraciones para sus futuras
La Organización regional Iberoamericana de
WONCA fue fundada en 1981 por un pionero de
la medicina de familia argentina, Julio Ceitlin. La
organización reunió a las sociedades y colegios
de medicina familiar en los países de la región y
en 1996 fue nombrada como Confederación
Iberoamericana de Medicina Familiar (CIMF). En
2004 se CIMF se unió a WONCA y trajo a los
países de América del Sur y América Central a la
familia WONCA, convirtiendo a WONCA en la
organización verdaderamente global que es hoy.
La Región Iberoamericana de WONCA ahora
incluye 20 países, desde México, Cuba, Puerto
Volume 41 Number 3
April 2015
países de América Central y América del
Sur, para asegurar que todas las
personas tengan acceso a la medicina
familiar de alta calidad.
El segundo reto de WONCA,
reconociendo la importancia de la
próxima generación de médicos de
familia, se acciona a través de nuestro
compromiso de apoyar a esa nueva
generación de médicos de la familia,
especialmente a través del desarrollo de
los jóvenes médicos de familia de los movimientos
de las siete regiones del mundo, y por medio de la
designación de un joven médico de familia que
represente a los jóvenes médicos de familia del
mundo en el ejecutivo de WONCA.
Foto: Presidente de WONCA con miembros del
Movimiento Waynakay de WONCA.
Rico y República Dominicana, en el norte, a
través de América Central y América del Sur, a
Uruguay, Argentina y Chile en el sur, además de
Portugal y España, e incluye a más de 600
millones de personas.
El tercer desafío de WONCA es nuestro
compromiso de fortalecer la labor de la WONCA
con la Organización Mundial de la Salud (OMS)
en los ámbitos mundial y regional para ampliar el
papel de la medicina familiar en el fortalecimiento
de la atención primaria de salud en todos los
países y el apoyo a la cobertura universal de
salud, y para asegurar que cada país tiene
profesionales en medicina de familia bien
entrenados y respaldados.
Uno de los aspectos más destacados de la
reunión de Montevideo fue un Comité con varios
presidentes de CIMF, entre ellos Julio Ceitlin (que
cuenta ahora con 90 años de edad), Javier
Domínguez del Olmo, de México (2000-2004),
Adolfo Rubinstein, de Argentina (2004-2010),
Liliana Arias, de Colombia (2010-2013) y Maria
Inez Padula Anderson, de Brasil (2013-2018).
Estos líderes de la medicina de familia, pasados y
presentes, están comprometidos con sus colegas
en la discusión de los desafíos que enfrenta la
medicina de familia en muchos países y las
oportunidades para fortalecer la atención primaria
y garantizar la
cobertura universal
de salud para todos
los habitantes de la
Nuestro trabajo con la Organización Mundial de la
Salud se vuelve más y más fuerte gracias al
liderazgo de nuestra persona de enlace de
WONCA con la OMS, Maria-Luisa Pettigrew. En
marzo, la OMS publicó dos informes provisionales
sobre su nueva Estrategia Global de Servicios
Integrados de Salud Centrados en la Población.
WONCA está contribuyendo al desarrollo de esta
estrategia y ha liderado un proceso de consulta
que ha involucrado a cientos de médicos de
familia de todo el mundo.
Esta nueva estrategia mundial de la OMS tiene
como objetivo proporcionar una "visión
convincente de un futuro en el que todas las
personas tengan acceso a los servicios de salud".
La estrategia requiere la reorientación de los
sistemas de salud para dar prioridad a los
servicios de atención primaria y comunitaria y se
incluye una referencia a la importancia del papel
de los médicos de familia en países como Brasil.
El informe provisional de la OMS contiene 10
citas, cuatro de pacientes y cuidadores, dos de
gestores sanitarios y cuatro de médicos de
familia. Este reconocimiento de la importancia de
las aportaciones de la medicina de familia
centrada en las personas y los servicios
integrados de salud es muy bienvenido. Éstos son
algunos de los extractos:
Foto: Palacio Salvo
en la Plaza de la
ubicado entre
Ciudad Vieja y el
centro de
WONCA está
jugando un papel en
el apoyo a la calidad
y la equidad en la salud mundial, y nos hemos
fijado tres retos principales. En primer lugar,
estamos comprometidos a entender mejor la
fuerza de cada una de nuestras organizaciones
miembro en cada región, y en ampliar la influencia
de WONCA, apoyando el desarrollo de nuevas
organizaciones miembro en más países con
ingresos bajos y medios, incluyendo todos los
Volume 41 Number 3
"Realmente valoro la relación a largo plazo que
tengo con muchos pacientes. De este modo,
también sé de sus familias y de la comunidad.”
Médica de familia de la Región del Pacífico
Occidental de la OMS.
April 2015
Foto: El Presidente de WONCA sucumbe a la
presión de un grupo de jóvenes médicos y prueba
por primera vez la yerba mate, una bebida
tradicional sudamericana rica en cafeína. Se trata
de una infusión caliente a base de hierbas,
servida en una calabaza vestida de cuero, de la
que se bebe con una pajita de metal.
"Necesitamos más apoyo del gobierno para
adoptar más la medicina familiar y aumentar el
presupuesto para la atención primaria de salud."
Médica de familia de la Región del Mediterráneo
"Lo que más valoro en mi trabajo es la buena
relación con la gente y las enfermeras y pongo
cuidado en ello. Tenemos una población
multiétnica de post-conflicto. En el pasado fueron
enemigos acérrimos los mismos que se sientan
en mi sala de espera juntos, ahora se hablan y se
entienden.” Médico de familia de la Región
Europea de la OMS.
"Los políticos deben entender que la atención
primaria es la columna vertebral de cualquier
sistema de salud y hacer las cosas bien dará
lugar a beneficios en los costes, poblaciones más
saludables y confianza pública en el sistema."
Médico de familia de la Región de América.
Michael Kidd
Organización Mundial de Médicos de Familia
Hay esperanza para la salud mundial mientras el
mundo abra los ojos a la importancia de fortalecer
la atención primaria y el relevante papel que
jugamos como médicos de familia, para garantizar
la cobertura universal de salud y la atención de
alta calidad.
El discurso magistral de Michael Kidd sobre
Calidad, Equidad y Medicina Familiar Global:
perspectivas de América Latina, realizado en el
cuarto Congreso WONCA Ibero América de
Medicina Familiar y Comunitaria, se puede
encontrar aquí
Traducción: Eva Tudela, Spanish Society of
Family and Community Medicine (semFYC)
La medicina de familia tiene el poder de jugar un
papel transformador en la formación de todas las
sociedades, como estamos viendo en los países
de América Central y América del Sur. Espero que
todos vosotros tengáis la oportunidad de ver esto
por vosotros mismos como participantes en
nuestro Congreso Mundial de WONCA 2016, en
Volume 41 Number 3
April 2015
From the CEO's desk: Young Doctors and Family
Doctor Day
Of course our oldest YDM is the Vasco da Gama
Movement (VdGM) in Europe, which celebrated its
10th anniversary last year in Lisbon. Now led by
Peter Sloane (Ireland) VdGM has always been an
immensely strong and active movement, amply
demonstrated by its recent forum held over two
days in Dublin. There are a couple of great clips
on YouTube from the forum, one showing the
messages of greeting sent to VdGM from other
young doctors’ movements (and from our
President) which can be viewed here. The second
clip is a short (three minute) summary of the
Forum, made by Ulrik Kirk. Also in this month's
news are several reports from the Forum.
Photo: WONCA CEO, Garth Manning (circled),
with a group of young doctors from the Rajakumar
Movement, in Taiwan.
WONCA Young Doctors’ Movements
We really are blessed in WONCA. In each of our
seven regions we now have a Young Doctors’
Movement (YDM), helping to support and
encourage and develop the next generation of
family doctors and WONCA leaders. At two recent
conferences – WONCA South Asia in Dhaka and
WONCA Asia Pacific in Taipei – I’ve been
privileged to take part in sessions run by the
regional YDMs – the Spice Route in South Asia
and The Rajakumar Movement (TRM) in Asia
Pacific. In both cases I was hugely impressed by
the energy and motivation of our young
colleagues, and there was lots of evidence that
our specialty is safe in the hands of the next
Coming up we look forward to inputs from Al Razi
Movement, led by Nagwa Hegazi of Egypt, at the
WONCA Eastern Mediterranean conference in
Dubai at the end of April, and from AfriWON, led
by Kayode Alao of Nigeria, at the WONCA Africa
conference in Accra starting on 6th May.
Vasco da Gama will again meet during the
WONCA Europe meeting in Istanbul in October,
and among the many highlights will be a preconference, which WONCA is pleased to support.
This will also feature key leaders from all seven
WONCA YDMs, as well as Dr Raman Kumar, the
WONCA YDM representative on Executive, who
does so much to facilitate discussion and
communication between the groups and to act as
a link to WONCA Executive.
For the Spice Route, Bhavna Matta (India) has
taken over from Raman Kumar and built on the
strong foundations he developed. Similarly in Asia
Pacific, Shin Yoshida (Japan) has built on Naomi
Harris’s hard work to take TRM to even higher
In Iberoamericana-CIMF too the Waynakay
Movement goes from strength to strength. I wasn’t
able to get to the Montevideo conference, but
Michael Kidd tells me that Waynakay, now under
the leadership of Andrea de Angulo (Colombia)
showed the same great energy and enthusiasm of
the other groups.
I haven’t yet mentioned North America, but here
too the young doctors are thriving. Polaris, led by
Kyle Hoedebecke (USA), really hit the ground
running at its formation last year – on World
Family Doctors Day on 19th May.
Volume 41 Number 3
April 2015
WONCA News will publish as many reports as we
can, to highlight the really wonderful work done by
so many of our great Member Organisations. All
news and reports from Member Organizations
should be sent to [email protected]
Much more information on all WONCA Young
Doctors Movements, including the leaders and
their contact details, can be found on the WONCA
World Family Doctor Day 2015
World Family Doctor Day – 19th May - was first
declared by the World Organization of Family
Doctors (WONCA) in 2010 and it has become a
day to highlight the role and contribution of family
doctors in health care systems around the world.
This year we have a number of possible posters
on the website for downloading. We have also
developed a new Family Doctor Day logo
(pictured), available via the website. Have a look
at all of these here.
Last year many of our colleagues across the globe
celebrated the day by organising a variety of
events and activities, and we received reports
from many countries. This year we want to
encourage even more organizations to celebrate
in appropriate style on 19th May, and we look
forward to receiving reports to show and tell.
Until next month.
Dr Garth Manning
Policy Bite: The role of primary care in the
ageing population
Prof Amanda Howe, Presidentelect, writes:
We shall argue that therefore health services need
strengthening through primary care. As Barbara
Starfield once wrote(1):“The achievement of equity in health services and
health is an imperative everywhere. Primary care
is inherently a more equitable level of care than
other levels of care. It is less costly (hence sparing
resources that could be devoted to providing
better services to more disadvantaged
populations), and through its key features,
narrows disparities in health between more and
less socially deprived..."
On 13 April 2015, I have the
privilege of attending the World
Health Summit in Kyoto, at the
invitation of an officer of one of
our member organizations (Dr
Tesshu Kusaba, Executive Vice President of
Japan Primary Care Association, with Dr Ryuki
Kassai’s support). Among other commitments, I
shall be part of a panel discussing ‘Primary Care
in the Super-Ageing Society’. My preparation for
this has drawn me to the following conclusions:
We also (still!) need to make an argument that
family medicine is an essential component within
primary care to achieve excellent outcomes for the
‘super-ageing society’: this is because family
doctors can deal with assessment and
management of multiple medical problems, which
assists the cost-effectiveness of primary care. As
Margaret Chan said (2):
“..in the absence of a family physician in overall
charge of care, treatment by several hospital
specialists can lead to duplication of investigations
and procedures, and risks of drug interactions to
which the old are prone” ..and “The world needs
more family physicians!”
Many higher and middle income countries are
enjoying falling mortality, and more social and
medical opportunities to prevent ill health. People
are living longer, and there are more treatments
for long – term conditions such as diabetes and
cardiovascular disease that can maintain health
and good quality of life in spite of NCDs. However,
there are also more older people with overall
higher medical and social care costs in later life;
and, in countries with reduced birth rates, there
are also fewer people available to look after them
at home. So there is a greater need for society to
find new ways to maintain quality of life and
function in spite of ageing.
Family doctors are community based medical
generalists who have been trained to deal with
Volume 41 Number 3
people across all life stages: a generalist who can
deal with all types of health problem at point of
first contact. We offer a service that is
“comprehensive, accessible, focuses on a specific
community, allows continuity over time, and is
centred on the care of people not specific parts of
their body or diseases”.
April 2015
may mean additional resource allocation, training,
and financial drivers such as no cost for
medications over 65, or annual care plans
including vaccines and NCD reviews.
At the end of the day good primary health care for
older people reflects the value we place on our
elders; the ‘pay back’ we offer for their
contribution, and the resources they still offer us. It
is a test of civilised societies, a moral imperative,
and what we hope for ourselves in our old age.
Patients can help us by being well informed, self
caring where possible, and by helping others in
the community.
The drivers to secure this service for older people
can act at Individual patient, professional, team,
community, societal and health system level.
These include training doctors and nurses in
community settings in regular contact with elders;
this reduces stereotyping, and gives positive
experiences of older people’s wisdom and
resilience. It is also an ideal opportunity to learn to
manage co-morbidities effectively in nonemergency settings, and to appreciate that some
of the specific problems of ageing and frailty (e.g
osteoporosis, cataracts, falls ) are not same as
In conclusion, primary care for a SUPER aging
society must:
• Have care of the elderly part of its core function
• Be resourced to give great health care in local
community in a way that is cost effective and
• Include nurses and other health workers
• Work alongside other community and hospital
resources – but avoid hospital admission if
• Enable patients and their families to live well for
as long as possible.
Our clinical service design needs to help older
people, and to be integrated around the person
not their diseases. Access, availability,
affordability, acceptability all matter, as do the skill
mix needed to meet the health and social needs of
older people. There are of course roles for family
doctors, nurses, and health care assistants; but
also in this age group there is significant need for
social and community care support, home
assessment, and nursing care, as well as
Interface with other services and specialities.
Remote technologies, local community support,
home based care, housing and good public
transport can all revolutionise the older person’s
life and lifestyle. Health systems need to
incentivise and reward good care for older people,
in both the primary care and hospital sector: this
I shall report back after the meeting, with new
ideas, new contacts, and look forward to seeing
Japan in the spring. (and for those facing autumn
and winter ….see you on the other side!)
Prof Amanda Howe
1. Starfield, B., Shi, L. and Macinko, J. (2005), Contribution of
Primary Care to Health Systems and Health. Milbank
Quarterly, 83: 457–502.
2 Chan M. Pers.comm. - Speech to the Hong Kong Academy
of Family Physicians 2013
Fragmentos de política (marzo 15): Influencia
exitosa para la medicina de familia
Recuperar el impulso: un ejemplo de influencia exitosa para la medicina
de familia en Reino Unido
Tendremos elecciones en mayo en el Reino Unido
y el servicio de salud ha sido un tema candente
para todos nuestros partidos políticos, mientras
las campañas en busca de votos se extendían por
todo el país. Hubo un debate parlamentario sobre
los médicos de familia, los problemas de personal,
y el gobierno ha publicado ahora un 'plan' de diez
puntos "específico para que Inglaterra haga frente
a este problema” (puedes ver los detalles), con la
promesa de dedicar a ello mil millones de libras
de nuevos recursos en los próximos cuatro años.
Estoy escribiendo este fragmento de política
sobre este tema por dos razones: una, compartir
con vosotros lo que podría ser necesario incluir en
términos de estrategia en una 'hoja de ruta' que
fortaleciera la medicina de familia en vuestro
propio país, y también para compartir con
vosotros las cosas que mi propia organización
Volume 41 Number 3
miembro de WONCA, el Royal College de
Médicos de Familia (RCGP) hizo para hizo para
tratar de asegurar este alto nivel de influencia.
April 2015
página de la campaña). Se requiere una gran
cantidad de personal y de tiempo del médico para
cubrir todos los medios, llevar pósters y peticiones
a las clínicas de los médicos de familia,
recogerlas, obtener entrevistas de prensa seguras
e impulsarlas a través de contactos locales y
nacionales (incluidas las otras academias,
colegios y organizaciones profesionales). Hemos
tratado de utilizar todas las partes de nuestra
propia organización (las oficinas regionales, los
grupos de médicos jóvenes, los colegas en las
escuelas de medicina y los pacientes), para
obtener los mensajes y para mejorar el
asesoramiento sobre las carreras y el apoyo en
todos los niveles de formación.
En cuanto a los titulares estratégicos, el Plan se
dirige tanto a la promoción de la práctica
generalista como a la carrera: publicidad,
incentivos, animar a todas las partes a ensalzar la
medicina de familia (no con paternalismo), y las
posibles oportunidades adicionales para los
médicos jóvenes dispuestos a formarse en las
áreas necesarias. También se ocupa de las
maneras de retener a personas en el ejercicio de
la medicina de familia a través de incentivos y
apoyo, aumentando la capacidad de formación y
reduciendo las barreras para volver a entrar en el
mercado de trabajo después de una interrupción
en la carrera profesional. Por último, existen
iniciativas paralelas que buscan la manera de
agilizar el traslado de médicos dispuestos a
cambiar de carrera y pasar a medicina de familia,
sujeto por supuesto, a la formación y cualificación
adicional, ya que no queremos que los nuevos
médicos tengan carencias. Esto no va a ser fácil
de hacer y esperamos ver los recursos en la
práctica, pero es una 'victoria' para el Royal
College de Médicos de Familia (RCGP), que ha
hecho una campaña dura durante un año para
conseguir poner esto en la agenda política.
En particular, muchos estudiantes de medicina no
ven lo suficiente de medicina de familia en su
formación, o la entienden como una disciplina de
"bajo estatus", algo que estamos tratando de
cambiar dando la bienvenida a los estudiantes de
medicina como miembros asociados de nuestra
propia universidad; y a través de vínculos directos
con las escuelas de medicina para confrontar las
actitudes negativas y conseguir más enseñanza y
aprendizaje en medicina de familia. Y hemos
tratado de hacer bien nuestro trabajo, porque la
defensa del paciente por parte de sus doctores
tiene un gran impacto político cuando llega a los
oídos adecuados.
Por supuesto, el futuro no es seguro, y las
consecuencias de las elecciones pueden conducir
a resultados muy diferentes a los esperados. El
RCGP tendrá que seguir luchando por su espacio
y no hay varita mágica: la formación de nuevos
médicos lleva mucho tiempo, así que tenemos
que tener más personas en el mercado de trabajo
y recuperar a los médicos que lo han dejado
atrás, siempre que sea posible. Aún así, he
aprendido mucho de observar lo que nos
funcionó. Esperemos que otros que intentan influir
en el aumento de médicos de familia en el
mercado laboral y de recursos, puedan aprender
de nuestra experiencia en el Reino Unido y de
aquellos otros que hayan mejorado su situación.
Podemos compartir estas historias en los
congresos y en la página web de WONCA.
¡Hagámoslo para animarnos unos a otros!
Prof Amanda Howe
Foto: cartel de la campaña
Traducción: Eva Tudela, Spanish Society of
Family and Community Medicine (semFYC)
Así pues, ¿cómo lo hacemos? Incluso para las
grandes organizaciones de la medicina de familia
es un verdadero reto: tenemos un equipo de
prensa y un equipo de política que trabajan muy
duro con el Presidente del Consejo y de la Mesa
de cara a organizar una campaña nacional (ver la
Volume 41 Number 3
April 2015
World Family Doctor Day - May 19 is
our day to celebrate
Dear colleagues
promote at least some in
WONCA News – and
then we look forward to
receiving reports after
the events to show and tell. WONCA News will
publish as many reports as we can, to highlight
the really wonderful work done by so many of our
great Member Organisations.
World Family Doctor Day – 19th May - was first
declared by the World Organization of Family
Doctors (WONCA) in 2010 and it has become a
day to highlight the role and contribution of family
doctors in health care systems around the world.
The event has gained momentum globally each
year and it is a wonderful opportunity to
acknowledge the central role of our specialty in
the delivery of personal, comprehensive and
continuing health care for all of our patients. It’s
also a chance to celebrate the progress being
made in family medicine and the special
contributions of family doctors all around the
Some posters - with our new World Family Doctor
Day logo - are now available on the WONCA
website, and we hope that these will prove useful
for everyone. There are two suggested themes “A family doctor for every family” and “Universal
Health Coverage”, but we have also produced
some blank posters in case organizations want to
feature a local theme. Click on the logo above to
download a larger version.
Last year many of our colleagues across the globe
celebrated the day by organising a variety of
events and activities, and we received reports and
photographs from many countries, which we were
able to feature in WONCA News. This year Karen
Flegg, the WONCA Editor, has even produced a
template for countries and College and societies
and associations, to aid reporting, available here.
We look forward to hearing of your Organization's
World Family Doctor Day celebrations.
Dr Garth Manning
WONCA Chief Executive Officer
See more on World Family Doctor Day - posters,
logo, previous activities
Send your 2015 activity proposals to the WONCA
This year we want to encourage even more
organizations to celebrate in appropriate style on
19th May. We would love Member Organisations
to tell us in advance of their plans – so that we can
One word for family medicine on
Family Doctor Day
The #1WordforFamilyMedicine initiative is
multinational and has reached six of seven (soon
to be all seven) WONCA regions to include over
35 countries. We have asked FPs/GPs to tell us in
one (1) word "What is your favourite part of Family
Medicine/General Practice?" With these responses
I have made images representing each country
(with input and suggestions from local colleagues).
Basically what I am suggesting, is for our
international colleagues to use their country's
image on their social media sites (ie as their
Facebook profile photo for the day). Not every
country will have an image by FFD so a generic
image will have to be selected (a map or the FDD
All my best,
Kyle Hoedebecke
chair of Polaris (WONCA North American
Movement for Young Doctors)
Above are some examples of various images that I
have created already.
Volume 41 Number 3
April 2015
Rural Round-up: networking with rural
colleagues around the world
Jo Scott-Jones of New Zealand writes this month's
rural round-up as rural family doctors from around
the world prepare to meet up in Dubrovnik.
The list server is a great vehicle to promote
meetings and events amongst the 400 plus
members around the world , the April EQuIP
meeting in Switzerland, a webinar about the
use of social media and WHO internships have
recently been promoted.
Dr Jo Scott-Jones is the WONCA News'
featured doctor for March 2015
One value of an international body like
the WONCA Working Party on Rural
Practice (WWPRP) is the ability to tap into the
“hive consciousness” of rural family medicine
doctors around the world.
Members have asked for advice about how to
get papers published, gathered information about
management of type 2 diabetes around the world,
promoted discussions about health and inequality,
rural proofing and national systems for monitoring
Understanding that the issues that we face in New
Zealand have parallels with what happens in
Brazil, Croatia and Africa is not only comforting,
but it also increases our ability to deal with those
issues through unified action.
The common themes raised on these “social
media” platforms are those we all know well in
rural practice. People need high quality services
provided close to home, but workforce shortages
and geographical isolation, often combined with
issues of poverty and the inequities faced by
indigenous and disenfranchised people mean that
doctors who care for rural communities face
unique but shared problems around the world.
The Working Party has a facebook page, a twitter
handle (@ruralwonca) and an email list server
where rural doctors around the world post
concerns, raise issues, make please for support
and organise themselves.
The WONCA Working Party on Rural Practice as
part of the WONCA Family provides support and
adds an influential voice at international policy
tables to further the needs of our communities.
The list server is hosted in a google group shared
privately and administered by WWPRP
chairperson John Wynn-Jones of Wales in the UK.
Recent issues include planning for the upcoming
conference in Dubrovnik “Bringing People
If the idea of being “linked in” to rural colleagues
around the globe appeals – you can be invited to
join the list server by sending an email to John
Wynn-Jones ([email protected])
People running workshops at the conference, for
example around the rural heroes project and
providing palliative care services in rural
communities use the list server to identify
supporters and to share ideas about how to make
the best out of the opportunities the conference
Jo Scott-Jones @opotikigp
Volume 41 Number 3
April 2015
Occupational health feature: Depressive
patients, work is relevant
Primary health care may contribute to the
prevention of permanent work disability and job
loss and can promote recovery from depression
through participation at work.
WONCA News has
begun a regular
feature on the subject
of Occupational Health
including useful
resources for clinical
practice. Peter Buijs
(right) & Frank van Dijk
(left) are the promoters
and main authors, they are Dutch occupational
physicians and former family doctors, and for
many years active in ICOH.
How to ask about work?
Some patients avoid talking about work, afraid of
complications. Health care workers can miss hints
about work, maybe feeling insecure. In this way
opportunities to discuss a better future might be
Every professional has her or his own style. Good
timing and tact are important. You may ask if there
is or are:
In this contribution, Frank and co-author Karen
Nieuwenhuijsen present reflections for the GP
when confronted with depression or depressive
disorders related to work.
• a problem with functioning at work, if the patient
is unable to perform work task as well as before
• a conflict, discrimination or bullying
• too much work or a lack of autonomy in the job
• a good balance between work and private life
• good contact with the supervisor, colleagues,
• sick leave currently; more episodes of sickness
absence last year; the expectation of a long
duration before returning to work
• uncertainties about continuation of the job, fear
for unemployment
• lack of orders, financial problems (self-employed
and business owners)
• contact with an occupational or mental health
Depression is almost daily practice
Depressive disorders and depression are familiar
mental health complaints and disorders in primary
health care (PHC) practice. In the Netherlands the
prevalence of depressive disorders in PHC was
15/1000 for men and 31/1000 for women per year
in 2007. In the general Dutch population, 52% of
the population with more severe common mental
health disorders, received treatment in primary
healthcare, while 39% received specialized mental
healthcare treatment. In a population of US
workers the 12 month prevalence of major
depressive disorder was 6%. Anxiety and somatic
complaints are often communicated.
Important goals for working with patients with a
common mental disorder are sustainable work
resumption or job continuation, job satisfaction, a
good work-life balance and good mental
functioning. In PHC various disciplines can be
involved in supporting the patient: physicians,
nurses, social workers, mental health
Attention to work
Asking patients about the impact of their
complaints on work functionality, you may notice
impaired communication, impeded decision
making, low concentration, lack of interest in work,
sometimes making mistakes. These impacts may
persist over time, even after the depression is in
remission. In addition, patients often consider
work as one of the main causes of depression.
Depression is associated with high rates of
sickness absence, more permanent work disability
and unemployment. A self-reinforcing process
may start: being at home for sickness absence or
having no job means a lower activity level, a lower
or no income, less social contacts, and a low selfesteem contributing to depressive feelings.
What to do?
• depressive symptom reduction by
psychotherapy, physical exercise and/or
appropriate medication e.g. following PHC
• if the patient is off work; advise on maintaining a
regular day structure.
• if the patient is still at work, promote a better time
management strategy, (temporary) modified work
hours or tasks, better social contact with
Volume 41 Number 3
April 2015
• after resumption of work, monitoring can be
effective to prevent a relapse. Propose a number
of consultations for that purpose.
supervisor and colleagues, if possible coaching on
the job.
• put forward the option of online or telephone
mental health programs that can be effective.
• referral to a mental health program which
includes a work focus aiming at work resumption,
such as work-focused cognitive behavioural
therapy or adjuvant occupational therapy
supporting workers in coping. An occupational
psychiatry service might be a good new option for
• when needed and available, contact the
occupational health physician, nurse or company
social worker. Informed consent is clearly needed.
Frank van Dijk (Learning and Developing
Occupational Health foundation, Netherlands),
Karen Nieuwenhuijsen (Coronel Institute, AMC
References available online
Meeting considers exposure to radiation
through medical imaging
radiation. The meeting had as key point of the
discussion the development and deployment of
Clinical Imaging Guidelines and their
implementation in Clinical Decision Support
systems. Developing good guidelines is not
enough; it is important to reach the users, by
placing the guidelines at the ready disposal of the
referrer with a simple click in the Clinical Decision
Support system.
Report from the Technical
Meeting IAEA-WHO
WONCA is concerned about the impact of
exposure to radiation through medical imaging,
and the risks of unnecessary exposure due to
inappropriate or excessive investigations. WONCA
has been working with the World Health
Organization (WHO) and the International Atomic
Energy Agency (IAEA) to look at ways to improve
the appropriateness of imaging, and to measure
each person's cumulative exposure to radiation
from imaging.
From 20 to 50% of imaging examinations are
considered inappropriate. The justification principle
is too often not fulfilled. Awareness of the referrers
(family doctors among them) of radiation risks is
very low worldwide.
In recent years WHO and International Atomic
Energy Agency (IAEA) have been making a
significant effort to promote the correct use of
radiological examinations. In particular, the
principles of justification and optimisation have
been stated, to increase the appropriateness of
imaging and to reduce the level of delivered
radiation dose.
The Clinical Imaging Guidelines are considered a
key tool to overcome these problems and an
important support to doctors in daily practice.
The Clinical Imaging Guidelines sit well with family
doctors’ work, because they are not “vertical”
guidelines, which are based on a complete
management of a disease, but “horizontal”, and
oriented to a diagnosis, based mainly on
symptoms and syndromes.
A technical meeting on the justification of medical
exposure and the use of appropriateness criteria
was held at the IAEA's Headquarters in Vienna,
Austria, from 9 to 11 March, 2015.
Not every country is able to develop Clinical
Imaging Guidelines, because developing
guidelines is time and resource intensive. A
possible approach for some countries is to adapt
and adopt international Clinical Imaging
Guidelines, or Clinical Imaging Guidelines tested in
other countries. There was a large discussion
concerning many issues, particularly:
- how develop and deploy Clinical Imaging
Guidelines in the countries with lack of technologic
The organisers invited WONCA to take part in the
meeting to put forward the point of view of family
doctors (FDs), in order to seize the opportunity to
examine the problem.
The process of justification uses an evidencebased approach to choose the best test for a given
clinical scenario, taking into account the diagnostic
efficacy of the radiological procedure, as well as
alternative procedures that do not use ionizing
Volume 41 Number 3
- the role of the IAEA and the WHO in supporting
the process of developing Clinical Imaging
- how to enable countries with similar infrastructure
and concerns to work collaboratively;
- the necessity of adapting Clinical Imaging
Guidelines at a national level particularly in
countries with lack of expertise and equipment.
April 2015
education. Also for this reason there was
unanimous agreement about the need of involving
family doctors in the core group of stakeholders to
develop and deploy Clinical Imaging Guidelines, at
international and national levels.
Experiences on the utilisation of Clinical Imaging
Guidelines in Clinical Decision Support systems
were illustrated by representatives of several
countries during the meeting.
There was also a discussion about the education
of doctors and patients. Education on diagnostic
radiation is considered crucial at every level of
instruction of doctors : undergraduate, postgraduate, and in continuing medical education. It
should be oriented to increase awareness of the
biologic harm of ionizing radiation, delivered
doses, use of the Clinical Imaging Guidelines, and
skills in communication of benefits and risks of
radiologic investigations to the patients.
For the future programs of IAEA-WHO,
involvement of regulatory stakeholders and
national health authorities has been planned to
promote a larger utilization of Clinical Imaging
WONCA intends to pursue the collaboration with
WHO and IAEA to improve appropriateness of
radiologic examinations and involve colleges and
academies of general practice to cooperate at
national level in developing and deploying Clinical
Imaging Guidelines.
Individual patient education is also very important.
Education by the referrers is important, especially
by family doctors, who maintain a continuous
relationship with patients based on trust. Individual
education is part of a unique process of:
information, education, involvement in decisionmaking. The Clinical Imaging Guidelines could
give significant support to doctors for patient
Ernesto Mola
Regional news
Speakers for WONCA Europe in Istanbul in October
University in Belgium. He is also chairman of the
European Forum for
Primary Care, and director
of the International Center
for Primary Health Care
and Family Medicine,
designated by WHO as a
Center” on Primary Health
Why not join us? More information
At our twentieth conference, WONCA Europe
invites you to look into the future from the
perspective of the past.
Come to Istanbul to share what you think about
family physicians, patients, diseases, health
systems and WONCA with your colleagues from
the speaker's corner.
Amanda Howe
Amanda is professor of
primary care practising at
the Bowthorpe Medical
Centre in Norwich,
England and president
elect of World WONCA –
she will become
president in 2016.
BRITE: BRIng your Thoughts and Experience for the first time gives a chance to all participants
to be a speaker at the conference. If you have
something to say, an experience to share, a
question to ask, you can submit your BRITE in
the abstract system.
Do not forget the deadline to be a BRITE speaker
is now extended until May 22, 2015.
Emin Kansu
Emin is a professor of haematology and chairman
at the basic oncology department of Hacettepe
University in Ankara, Turkey. He is also a former
member of European Union and Europe Scientific
Who are the main speakers (apart from you)?
Jan de Maeseneer
Jan is professor and head of the department of
family medicine and primary health care at Ghent
Volume 41 Number 3
Committee Ethics Working Group, a member of
Ethics Committee of Turkish Scientific and
Technical Research Council (TUBITAK) and an
executive board member of Turkish Academy of
April 2015
Diederik Aarendonk
Jose Lopez Abuin
Justin Allen
Elizabeth Ann Angier
Jachym Bednar
Annette Berendsen
Trevor Brown
Ruth Kalda
Adam Windak
Oleg V. Kravtchenko
Manfred Maier
Kristof Nekam
Ferdinando Petrazzuoli
Many other speakers
We will host many speakers from WONCA
special interest groups, networks, working parties
in a variety of courses, workshops and panels.
These include:
Waris Qidwai
Jim Reid
Miguel Román
Dermot Ryan
Bohumil Seifert
Alice Shiner
Aziz Sheikh
Peter A. Sloane
Jaime Correia De Sousa
Allyn Walsh
Niek De Wit
William Wong
Countdown to WONCA Africa conference
The countdown to the WONCA Africa region
conference is on! In March, I led the team from
Ghana who were at the 37th Annual Conference
of the Association of General and Private Medical
Practitioners of Nigeria (AGPMPN). They are the
largest single registered association under
WONCA, in Africa. The enthusiasm they exhibited
towards the conference was palpable and many
have registered to attend the conference.
The draft programme will be advertised on the
conference website soon after abstract
submission closes at the end of March. It includes
several research presentations, workshops to
enhance skills of practitioners in their daily work,
and several programmes by the Special Interest
Groups and Working Parties of WONCA.
We have planned an
exciting programme for
accompanying persons,
so come with your
spouse. Besides, there
are also elaborate tours
designed to visit notable
sites in Ghana.
Ethiopia, the latest country to establish Family
Medicine in Africa, has agreed to come and share
their story with us. The Scandinavian delegation of
Family Physicians is also mobilising its members
to attend the conference.
The WONCA World President, Prof Michael Kidd,
has agreed to come to the conference and will be
speaking at the opening ceremony on the theme
‘Sustainable Development Goals for the Health of
We don’t want to leave out your personal
experience in practice. Visit our website today and
complete your registration process (early bird
registration closes March 31)
In addition both the WONCA World CEO, Dr Garth
Manning, and the WONCA Africa Regional
President, Dr Matie Obazee, will be speaking at
the conference.
Looking forward to see you in Accra soon!
Dr Henry Lawson
Volume 41 Number 3
April 2015
WONCA History - WONCA Asia Pacific returns to Taipei
From March 4-8, 2015 WONCA Asia Pacific
region held their conference in Taipei, Taiwan.
This was preceded as usual by the WONCA Asia
Pacific council meeting. WONCA Asia Pacific
region has met before in Taipei -16 years ago
from March 6-9,1999.
Shih-Tzu "Steve" Tsai (Taiwan). Did we miss
anyone? (mail [email protected])
Note also the 1999 picture features current
members of WONCA World executive Karen
Flegg and Donald Li (now WONCA Executive
members-at large, then representing New Zealand
and Hong Kong respectively) and Pratap Prasad
(now WONCA South Asia region president - at the
time South Asia region had not yet been formed
and he was representing Nepal on the Asia Pacific
Compare the photographs below and note some
representatives on the Asia Pacific council
meeting remain after 16 years! Daniel
Thuraiappah (Malaysia), Donald Li (Hong
Kong), Tai-Yuan Chiu (Taiwan), Ching-Yu Chen
(Taiwan), Zorayda "Dada" Leopando (Philippines),
Volume 41 Number 3
April 2015
Young Doctors' News
VdGM award to Per Kallestrup
VdGM is delighted to
announce Per
Kallestrup (pictured) as
the inaugural recipient
of the "Being Young
Staying Young" award.
Per Kallestrup has been an inspirational figure to
many within VdGM. Being responsible for the
establishment of the VdGM Hippokrates Exchange
Programme he has remained in close contact with
its development and continues to act in a senior
supervisory capacity. He plays an active role
within the VdGM community and frequently
attends meetings at which he motivates, enthuses
and galvanizes young GPs and Family Doctors as he describes, the "Troubadours of general
To mark the occasion
of the second VdGM
Forum and also
acknowledge the
landmark of being ten
years old, in July 2014, the Vasco da Gama
Movement decided to create the "Being Young
Staying Young" award. The desire was to create a
prestigious award that recognised an individual of
significance and substance within the VdGM
sphere; an individual who over a prolonged period
of time had made a valuable and key contribution
to VdGM. It was also of crucial importance that the
inaugural recipient would be an individual who not
only contributed to and influenced the
development of VdGM, but also epitomizes,
espouses and evokes in others the youthful
mindset which characterizes and underpins the
heart, soul and ethos of VdGM. For these reasons
it was unanimously decided to award the first
VdGM "Being Young Staying Young" award to Per
Per is not only a father figure but also lives
through the values which are important to VdGM;
collaboration, empowerment, valuing each
individual, striving to be the best we can and as
the award title expresses so simply yet powerfully,
at all times having an attitude which is "Being
Young" and "Staying Young". For the members of
VdGM it was therefore a great honour that Per
Kallestrup so graciously agreed to be the
inaugural recipient of the VdGM "Being Young
Staying Young" award.
Per Kallestrup is WONCA News' featured doctor
for April 2015 (read more about him)
On behalf of everyone in VdGM, I offer Per our
thanks and congratulations.
Peter A Sloane,
President, VdGM
Health Systems and Young Family Doctors - VdGM Forum 2015
A report from the World Café workshop at the 2nd Vasco da Gama Forum in Dublin, 2015: The Best
and Worst of Contemporary Health Systems in Europe.
discussion rounds at six tables, each covering a
different health system building block and
facilitated by a VdGM member. The WHO’s
framework offered a structure under which
participants were able to exchange knowledge
and experiences of their own health system.
Discussions were lively and dancing between
discussion rounds was of the finest quality!
With young family doctor participants and music
from across Europe and beyond, the ‘world café’
format workshop on Health Systems kicked into
action at the 2nd Vasco da Gama Movement’s
Forum in Dublin earlier this year.
The World Health Organization’s 'Health System
Building Blocks' provided a framework to three
Volume 41 Number 3
April 2015
the WONCA network to think about
their health system and about how to
improve it through a 'building blocks'
Facilitators reports included in the
attached full report:
Service Delivery - Kalle Saikkonen
Health Workforce - Eline Dekker
Financing – Nina Monteiro (Portugal)
Information – Elena Klusova (Spain)
Medical Products, Vaccines and
Technologies - Amy Morgan (Ireland)
Leadership & Governance - Claire Thomas
(United Kingdom)
This report which can be found here brings
together the six facilitators' summary of
discussions with the aim of sharing the experience
and inspiring other young family doctors across
With many thanks to all the participants from
across Europe and beyond!
Coordinators: Luisa Pettigrew, Per Kallestrup
Facilitators: Kalle Saikkonen, Eline Dekker, Elena
Klusova, Amy Morgan, Nina Monteiro, Claire
Download full report
Proud to call myself a Vasco da Gamian.
Dr Deirdre Kelly a fourth year GP registrar on the
Ballinasloe GP training scheme, in Ireland, writes
on why she's proud to call herself a Vasco da
Gamian after attending the recent Vasco da Gama
forum in Dublin.
room. I was startled to see that there was well
over twenty nationalities. In the 45 minute session
Ming and Paula presented an excellent picture of
mindfulness including the history and beneficial
uses both for us and our patients. Paula
mentioned you can look at the chocolate cake,
you can read about the chocolate cake, you can
study the recipe in detail but you need to taste it to
gain the real experience. And we did just that with
mindfulness. A marvellous experience.
I attended the second Vasco da Gama Movement
forum on the weekend of Feb 20 and 21. My aim
was to present my research project. Little did I
realise that it was going to change my entire
perception of my career in the future as well as
enabling a rediscovery of passion for general
practice. The Vasco da Gama Movement as you
know is the WONCA Europe movement for newly
qualified GPs and GP trainees.
I brought my new found sense of calm with me to
the first plenary session. This focused on the
impact the economic crisis has had on Portugal,
Italy, Ireland, Greece and Spain. A GP from each
country spoke for five minutes on the impact. I
realised that I’ve been so caught up in the Irish GP
struggle that I hadn’t considered that GPs across
Europe might be struggling also – and in some
cases worse off.
The forum, entitled ‘Family Medicine 2.0,
Innovation and Awareness’ took place in Dublin. I
began my day by joining in the ‘Mindfulness’
session run by Drs Ming Rawat and Paula Martin.
These wonderful ladies began the session by
enquiring as to what nationalities were in the
Volume 41 Number 3
April 2015
Next came participation in a workshop on
domestic violence. My group included doctors
from Turkey, Netherlands, France, Portugal and
Denmark. Again I was witness that while laws may
differ from country to country, we are all ‘singing
from the same hymn sheet’ despite our differing
Movement and WONCA. We could all sense that
morale was low across Europe – especially after
the plenary on the impact of the Economic Crisis.
But, the future is bright – we just need to know
how to make it bright. As Peter Sloane pointed out
it involves a seismic shift in attitude – we need to
first and foremost have a positive attitude.
The results of the ‘Design Thinking’ workshop
were delivered to us in the form of role plays.
There was clearly a lot of fun doing these role
plays and at the same time dealing with genuine
dilemmas in general practice - for example how to
encourage GPs to set up a rural practice. I learnt
from this that European GPs are incredibly
creative when given the right platform.
There are approximately 80,000 GPs and family
physicians across Europe. We have the potential
to speak loudly on behalf of our patients. But we
need to come together to succeed. As young GPs
we need to join Vasco da Gama. We’re a family
of family doctors representing an entire
continent. Whining and complaining to each other
is futile. We need to get the attention of policy
makers and governments. We need to emphasise
global health. If we learn how systems work we
can use them to our advantage and implement
positive change. We are a large group and can
have a powerfully loud voice if we know how to
funnel it. There is strength in numbers. As Dr
Anna Stavdal, Vice President of WONCA Europe
pointed out on the plenary panel “patients don’t
change.” We deal with their issues regardless of
resources or pay/funding. At the end of the day
the patient is still in front of you. We need to seek
assistance from them to empower the system and
fight the fight.
Summary video made by Ulrik Kirk (under 3
Following this the plenary session on ‘Innovation
and Awareness’ began. Eight presenters with five
minutes each were able to somehow inspire the
entire audience. Topics varied from patient
orientated medicine to using technology; to
overcoming physical disability to e-learning, each
pair of speakers offered inspiring ideas and
experiences. The future of general practice is
bright. One talk demonstrated the powerful
combination of clinical practice with technology.
This pairing has helped patients in India use
online consultations between their local doctor and
specialists situated hundreds of miles away to
work together thereby avoiding the arduous trek to
the tertiary centre. Dr Tom O’ Callaghan has set
up ‘iheed’ – teaching online tutorials to medical
students in Africa. There are approximately
140,000 doctors for a European population of one
billion. Africa has 10,000 doctors for a population
of approx. the same population. As the saying
goes ‘Give a man a fish and you feed him for a
day. Teach a man to fish and you feed him for a
lifetime’. This is what Dr O’Callaghan has done in
terms of improving the number of doctors in Africa.
And he’s looking for recruits!
What can I say but I drove home from the
conference on a high. I’m empowered. I’m proud
to be a general
practitioner in Ireland, and
in Europe. I’m proud to be
a Vasco da Gamian. Get
involved. Take on the
challenge. Have
confidence. We need to
join together and grow
Vasco da Gama so we
can become stronger.
The question shouldn’t be
“are you going to the conference next year?” but
‘Why are you NOT going to Vasco da Gama
conference next year.” As Dr Tom O’Callaghan
put it: “Only dead fish go with the flow.”
Caroline Carswell is a deaf woman who described
beautifully about hearing the birds for the first time
following a cochlear implant. What an awakening.
Deirdre Kelly
The incredible ‘Innovation and Awareness’
session was followed by a further plenary on the
future of general practice, the Vasco da Gama
Volume 41 Number 3
April 2015
Rajakumar movement for young doctors- photos from Taiwan
The WONCA Asia Pacific movement for young
doctors, The Rajakumar Movement, recently met
at the WONCA Asia Pacific conference in Taipei,
Chair of the movement, Shin Yoshida (Japan), has
collected photos, of which a few are visible below.
The full collection is available here.
To contact Dr Shin Yoshida email
[email protected]
Volume 41 Number 3
April 2015
Member Organizations
Caribbean College of Family Physicians conference report
Prepared by Pauline Williams-Green MD,
Conference Chair
3. Smoking Cessation - What can the Family
Physician Do?
4. The biopsychosocial perspective of marijuana.
The Caribbean College of Family Physicians in
collaboration with the Family Medicine Section of
the University of the West Indies, Mona Campus
hosted its 6th Triennial Pan-Caribbean Family
Medicine Conference from February 6 – 8, 2015 in
Kingston Jamaica, under the theme – “Family
Physicians: Integrating Mental Health Care in
Family Practice”
Another workshop looked at the ethical dilemmas
encountered by the family physicians in caring for
persons with mental illness.
The second day was devoted to research in family
practice. A workshop on “Primary Care Research
in Mental Health Conditions” was directed by Dr
Rohan Maharaj, chair of the CCFP research subcommittee. This was followed by research
presentations from across the Caribbean, Nigeria
and Canada.
President Elect of WONCA, Professor Amanda
Howe was present at the conference via a live
teleconferencing link and also a pre-recorded
video of her presentation; “The role of the Family
Physician in Mental Health Care.” She illustrated
how family physicians are called upon by families
and members of the community to assist persons
with mental disorders. Often family physicians are
expected to coordinate the care of physical and
mental illnesses. Routinely, family physicians must
liaise with mental health officers and psychiatrists
to achieve optimum care for their patients.
The launch of the CCFP young doctors’ movement
(YDM) took place on the second day. The internet
(Skype) was used to bring Dr Kyle Hoedebecke to
the meeting and he introduced Polaris – the North
American YDM to the audience.
Mental health problems of the elderly were
presented by Professor of Public Health and
Ageing, Denise Eldemire-Shearer. On the other
end of the spectrum, Director of Child and
Adolescent Health in the Ministry of Health, Dr
Judith Leiba presented on Mental Health Issues in
The Pan-American Health Organisation/ World
Health Organisation was a major sponsor of the
conference since training for family physicians is
critical to the thrust by PAHO/WHO for the
integration of mental health care into primary care
services. Devora Kestel from PAHO and Maureen
Irons-Morgan from the Jamaican Ministry of Health
presented the case for the integration of mental
health care into primary care services.
The final day highlighted presentations on
conducting a mental status examination;
motivational interviewing and the clinical
management of common mental health disorders
such as depression and Schizophrenia.
The three day conference focused on multiple
aspects of the theme in order to highlight the
critical role of family physicians in the community
management of mental health conditions in the
Caribbean. Family Physicians and psychiatrists
conducted a panel discussion on drug abuse with
the following topics:
Overall, the three days provided opportunities to
reinforce current information on caring for persons
with mental health conditions in the family practice
setting. It also gave participants networking
opportunities for the future. The conference
organisers were pleased with use of the prerecorded video for the keynote speaker, Professor
Amanda Howe and the Skype conversation. In the
future it is hoped that videoconferencing could be
incorporated, to reduce the inconvenience of
international travel.
1. Drug Abuse: The Jamaican Landscape;
2. The Management of Alcohol Abuse by the
Family Physician;
Volume 41 Number 3
April 2015
Spanish Society creates new social network profiles
The Spanish Society of Family and Community Medicine (semFYC) streamlines its digital channels and
create new profiles on social networks
Now you can follow semfyc_int on Twitter
semFYC launched a new digital strategy to redesign the form and substance of its digital channels. One of the
first changes is now on Facebook, where patient information will be disseminated to be a source for questions
of citizens and answers from experts and working groups of this scientific society.
semFYC is also making changes on its Twitter profiles. Now is available one international profile on Twitter
and soon, one of member service. You can now follow semfyc_int, a new channel aimed at the international
community of specialists in Family and Community Medicine. The member service profile, “semFYC
responds”, is coming soon and will be dedicated to answer to the concerns of its nearly 20,000 members and
In a third phase semFYC could enter into new social networks or digital channels. All this with the aim of
adapting the organisation to changing times and reach specialists in Family and Community Medicine from all
around the world, and so continue its task of information, support and defence of the professionals and the
Family Medicine specialty.
semFYC apuesta por una nueva estrategia digital
La Sociedad Española de Medicina de Familia y Comunitaria (semFYC) apuesta por una nueva estrategia
Ya puedes seguir en Twitter a @semfyc_int
La semFYC ha iniciado una nueva estrategia digital en la que está rediseñando el fondo y forma de sus
canales digitales. Uno de los primeros cambios se está produciendo en Facebook donde ahora se difundirá
información para pacientes en lo que pretende ser una fuente para resolver dudas de la ciudadanía a través
de los expertos y grupos de trabajo de esta sociedad científica.
Otra novedad son los nuevos perfiles de la semFYC en Twitter: uno internacional y otro de atención al socio.
El primero de ellos ya se puede seguir, @semfyc_int, es un nuevo canal dirigido a la comunidad internacional
de especialistas en Medicina de Familia y Comunitaria. El de atención al socio, semFYC responde, llegará
próximamente y estará dedicado en exclusiva a dar respuesta a las dudas de sus cerca de 20.000 socios y
En una tercera fase, la semFYC podría entrar en nuevas redes sociales o canales digitales. Todo ello con el
objetivo de adaptarse a los nuevos tiempos y llegar al máximo número de especialistas en Medicina de
Familia y Comunitaria, y así seguir con su tarea de informar, apoyar y defender a los profesionales y a la
Volume 41 Number 3
April 2015
Featured Doctor
A/Prof Per KALLESTRUP: Denmark - Hippokrates founder
Per Kallestrup is a
Medical Doctor,
Specialist of Family
Medicine and work
part-time in an eight
partner practice close
to Aarhus, Denmark.
He is also Co-Director
of the Center for
Global Health at
Aarhus University (GloHAU) focusing on the
contribution of Primary Health Care to Global
Health through research and education.
Furthermore, he is the Chairman of “Partners in
Practice” an International Development Program
of the Danish College of General Practitioners
devoted to fostering development of Primary
Health Care worldwide through established
health systems, is the universal tool through which
we make a remarkable difference - building trust
through continuous, comprehensive, communityoriented care delivered by family health teams.
A tall order, but all family physicians are extremely
hard-working – and a Danish proverb says: “if you
want to get something done, go to the one, who is
Could you say something about how the
Hippokrates Exchange Program was created?
Life is full of journeys. And our professional
journey is one of these. Let me tell you a little bit
about my own professional journey, as an
During my secondary schooling when I was 16-17
years old I was fortunate to do a year of studies at
an American high school as part of an exchange
programme. This was a world-opening and mindopening experience for me. Later, during my pregraduate medical studies, it inspired me to do a
year of medical school at a University in Spain, as
part of a European Exchange Programme for
university students – the so-called ERASMUS
At the recent Vasco da Gama Movement Forum,
in Dublin, he received the inaugural “Being Young
Staying Young” award. See news item on this.
What work do you do currently?
Dividing my working time between clinical work in
my practice and academic developmental work at
the Center for Global Health at Aarhus University,
I consider myself extremely lucky to be able to
“walk on two legs” – being able to combine the
diverse real-life wonders of practice work and the
challenges of development of Primary Care on a
global scale. Although the contrasts between
these work environments may seem
unfathomable, they do actually complement each
other well and contribute mutually as great
sources of energy and admiration for the diverse
realities within our profession. I find that the
dynamics of this way of working ‘keeps me on my
toes’ as well as provides me with ‘street
Again, I found myself rewarded by much more
than just scholastic knowledge - I brought home a
new foreign language, an insight into another
culture, lots of diverse exciting experiences and
new friendships.
With this momentum I moved on to postgraduate
studies and work placements – and the Vocational
Training Scheme of a family physician trainee is a
multifaceted journey of exposures. During this
period, I wondered how I could add some of the
same spice to my postgraduate medical studies:
to once again be able to combine professional and
cultural education. I was able to arrange a two
week visit to the Cedar House Surgery, in St
Neots, Cambridgeshire, UK.
I can come home to Denmark, after having
completed field work in Rwanda, and feel fully
rejuvenated, ready to attend to my patients in the
practice. Similarly I can take inspiration from our
Danish Primary Care organisation to meetings
with the Ministry of Health of Nepal. I find it even
more satisfying, when I am able to bring foreign
colleagues to our practice, to stimulate
professional and personal exchange.
I had by then become a member of the
International Committee of the Danish College of
General Practitioners, and I proposed to design
and develop a European Exchange Programme
for medical doctors specialising in GP/FM. That
became “Hippokrates”, which was launched at the
WONCA Europe Conference, in Vienna, Austria,
in 2000.
The constant attention to, and advocacy for, our
patients and our communities at the frontier of our
Volume 41 Number 3
From a beginning of five participating countries
and 25 host practices, and with only few
exchanges taking place every year, this
programme has grown tremendously. It now
embraces 26 countries, and more than 100 host
practices across Europe. In 2014, it resulted in
105 exchanges and a magnitude of experiences
shared. Since 2008, the Hippokrates has been
entrusted and re-invigorated by the Vasco da
Gama Movement.
April 2015
think are quite universal. They use the metaphor
of ‘the dog chasing the bus’. And they argue, that
now that they have finally caught up with it (the
bus) they are not quite sure, what to do with it.
Some of the questions that they raise are:
• Why do we have a need to be equal to other
• Why do we want to be valued by specialist
colleagues more than by patients or communities?
• Why is our training so focused on skills and
• What is our role in primary healthcare reengineering?
Hippokrates is very much alive and all European
trainees/GPs/FDs are encouraged to participate.
What other interesting activities that you
have been involved in?
And I feel these concerns translate well to the
challenges family medicine are facing across the
globe. Of course, these concerns are in various
disguises depending on the state or - should I say
- status of family medicine in the individual
My PhD on “Schistosomiasis and HIV in rural
Zimbabwe”, was completed during a family stint of
five years in Zimbabwe (2000-2005), where my
wife was heading the EU Health Assistance to
Zimbabwe. After that, I got involved in the
“Primafamed (Africa) Network” (Primary Care and
Family Medicine Education Network). The network
aims at developing and strengthening family
medicine higher education and training through
capacity building, curricula enhancement and
academic research development.
However, I think it is similar for all. The
development of family medicine and the continued
efforts to define ourselves as a specialty have
taken place – or are taking place - as a reactive
process forming ourselves in the image of the
classical medical specialties and we have created
or are creating our teaching and research
institutions alike.
It is in the process of building new institutions and
in shaping new professionals, that enthusiasm and
innovative awareness create a platform for
renewal and consolidation of the core of our
Paradoxically, when we shape ourselves like the
other ‘specialists’: we risk getting away from who
we are and from the reality of our patients and
communities, by whom we define ourselves and
by whom ‘specialists’ do not define themselves.
We risk forgetting to be different, to be
compassionate, embracing collaborators who
serve and thrive best in teams (as opposed to
those who work in silos of hierarchical institutions,
nourished by prestige and authority).
This work has also inspired me to create “Partners
in Practice”, an International Development
Program of the Danish College of General
Practitioners, devoted to fostering development of
Primary Health Care worldwide, through
established partnerships. This is a fairly new
organisation, which aims at recruiting Danish GPs
to partake in projects to support and capacity-build
emerging family medicine institutions in partner
We are getting involved in research, quality
improvement activities, production of guidelines,
endorsing recommendations and requirements etc
– everything appropriate and necessary. At the
same time, we must remember where we come
from and not get caught up in a charade similar to
the fairy tale of the “Emperor’s new clothes”.
What are your interests as a family physician
and how do you see the future of Family
My best ideas at how we may secure a new deal
for family medicine in the future with regard to
three levels of engagement are:
I am a great fan of inter-collegial inspiration and
‘infectivity’ and I have always found this through
WONCA. The WONCA family is a great nest of
restless busy-bees always eager to explore and
exchange views and ways.
• Individually. Throw yourself into the mess, get
entangled, ‘don’t be a whiner, be a diner’. Take to
life with a grand appetite and share meals. Be
sure to share your successes – use these as a lift
for everybody around you, which creates synergy
Some of our South African colleagues have
recently in an editorial expressed concerns on the
state of family medicine in South Africa, which I
Volume 41 Number 3
and simultaneously makes you flourish. Be the
heroes of everyday, in settings where life is lived.
April 2015
• Globally. Engage with your communities, share
your experiences, keep promoting possibilities to
form family health teams. Always think in broader
terms of socio-economic and environmental
determinants. Get out – go to meetings, do
exchanges, participate in and contribute to
development across professions and borders.
• Professionally. Dare to be different: involve
your patients, make them partners. Keep being
the voice for continuous, comprehensive,
community-oriented care delivered by a family
health team. Also respect the need for balanced,
mutually sustained integration with colleagues and
collaborators in the wider health system.
Prof Mehmet UNGAN: Turkey - WONCA Europe executive
Prof Mehmet Ungan is a specialist in family
medicine working both in
his practice and also in a
university department as an
academic. He was one of
the founders of the Turkish
Association of Family
Physicians (TAHUD) in
1990, and is also a past president of TAHUD.
Now, he is Honorary Secretary of the Turkish
Family Medicine Board, a member of the WONCA
Europe Executive Board representing its
Research Network (EGPRN) of which, he is the
vice chair.
Prof Ungan is the chair of the Scientific Committee
for the WONCA Europe conference being held in
Istanbul, in October 2015.
refugees, and school and occupational health
What other interesting activities that you
have been involved in?
I do not know if it is interesting for all, but the rest
of my work is all about research in primary care.
Since 1998, I have been a member of the
European General Practice Research Network
(EGPRN), which is a network of the WONCA
Europe. We have two meetings a year in different
European countries. Creating the research
agenda for European Primary Care was one of the
collaborative works of EGPRN in which I have
enjoyed a lot.
ESPCG (Special Interest Group on Primary Care
Gastro) is another group in which I feel
comfortable due to having a common research
and clinical interest.
What work are you doing currently?
Like many others in the family medicine world, I
have a very busy schedule. The main part of my
day is comprised of seeing patients, both in my
practice and in the Medical School, and with lots
of training activities. I’m a professor in the
Department of Family Medicine, founded in 1993,
one of the pioneers in my country. Our department
belongs to Ankara University School of Medicine
which was founded in 1945 - the first one for the
young Turkey after the Ottoman Empire. We are
almost 30 residents, two assistant professors and
two family physician specialists involved in
educational activities. We provide educational
programs for first, fifth and sixth grade medical
students, and run five family medicine outpatient
clinics. Our department centre is located in
Avicenna (Ibn-İ Sina) Hospital of Ankara
University Medical School.
For the past four years, I have been attending
some of the CDC (American) training, especially
on tuberculosis and migrant health, and trying to
undertake research on related subjects. For
example, I was one of the partners of the
European project on HIV/AIDS trainers training;
the osteoporosis project of International Atomic
Energy (for Turkish data), and the European
FP/GP burnout study. Nowadays I am studying
latent TB infection screening among different
migrant populations.
What are your interests in work and outside
I am afraid I don’t have interesting things to tell
you away from work :-).
As well as my position in the university, I have a
private family medicine clinic affiliated with a wellknown laboratory chain, in Ankara. There, with
other family physicians, we have been providing
services mainly to embassies, foreigners, those
preferring private services for periodic health
screening, health screening of immigrants and
My special interest areas at work are migrant
health, tuberculosis, gastrointestinal diseases,
primary health care research, FM education &
training, information & communications
technology, health promotion & disease
prevention. I have been implementing IT tools with
Volume 41 Number 3
other disciplines to make research on daily work
possible through proper data management. In this
way I really enjoy looking at retrospective data and
improving the service we provide in primary health
care, mainly on behalf of the patients but also for
the physicians.
April 2015
between 1915 - 1916. The mountain Ida (Kaz
Daği) is near the site of ancient Troy and the
Dardanelles. From its highest peak, about 1,800m,
the gods are said to have witnessed the Trojan
War. Those living there "stay young" as it is known
to have the highest oxygen concentration in the
world after the Amazon. It is a paradise of olives
and olive oil, which is the food of the gods.
Balneology (Latin: balneum "bath"), the science of
the therapeutic use of baths in ancient medicine,
is still alive there, where also my family has a
summer house. One month every year, we go
there with our children, to refresh ourselves for the
new work year. We are lucky to have sea, sun,
fish, olive oil, good food, fun and history all in the
same environment, near the edge sea.
Outside of my professional work, I try to make
sports as a lifestyle, to enjoy the good quality and
taste of the Turkish kitchen, and travelling around
Turkey which has endless attractions in each city.
Like many of my colleagues, I am also a dedicated
father and husband. I’m lucky to have my wife,
who is also a family physician and one of the
founders of the TAHUD. She has supported me a
lot not only as my wife, but also as a good family
physician. We have a 13 year old son and a 21
year old daughter who is studying Law.
Sometimes, I realise that I should find more time
to spend with them.
My country has many attractive sights to see for
those interested in the history of humans and
science. As well there are places to be in nature,
or enjoy the sea life (sailing and diving), mountain
life, plants, caves etc. I have been all around the
world, but nowhere is more attractive than Istanbul
in my eyes. Walking around Istanbul streets and
still discovering the city with endless secrets is
unbelievable. Taking photos of the city while
travelling in between the Asian and European
sides by a regular boat has always been a real
hobby for me. Also drinking Turkish tea and eating
simit, while sharing some with the seagulls on the
boat, is one of my favourite moments.
You are interested in the history of medicine
and you love Istanbul – both seem relevant to
the coming WONCA Europe conference?
As a physician I am interested in history of
medicine. In Turkey we live on a land which has
hosted many civilizations. As written in many text
books, one of the earliest known medical schools
opened in Datca (Cnidus) in 700 BC and that had
an ‘organ’ based approach. Just 30-40 minutes
distance by boat in Kos, the ‘generalist’ approach
of medicine began 300 years later, around 400
BC. The region is important for the history of
holistic and comprehensive care.
World family physicians are lucky to visit Istanbul
during the next WONCA Europe conference and I
hope they may see my Istanbul.
ex oriente lux*!
You might remember the Trojan war in ancient
history (1194–1184 BC) and also the very sad
Dardanelles Campaign, the Battle of Gallipoli of
World War I that took place in the Ottoman Empire
* out of the East, light
Volume 41 Number 3
April 2015
Chloé Perdrix writes: Vietnam and Laos
My name is Chloé Perdrix, I’m a 27 year old
French GP resident,. I am taking a sabbatical year
travelling around Asia. In order to stay in touch
with the medical network, I intend to meet general
practitioners during this journey. I proposed to
WONCA and the Vasco da Gama Movement
(VdGM), to write an article each two months in
order to share my discoveries, my questions and
my reflections about this experience. This is my
fourth story.. to see others click here.
the defoliation, it was later revealed to cause
serious health issues among the Vietnamese
population and US veterans.
The US Institute of Medicine’s July 2009 report
cited sufficient evidence of association between
exposure to Agent Orange/dioxin and five
illnesses: soft-tissue sarcoma, non-Hodgkin’s
lymphoma, chronic lymphocytic leukaemia
(including hairy-cell leukaemia), Hodgkin’s
disease, and chloracne. The report also found
evidence suggesting an association with prostate
cancer, multiple myeloma, amyloidosis,
Parkinson’s disease, porphyria cutanea
tarda, ischemic heart disease, hypertension,
Type 2 diabetes, peripheral neuropathy,
cancers of the larynx/ lung/ bronchi/ trachea,
and spina bifida in exposed people’s
Agent Orange in Vietnam
In Vietnam, the Vietnamese Red Cross also
associates the following with exposure to
dioxin: liver cancer; lipid metabolism
disorder; reproductive abnormalities and
congenital deformities such as cleft lip, cleft
palate, club foot, hydrocephalus, neural tube
defects, fused digits, muscle malformations and
paralysis; and some developmental disabilities.
After our bike trip detailed in my previous article,
we arrived in Mekong Delta and moved toward the
North Vietnam. During our Halong Bay visit (photo
above), we hiked on an Island named Cat ba.
There, we met a French nurse who explained her
work experience in Ho Chi Minh. She told us how
surprised she was to see how Vietnamese people
took care of their relatives. All her patients were
always accompanied by a family member.
Vietnam has reported that some 400,000 people
were killed or maimed as a result of exposure to
herbicides like Agent Orange. In addition, Vietnam
claims half a million children have been born with
serious birth defects, while as many two million
people are suffering from cancer or other illness
allegedly caused by Agent Orange.
Family in Asia is very important. Children and
parents often live in the same house all their lives.
Children taking care of their parents when they get
older. No old people live alone.
I was very surprised by this story and disappointed
to realise that even when the war is long over,
there are still consequences on the environment
and for public health in Vietnam.
She also told us about patients who were victims
of Agent Orange.(1)(2)(3) To explain, Agent
Orange was a powerful mixture of chemical
defoliants (X 50 times standard levels) used by US
military forces during the Vietnam War to eliminate
forest cover for North Vietnamese and Viet Cong
troops (in South Vietnam), as well as to eliminate
the crops that might feed them. The data say the
more than 20 million gallons of herbicides were
sprayed over 5 million acres of land in Vietnam
from 1961 to 1971.
If you want to know more about it, here is a very
good video to inform people about Agent Orange
effects in Vietnam. (4)
Tet in Laos
After Vietnam, we went back to Laos to visit the
north of the country. After three wonderful days
kayaking on the Nam Ou River, we arrived in
Luang Prabang. There, it was very hard to find a
room because it was the 21 February, two days
after the “Tet celebration” (Chinese and
Vietnamese New Year).
Agent Orange contained the chemical dioxin. In
addition to the massive environmental impact of
Volume 41 Number 3
April 2015
There were a lot of Chinese tourists on vacation in
Luang Prabang. Consequently, all guesthouses in
downtown were full. Fortunately, my brother,
Romain and I found a room in the Luang Prabang
suburbs, whereas some of our kayaking friends
had to sleep in the entrance hall of the hostel, on a
mattress the owner gave to them.
But some of you must wonder: What is Tet? Tet is
the occasion to express respect and
remembrance for ancestors as well as welcoming
the New Year with beloved family members.
In the past, Tet was essential as it provided one of
few long breaks during the agricultural year,
between the harvesting of crops and the sowing of
the next ones.
Bears in Asia are captured for their bile, which is
extracted using cruel, painful procedures and sold
as traditional medicine.
To make it easier, westerners can imagine Tet as
a combination of Christmas and New Year: every
family will get together to have big meals,
decorate Tet trees and eat Tet food but to
welcome the New Year instead of for a religious
cause. These celebrations can last from a day up
to the entire week.
Bear bile contains high levels of ursodeoxycholic
acid (UDCA)
known to be useful
for treating liver
and gall bladder
However, there
are now many
readily available
herbal and
alternatives with
the same
During Tet, one takes extra care not to show
anger and not to be rude to people. The Tet is an
occasion for people to share a common ideal of
peace, concord and mutual love.
Bear bile traffic in Asia (5)(6)(7)
Despite the availability of inexpensive and
effective herbal and synthetic alternatives – and
the dangers of consuming bile from sick bears –
bile farming continues.
Bear bile has been used in traditional Asian
medicine for thousands of years. In the past bear
bile would be obtained by hunting bears in the wild
and killing them to remove their gall bladder. It
would have been a particularly rare and prized
ingredient at the time used sparingly for specific
medical conditions.
Once we found a room, we were advised to go to
a beautiful waterfall where the water had a very
special blue colour. (above photo) There, we
discovered a bear refuge (photo above right)
which protected bears from bear bile traffic.
These captive bears suffer in filthy and cramped
conditions, often in cages no bigger than phone
booths. In China, the cages are sometimes so
small that the bears are unable to turn around or
stand on all fours. Some bears are caged as cubs
and never released. Bears may be kept caged for
up to 30 years.
I learned how traditional medicine could be
sometime so inhuman. (Without forgetting that
western medicine can also be inhuman
More than 10,000 bears – mainly moon bears but
also others such as sun bears and brown bears –
are kept on bile farms in China, and just under
Volume 41 Number 3
2,000 suffer the same fate in Vietnam. The bears
are "milked" regularly for their bile, which cause
massive infections. Most farmed bears are
starved, dehydrated and suffer from multiple
diseases and malignant tumours that ultimately kill
April 2015
who taught me a lot about Myanmar primary care
and Myanmar culture. But you must wait the next
article because I need an entire article to tell you
about Myanmar.
s on sale
in a
Demand for bear bile products comes mainly from
China, Japan, Korea, Vietnam, Malaysia and
Taiwan. Bear bile products are also found in
Australia, Indonesia, Laos, Myanmar, Singapore,
the US and Canada.
Unfortunately, bear bile farming is still completely
legal in China. In Vietnam, bear bile farming has
been technically illegal since 1992, but it wasn’t
until 2005 that species-specific legislation was
introduced banning the exploitation of these
endangered animals. Sadly, bear bile farming
persists in the country due to legal loopholes as
well as the fact that demand still exists.
I hope
this one
d you.
Bibliography : available online
Moving on
Note: The views expressed and research
conducted is that of the author and not necessarily
the views of WONCA.
After visiting Luang Prabang, we flew to
Mandalay, former capital of Myanmar. I met in
Mandalay and Yangon wonderful family doctors
Final call for the 47th EQuiP Meeting in Switzerland, 24-25 April
Open EQuiP Spring Meeting 2015: Knowledge
Translation in Primary Health Care - Focus on
Quality Circles
EQuiP is the European Society for Quality and
Safety in Family Practice - a WONCA Europe
Ongoing quality improvement (QI) is fundamental
to modern family medicine; it is about providing
person-centred, safe and effective care, and
efficient use of current resources in a fastchanging environment. Whereas QI affects local
problems like perceived inefficient, harmful or
badly timed health care, Knowledge Transfer (KT)
deals with generalisable concepts to increase and
disseminate knowledge.
components act within them have to be
investigated and mapped in relation to variations in
these underlying mechanisms and the local
The aim is to identify optimal conditions for
success which may then inform participants as
they manage and maintain current QCs and plan
future ones to improve clinical practice. Basically, it
is about unpacking the black box to see what
variations of the programme work for whom and
under what contextual features by looking at
numerous projects that have been undertaken.
Successful projects may show what works,
whereas unsuccessful projects will show what
does not work. Oral presentation of projects will be
followed by discussions in small groups.
Workshops on various aspects will give insight into
the different issues QCs work with.
In other words, KT is the synthesis, dissemination
and exchange of knowledge for providing effective
health care, and QI is the process at the local or
organizational level where quality issues arise.
Quality Circles/ Peer Review Groups / Practice
Based Small Groups/ CME Groups seem to be an
effective tool to do that!
The objective of the conference is to document the
range of components that characterise QCs, their
underlying mechanisms and the local context in
which they are conducted. The patterns in which
Date: Friday 24 and Saturday 25 April 2015.
Venue: Kloster Fischingen, Switzerland.
With best wishes
Dr Adrian Rohrbasser
Volume 41 Number 3
April 2015
Collaborators: College of Family Physicians of
Singapore, Ministry of Health Malaysia
Asia Pacific research conference
Submission of abstracts: 15th August 2015
Early bird registration: 15th September 2015
The 5th Asia Pacific Primary Care Research
Conference 2015 come to Malaysia this year
Registration Fees:
Local Delegates RM 750
Foreign Delegates USD 350
Early Registration RM 650
Preconference: RM 150
Further details: http://www.mpcrg.net
Email: [email protected]
Date: 4 -6 December 2015
Venue: Everly Hotel, Putrajaya, Malaysia
Organisers: Malaysian Primary Care Research
Group (Academy of Family Physicians of
Malaysia), Family Medicine Specialists Association
of Malaysia
Volume 41 Number 3
April 2015
Volume 41 Number 3
April 2015
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June 15-18, 2016
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Volume 41 Number 3
April 2015
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