From the Wonca President
:
Are the World’s Family Doctors Prepared
2
for an Avian Influenza Pandemic?
From the CEO’s Desk
:
Celebrating Our Wonca Website’s First
3
Anniversary
From the Editor
:
Recording Important Dates for Wonca and
5
our World
FEATURE STORIES
5
•Family Medicine in Bolivia: Thirty Years of Implementation
•Medicina Familiar en Bolivia: 30 Años de su Implementación
•Iberoamerican Conference Calls for Family Doctors to Play Central
Health System Role
Wonca REGIONAL NEWS
9
•Meet Dr Adolfo Rubinstein: Iberoamericana-CIMF Regional President
•First Lady of Timor-Leste Addresses RACGP: Asks for Help for Mothers
and Children
HEALTH AND HEALTH SYSTEM NEWS
12
•Avian Flu Spreads: Countries Prepare for a Pandemic
•Wonca Participates in Millennium Development Goals Workshop
MEMBER AND ORGANIZATIONAL NEWS
15
•Leela De A Karunaratne: Wonca Global Family Doctor for November
2005
•Pakistan Family Doctors Offer Support and Thanks Following
Earthquake
RESOURCES FOR THE FAMILY DOCTOR
17
•Useful Websites on the Avian Influenza Virus
•Global Fellows Positions Available
WONCA CONFERENCES 2005-2011 AT A GLANCE
19
GLOBAL MEETINGS FOR THE FAMILY DOCTOR
20
VOLUME 31
NUMBER 6
DECEMBER 2005
CONTENTS
Wonca website:
http://www.GlobalFamilyDoctor.com
Wonca President
Prof Bruce Sparks, South Africa
2 Cruden Bay Road
Greenside
Johannesburg 2193
South Africa
Tel: 27 11 646 2140
Fax: 27 11 717 2558
Email: brucespa@global.co.za
Wonca Chief Executive Officer
Dr Alfred W T Loh
Wonca Administrative Manager
Ms Yvonne Chung
World Organization of Family Doctors
College of Medicine Building
16 College Road # 01-02
Singapore 169854
Tel: 65 6224 2886
Fax: 65 6324 2029
Email: admin@wonca.com.sg
Wonca President-Elect
Prof Chris van Weel, Netherlands
Wonca Immediate Past President
Dr Michael Boland, Ireland
Honorary Treasurer
Richard Roberts, MD, USA
Wonca Regional Presidents
Dr Abra T Fransch, Africa
Warren A Heffron, MD, Americas
A/Prof Goh Lee Gan, Asia Pacific
Prof Igor Svab, Europe
Dr Shatendra K Gupta, Middle East
South Asia
Dr Adolfo Rubinstein,
Iberoamericana-CIMF
Wonca Executive Members at Large
Dr Javier Dominguez del Olmo, Mexico
Prof Michael Kidd, Australia
Richard Roberts, MD, USA
Chair, Bylaws and Regulations
Dan Ostergaard, MD, USA
Chair, Publications & Communications
Dr Geoffrey D Martin, Australia
Editor, Wonca News and Editorial Office
Marc L Rivo, MD
4566 Prairie Avenue
Miami Beach, Florida 33140, USA
Tel: 305 671 7327
Fax: 305 674 8839
Email: marcrivo@aol.com
WONCA GLOBAL SPONSORS
FROM THE WONCA PRESIDENT:
ARE THE WORLD’S FAMILY DOCTORS
PREPARED FOR AN AVIAN INFLUENZA
PANDEMIC?
“Is the world adequately prepared? No. Despite an
advanced warning that has lasted almost two years, the
world is ill-prepared to defend itself during a pandemic.
Most developing countries will have no access to
vaccines and antiviral drugs throughout the duration of
a pandemic.”
WHO. 3 November 2005 (http://www.who.int/csr/
disease/avian_influenza/avian_faqs/en/index.html)
When I have raised the possible impending Avian
influenza pandemic, many practitioners have dismissed
the possibility, with statements such as, “It will never
happen – look what happened when there was panic
about SARS”. But, are the circumstances the same? The
low transmissibility of the SARS virus, combined with
the fact that victims didn’t reach peak infectiousness
until they were already showing clinical symptoms,
made it feasible to control the epidemic using public
health measures. In contrast, the Avian flu viral subtype
H5N1 spreads before symptoms are evident. In
addition, this bird virus is now more lethal to
experimentally infected mice and ferrets and is able to
survive longer in the environment. It has also expanded
its host range, with domestic ducks becoming recent
silent hosts to the virus. Finally, the mutated form of
the virus transmittable from human to human may be
more virulent.
The WHO says in the best-case, conservative
scenario, two to seven million people will die in the
pandemic and tens of millions will need medical
attention. The organisation warns that the global spread
of a pandemic can’t be stopped – but preparing
properly will reduce its impact. It has stated that the
virus may possibly reach all continents in less than
three months! The major impact of the pandemic will
most likely be in the developing world!
The H5N1 virus is particularly worrisome for several
reasons. It mutates rapidly and now has a history of
being able to acquire genes from viruses infecting other
animal species. Laboratory studies have demonstrated
that isolates from the virus have a high pathogenicity
and cause severe diseases in humans and birds. Those
that survive infection excrete virus for at least 10 days
making it easier to spread the virus to poultry and
WONCA
News
FROM THE WONCA PRESIDENT
2
migratory birds. The mutation to a human form is more
likely if humans or pigs are infected with human and
avian strains at the same time, since genetic material is
able to be exchanged in a ‘reassortment’ event, giving
birth to a human form of the virus. By the end of
November 132 confirmed cases of Avian Influenza A/
(H5N1) were reported to WHO of whom 68 (51%) had
died. WHO has declared that the 3
rd
phase of pandemic
alert out of an series of six increasingly severe levels
has already been reached. Officials in Thailand and
Indonesia suspected early in December that the avian
virus may have mutated into a human-to-human form. If
so, then we may be close to entering the 4
th
and more
significant human-to-human spread of the pandemic.
If the world’s nations are ill-prepared, are our global
family doctors any better prepared to meet a possible
pandemic – one which most scientists say is inevitable
rather than a probability. Given the predicted numbers
of infected persons and deaths, the health facilities will
not be able to cope. The major load will fall on primary
care services including family doctors. But in
discussions with practitioners in various Wonca regions,
few knew:
•the first and subsequent symptoms of avian flu, the
complications, clinical syndromes and modes of
death?
•who is most vulnerable? (so far those affected by the
bird flu have been the young and healthy, not the
usual at risk groups)
•how to prevent or lesson the flu, treat patients and
prevent the spread of the virus? (A most important
preventive measure is the use of face masks – since
it is droplet carried and not airborne - ordinary
masks will suffice).
•that antiviral medications oseltamivir (Tamiflu) or
zanamivir (Relenza) which may lessen or prevent
morbidity, must be given within 48 hours of onset of
symptoms, and that indicators suggest that H5N1
may be developing resistance to Tamiflu.
•that vaccines or medications for developing countries
may be unlikely given that stockpiling and advanced
orders in the US and Europe are expected to
consume the available market.
•that a vaccine may not be available, in any event,
until several months after the onset of the pandemic
•that the virus is spread before symptoms occur – a
risk contributing to the international spread by
travellers in the pandemic.
•that death rates among HIV / AIDS patients are
expected to be lower since these patients may not
be able to mount the immune response required to
produce Adult Respiratory Distress Syndrome, or
ARDS,
the major cause of death in patients so far,
WONCA
News
FROM THE WONCA PRESIDENT / FROM THE CEO’S DESK
3
FROM THE CEO’S DESK:
CELEBRATING OUR WONCA WEBSITE’S FIRST
ANNIVERSARY
This January 2006 marks the first anniversary of our new Wonca Website
under the exclusive financial and operational management of Wonca. It is
therefore appropriate that we take stock of what has been achieved during
this past year.
The three year agreement between Wonca and medi+World International
on the management of the Wonca Website www.GlobalFamilyDoctor.com
(GFD in short) ended in May 2004 with the somewhat bleak prospect then
of the website continuing given inadequate funding. At their meeting in
St Augustine, Florida in November 2004, the Wonca World Executive
decided, after much discussion, that the website continue under direct
Wonca management and funding. This led to two months of flurried
activities during which the management of the website was transferred from
medi+World International to Wonca. At the same time, with the approval of
the Orlando Wonca Council, the Wonca Secretariat set about seeking
collaboration and sponsorship from the pharmaceutical industries to
support GFD.
By January 2005, Wonca had assumed full control of its website and had
installed its own server housed within Dolphin IT in Melbourne, Australia. A
new company, Paradigm Multimedia in Melbourne, was appointed to
manage the site with the new Webmaster, Mr Alex Westcott, replacing Prof
•that health workers and
morticians are expected to be
particularly vulnerable, and that
they and the military, police, and
politicians have been classified
as the first to receive vaccine
and preventive drugs, to prevent
disruption of essential services.
Civil unrest and riots may be
more likely to occur where
health care professionals and
health systems are ill-prepared
or unable to cope with the rate
of infections, admissions to
hospitals and deaths in the first
wave of the pandemic. A second
wave is usual within a year.
Whether or not the predictions
of a pandemic of this magnitude are
realized, an urgent need exists to
upgrade the preparedness of the
world’s family doctors. Member
on developments related to this
potentially devastating pandemic.
I hope, in the words of the Bard,
that this is ‘Much ado about
nothing’ and that, gladly and with
thanks, I will have to eat my words.
On the other hand, if the Avian flu
pandemic is to become as
significant as some predict, then I
hope we family doctors will not miss
the opportunity to make a
significant difference in the lives of
our patients and their communities.
Bruce Sparks, M.D.
President
World Organization of Family
Doctors
Wes Fabb who was then appointed
as GFD Medical Editor. Sub-
sequently, a new Homepage for GFD
was introduced with top and side
menus instituted for better site
navigation.
Stable funding was secured by
having five pharmaceutical
multinationals as Wonca Global
Sponsors. With the website’s
infrastructure properly constituted,
GFD has in the period of this one
year grown from strength to
strength. The website has now
become the ‘image of Wonca ’ to
the outside world. During the year,
significant enhancements and
progress have been made.
We have experienced continued
growth and popularity of ‘Journal
Alerts’. Today, more than 4600
recipients receive on their
computers, three days a week, the
latest in medical journal articles of
relevance to FPs/GPs. Over one
hundred medical journals are
scanned every week by the Medical
Editor and two Assistant Medical
organisations of Wonca and
departments of family medicine are
best poised to initiate awareness
and information programmes for
family doctors and other health
professional and community leaders
in their countries and regions. Such
programmes should be organised in
conjunction with others in primary
health care, particularly nurses and
community workers. Family doctors
should be encouraged to update
and familiarise themselves with
national strategies if they exist, and
improve their ability to deal with the
massive loads of patients who could
seek their care and require accurate
and helpful information.
I have attached a list of useful
websites in the Resources for Family
Doctors section of Wonca News for
those who wish to keep up to date
pg_0004
WONCA
News
FROM THE CEO’S DESK
Editors to keep this service going.
The two Assistant Editors appointed
during the course of the year are
Drs Stephen Wilkinson of Australia
and Jim Vause of New Zealand. More
than 5,000 Journal Watch items
posted during the past week, month
and twelve months are now
accessible via the Homepage via a
new clinical database. A new search
facility on GFD allows our readers to
identify Journal Watch items and
Clinical Reviews by keyword titles.
Journal Alert is also now translated
into Spanish for the benefit of our
colleagues in Iberoamericana-CIMF.
Many other popular GFD clinical
features have been enhanced.
POEMS (Patient-Oriented Evidence
that Matters) and eMedicine cases
are regularly posted of the website.
POEMS have also been translated
into Portuguese. Disease and Travel
Alerts are updated daily. Wonca
Regional and World Conferences are
promoted on the Homepage.
Bimonthly issues of Wonca News
are also available on the GFD
website and may be downloaded as
PDF files. Prior issues of Wonca
News are archived and accessible on
GFD beginning with the October,
2001 issue which followed the 16
th
Wonca World Conference in Durban,
South Africa.
An Educational Resource Centre
was introduced to the website in
mid-2005 and is intended to be an
enlarging repository of online
education such as CEMedicus and
Arbor Clinical Nutrition Updates for
the world’s GPs/FPs. CEMedicus is a
repository of case-based clinical
problems for health professionals,
prepared by experts in the wide
variety of fields covered. It has a
rich collection of clinical problems,
many of relevance and interest to
family doctors. Arbor Clinical
Nutrition Updates is a service on
nutrition topics distributed
4
worldwide to over 100,000 health professionals. This is a useful service
that analyses, in a way not dissimilar to Journal Watch, articles in the
literature on clinical nutrition. Articles on a topic are gathered from several
sources and clustered in each issue. The analysis is thorough, scientific, and
a helpful commentary is often provided. Recent publications on Chronic
Obstructive Pulmonary Disease like the IPAG Handbook and the Time to Live
Report have also recently been added to the website.
Most recently, the Wonca Global Resource Directory was introduced to
the website in mid-August 2005. The objective of the Resource Directory is
to make available, on the Wonca website, information about developments
in family medicine around the world, and particularly in countries where
development is still in its infancy. It is also planned to create a database
within the Directory where people and institutions can enter details of
overseas development projects to which they are contributing. This will
enable those interested in international collaboration to ascertain ‘who’s
doing what and where’, thereby increasing collaboration and minimizing
overlap and duplication. It is anticipated that this database will soon build
into a valuable resource for those already involved in, or wishing to
participate in, international collaborative endeavours.
Currently, family medicine related articles are posted on Mongolia,
Russia, Uganda, Lebanon and India.
These are but some of the progress made and new features added to
the Wonca Website during the past year. Statistics gathered from the
website over a nine month period in 2005 testify to the increasing
popularity and value of the website to FPs/GPs globally. For the nine months
of 2005, statistics for the website have revealed over 1,615,243 pages
visited. There were 498,334 unique visits to the website with over 3,873,107
hits for the same period.
For a very young website, www.GlobalFamilyDoctor.com has done quite
well. Our challenge for the years ahead is to keep improving on the many
aspects of the site and become increasingly relevant to the needs of all
family doctors around the world. We hope all family doctors will come to
see the Wonca Website as the richest source of information of value to
them.
Dr Alfred Loh
Chief Executive Officer
World Organization of Family Doctors
WONCA
News
FROM THE EDITOR / FEATURE STORIES
5
FROM THE EDITOR:
RECORDING IMPORTANT DATES FOR WONCA AND OUR
WORLD
It seems appropriate that this last issue of the 31
st
year of Wonca News
would capture many important milestones in both our global organization
and in the world at large.
This issue features a story on 30 years of family medicine development
in Bolivia. The article, published in full in Spanish and summarized in
English, exemplifies the proud and rich family medicine tradition in Wonca’s
Iberoamericana-CIMF Region. Today, the central role of family doctors in
health systems throughout the Iberoamerican Region is recognized in an
article describing the recent, historic Iberoamerican Conference on Family
Medicine in Chile. In addition, the President of Wonca’s newest region, Dr
Adolfo Rubinstein, is profiled. Although celebrating only its 2
nd
birthday as
Wonca’s 6
th
region, this young region with its distinguished history has
already made its mark on Wonca.
This issue also marks the recent global pandemics and disasters that we
have or will face, including reminders of our successful containment of the
SARS outbreak, the struggle to rebuild from the devastating earthquake in
Pakistan and the emerging Avian Flu pandemic. In his President’s Column,
Professor Bruce Sparks draws important attention to this important time in
our history as he urges vigilance and readiness to contain the Avian Flu
pandemic. Wonca and its member Organizations and family doctors
continue to contribute to global efforts to improve health, as described in
the article on the Millennium Development Goals.
Today, Wonca’s website (
www
.G
lobalF
amilyD
octor
.com) plays a vital role
making a rich array of vital information and resources available to the family
doctor. In his CEO’s Column, Dr Alfred Loh celebrates GFD’s 1
st
year of
operation and describes its online resources accessible to family doctors
throughout the world.
Please send me your stories of the important health issues of our time
and of our global organization so that we both share and record the
important dates in the history of Wonca and our world.
Marc L. Rivo, M.D, M.P.H.
Editor, Wonca News
marcrivo@aol.com
4566 Prairie Avenue
Miami Beach, FL 33140 USA
1-305-674-8839 (fax)
FEATURE STORIES
FAMILY MEDICINE IN
BOLIVIA: THIRTY YEARS
OF IMPLEMENTATION
Family Medicine in Bolivia was
initiated in 1975 based upon
recommendations of the Committee
to Implement Reforms of the Social
Security Administration, a new
health care model to meet people’s
health needs. On December 24,
1975, legislation was signed with 11
articles referencing family medicine
as a means to address the health
system crises and its fragmentation,
inefficiency and deficiencies. In this
manner, Bolivia became one of the
pioneers in South America to
support a family medicine model of
personal and integrated health care.
During 1976 and 1978 the basic
requirements and courses of the
new model were established. In
1979, a three year program follow-
ing the new model was established
under the medical residency in La
Paz with a hospitalist focus. In
1984, the hospitalist program was
modified and administrative and
psychology programs were
established. In 1986, they
established a family medicine
residency in Cochabamba. In 1991,
the Medical Collage of Bolivia
established in the Statutes and
Regulations that a Family Medicine
Specialty should require a minimum
of three years of training and that
family medicine residencies are
three year programs. In 1999, an
important year for Family Medicine,
the Public Health System began
family medicine residencies in three
capital cities, although with only 2
positions per city. Today, nine family
medicine programs exist that
graduate 20 residents per year.
According to a 2002 study, family
physicians represent around 5.5% of
WONCA
News
FEATURE STORIES
6
the total physicians in the county.
No agreement exists as to how
many patients should each family
doctor be expected to treat, with
estimates ranging from 2,500 to
10,000 per family doctor. While it is
good that the Public Health System
is built on family medicine,
inadequate space and support for
the specialty is a limiting factor.
In 1977, 44 family physicians
meeting at the Polyclinic “Piloto” of
Miraflores in La Paz founded the
Bolivian Society of Family Medicine.
From its creation, they have focused
on the education of family doctors,
on creating an academic society, a
biennial Congress and have been
active members of the new Wonca
Iberoamericana-CIMF region. They
currently have 6 regional family
medicine societies located in La Paz,
Cochabamba, Santa Cruz, Oruro,
Potos’ and Chuquisaca.
Thirty years since the establish-
ment of Family Medicine in Bolivia,
our specialty has had to overcome
many crises that have confronted
the specialty, above all the lack of
interest and support of the govern-
ment and the preoccupation with
hospital based care. However,
progress has taken place in the
following areas:
•More asistance to primary care
which takes care of 80-90% of
people’s health problems at an
affordable cost to the patient.
•A growth in the number of
family doctors and improve-
ments in the training curriculum.
•Participation in regional and
global conferences and events
of Wonca and its family doctors
•The growth of a scientific
society of family doctors.
Despite our successes over the
past 30 years, we still have many
needs to address to enhance the
quality of the profession, including:
•Development of a standard
residency curriculum for the
profession.
•A recertification process to
assess the competence of family
doctors.
•The inclusion of family medicine
as a required undergraduate
medical education course.
•The broad recognition of family
medicine as the entry point
into and ambulatory care model
for the health system.
•The formation of family
medicine departments in all
universities.
•Support for and training of new
family medicine leaders.
•Enhancements in medical
consultation standards and
measurement systems to
improve access, visit time and
quality of family medicine care.
•More government funding and
scholarships.
(Editor’s Note: The English
translation above summarizes the
following article on Family Medicine
in Bolivia submitted by Dr Miguel A.
Su‡rez Cuba)
Medicina Familiar en
Bolivia: 30 Años de su
Implementación
La medicina familiar en Bolivia
se implanta como respuesta a las
recomendaciones del Comité de
Implementación de Reformas de la
Caja Nacional de Seguridad Social
(CNSS), el mismo sugiere al
Gobierno Boliviano, la
implementación del Sistema de
Medicina Familiar como un nuevo
modelo de atención para satisfacer
las necesidades de los pacientes, el
Gobierno mediante Decreto Ley del
24 de diciembre de 1975 en su
capitulo III, en 11 artículos hace
referencia a la medicina familiar y la
reconoce como la especialidad
capaz de satisfacer las necesidades
de la crisis asistencial de ese
momento; surge esta motivación
como una necesidad de cambio
generado por la fragmentación, la
ineficiencia y la cobertura deficiente
de la atención de salud.
Es así como la Caja Nacional de
Seguridad Social se constituye en la
pionera en Sudamérica en adoptar
un nuevo modelo basado en la
atención integral de las personas.
Dr. Miguel A. Suárez Cuba
Medico de familia
Vicepresidente Sociedad Boliviana de
Medicina Familiar Filial La Paz
Formación de recursos humanos:
Inicialmente se forman bajo la
modalidad de cursos intensivos de
9 y 12 meses durante los años 1976
a 1978, con la finalidad de cubrir a
la brevedad posible los
requerimientos del nuevo sistema.
En enero de 1979 se instituye la
formación de los recursos humanos
bajo el sistema de residencia
médica, con sede en la ciudad de
La Paz, regulada por el
Departamento de Enseñanza e
Investigación de la CNSS, con una
duración de 3 años, bajo un perfil
netamente asistencialista, porque se
lo realiza con enfoque hospitalario.
En 1984 se reformula el tiempo de
formación a 2 años, se modifica el
perfil de formación, un año de
formación hospitalaria, otro en el
área técnico-administrativa y
psicosocial. Por 1986 se crea la
residencia en medicina familiar en
Cochabamba, donde la Universidad
Mayor de San Simón (UMSS) y el
Consejo Nacional de Residencia
Médica (organismo que cuenta con
representantes del Ministerio de
Salud, Caja Nacional de Seguridad
Social y Facultad de medicina),
7
WONCA
News
FEATURE STORIES
juegan un papel importante en la formación de
recursos humanos a través de un convenio
interinstitucional.
El Colegio Medico de Bolivia en 1991, establece en
sus Estatutos y Reglamentos que la formación de
especialistas deberá tener un mínimo de 3 años; a
partir de este año la formación en residencia son 3
años. El ano1999 marca un hito importante para la
medicina familiar, el Sistema Publico empieza la
formación de Médicos residentes en la especialidad en
3 ciudades capitales, aunque con un número muy
pequeño, dos por ciudad. Actualmente existen nueve
residencias para formación de recursos humanos en
medicina familiar, cuatro corresponden a la Caja
Nacional de Salud, cuatro al Sistema Publico y uno a la
Caja Petrolera de Salud, con un promedio de egresados
de 20 por año a nivel nacional.
A la fecha no existe un censo del número exacto de
médicos familiares formados por residencia y
reconvertidos bajo la modalidad de reconversión por 10
años de ejercicio en el primer nivel de atención. De
momento, no esta completamente normado el numero
de familias adscritas por cada medico familiar, la
asignación es caótica, va desde 2.500 personas en
algunos consultorios, hasta 10.000 en otros con un
promedio de 5.000. Si bien el Sistema Publico esta
formando médicos familiares, lo lamentable es que no
esta creando espacios de trabajo e ítems para la
especialidad, situación que desmotiva a quienes ya se
formaron y los que desearían formarse.
Según un estudio de la OPS del año 2002, al
momento los médicos familiares en Bolivia, representan
alrededor del 5.5% de total de médicos en el país.
Después de la formación de un “pool” de médicos
familiares, se vio la necesidad de que se agrupen para
poder mantenerse por una parte, organizados y por
otra, actualizados a través de eventos académicos que
además les servirían para mantenerse competentes. Es
así que en fecha 3 de agosto de 1977, en instalaciones
de la Policlínica “Piloto” de Miraflores, en la ciudad de
La Paz, con 44 médicos familiares en calidad de
fundadores, se funda la Sociedad Boliviana de Medicina
Familiar.
Desde su creación se ha convertido en la entidad
que más se ha preocupado por la educación continua
de quienes trabajan en el primer nivel de atención
(Medico Familiares, Médicos Generales, enfermeras,
trabajadoras sociales, odontólogos y otros). Se
constituye en el ente académico científico que aglutina
a todos los médicos familiares y a los socios
adherentes, profesionales de la salud afines a la
especialidad del país. Principal impulsor y difusor de la
especialidad al interior de la CNSS y el gremio medico,
destacándose como una de las más activas, organiza
dos tipos de reuniones, un Congreso y Jornadas
nacional. Las jornadas son cada dos años al igual que
los Congresos, en este ultimo se elige la nueva Junta
Directiva que llevara las riendas de la sociedad en los
siguientes dos años; estos eventos están destinados a
la reflexión, sobre temas de interés para el Medico
Familiar, al análisis de programas o acciones comunes a
todos los países miembros de CIMF-WONCA, y la
actualización, e intercambio de información y
experiencias locales e internacionales sobre la marcha
de la medicina familiar y la atención primaria.
Agrupa a 6 sociedades regionales, en orden de
importancia, La Paz, Cochabamba, Santa Cruz, Oruro,
Potosí y Chuquisaca. Participa en la formación de
médicos residentes de la especialidad de medicina
familiar, aunque la mayoría lo los docentes son de
carácter ad honorem, diseña las líneas de base para la
mejora curricular de la especialidad, otorga el certificado
de especialista junto al Colegio Medico de Bolivia. Entre
sus objetivos se planteo la formación de docentes
propios de la especialidad, para cumplirlo el año 2002
se lleva a cabo el diplomado en formación de docentes
para Medicina Familiar y Atención Primaria, de carácter
semipresencial con el apoyo de la facultad de
medicina de la UMSS, y Fundación para la Medicina
Familiar del Hospital Italiano, cuyo plantel de profesores
son los encargados de hacer realidad este proyecto. Se
llegan a formar cerca de 40 docentes bajo esta
modalidad, provenientes de 3 ciudades, La Paz,
Cochabamba y Oruro. Producción científica: La
Sociedad Boliviana de Medicina Familiar publico una
revista científica durante los años de 1990 a 1994,
reedita el 2001 al 2003.
El CIMF se funda en agosto de 1981 con participación
de representantes de Canadá, Estados Unidos, México,
Argentina y Venezuela; Bolivia hace su ingreso en
diciembre de 1989. Mediante el representante de CIMF
en Bolivia, el Dr. José Ruiz Guzmán, se consigue la
visita del Dr. Julio Ceitlin, Director General de CIMF, su
presencia y apoyo fue importante en momentos en que
se encontraba en crisis el Sistema de Medicina Familiar.
El año 2004 como miembro titular del nuevo CIMF
(Confederación Iberoamericana de Medicina Familiar),
pasa a formar parte de la Sexta Región de WONCA
(CIMF-WONCA).
Se han cumplido 30 años desde la implementación
de la Medicina Familiar en Bolivia, desde entonces
WONCA
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FEATURE STORIES
8
nuestra especialidad ha tenido que
pasar por muchas crisis que han
estado a punto de terminar con el
sistema de medicina familiar,
inherentes al propio sistema, y
sobre todo a un desinterés y
desconocimiento de las bondades
de la especialidad por parte de las
autoridades de la propia institución
y de Gobierno, quienes centran su
preocupación e interés en el nivel
hospitalario. Existieron también
muchos progresos como en el área:
•asistencial, puerta de entrada al
sistema de salud de la CNSS,
mayor resolución de los
problemas inherentes al primer
nivel de atención (80-90%), a
un bajo costo, relación de 10/1
en relación al hospital, manejo
integral y trato mas humano
que en el hospital.
•docente, con un aumento del
número de docentes médicos
familiares, mejora permanente
de la curricula de la residencia
en medicina familiar, haciendo
mayor énfasis en temas propios
de la especialidad, mayor
tiempo de rotación por centros
de medicina familiar y atención
primaria.
•integración internacional,
participando y asistiendo a la
mayor parte de eventos
académico científicos
convocados por la entidad
regional y mundial de médicos
de familia.
•como sociedad científica, ha
jugado y juega un papel
importante en educación médica
continua, dando realce a
muchos de sus eventos la
presencia de profesores con
mucha calidad humana y
científica; aun son escasos los
avances en el área investigativa.
•Los éxitos y progresos
obtenidos aun no son
suficientes, porque existen
necesidades sentidas y
percibidas que en 30 años no
han podido ser otorgadas como
ser:
•una educación medica continua
bien reglamentada, capaz de
cumplir su objetivo primordial,
mejora de la competencia
profesional, con una mejora de
la calidad de atención,
•una curricula homologa de
formación de residentes en la
especialidad,
•un proceso de recertificacion
que evalué mas adecuadamente
si el medico familiar es
competente o no,
•Por falta de una decisión
política de Gobierno y de las
Universidades, en complicidad
por los fermentes cambios de
Gobierno y con ello de Ministros
de salud, a la fecha no se ha
logrado introducir la medicina
familiar en el pregrado,
•Tampoco se ha podido
introducir a la Medicina Familiar
como puerta de entrada al
sistema de salud a nivel público
y en el resto de la seguridad
social.
•Necesidad de un mayor apoyo
logístico de la institución y del
gobierno a la atención
ambulatoria, adaptada a la
medicina familiar,
•introducción y creación de un
departamento de medicina
familiar en las universidades
formadoras.
•Mayor financiamiento para mas
becas en el post grado,
•fortalecer y favorecer la
formación de nuevos lideres en
la especialidad
•En la consulta medica:
introducción de indicadores para
la mejora de la accesibilidad, la
organización asistencial,
duración real de la consulta,
tiempos de espera, referencia
contrarreferencia.
Dr. Miguel A. Suárez Cuba
Medico de Familia
Vicepresidente Sociedad Boliviana
de Medicina Familiar Filial La Paz
Iberoamerican Conference
Calls for Family Doctors to
Play Central Health
System Role
Ibero America is a diverse region
with a wide heterogeneity regarding
both its socio-economic develop-
ment and its health outcomes, with
childhood mortality rates ranging
from about 10% in some areas of
Bolivia, Brazil or Perœ to less than
1% in Cuba or Chile. Since the
beginning, almost 25 years ago,
Wonca Iberoamericana-CIMF was
created as a NGO devoted to the
development of Family Medicine in
Iberoamerica. At present, is made up
of 19 National Associations of Family
and/or General Medicine of the
Region organized into four sub-
regions: Andean, Southern Cone,
MesoAmerica and the Iberic
Peninsula.
As of our regional initiatives,
driven by the WONCA/WHO
Conference held in Ontario in
November 1994, the academia, as
well as representatives of
international organizations and
governments of Ibero America met
in Buenos Aires. The aim was
promoting the inclusion of Family
Medicine into the health services
and universities following the
reforms that were taking place in
several countries. In May, 2002, in
Seville, Spain, the first Ibero
American Summit in Family
Medicine, entitled “Committed to
Improve the Health of the
Population”, was organized
addressing four important issues:
Family Doctors, Health Systems and
Demands of Citizens, Quality
Improvement in Family Practice and
Primary Health Care, and
Undergraduate Education and
Postgraduate Training of Family
Physicians. The Summit concluded
with the publication of technical
documents framed in the
“Declaration of Seville”. In
November 2003, in Margarita,
Venezuela, following the com-
promises adopted in Seville, experts
in medical education and scientific
representatives of Family Medicine,
gathered to define regional
standards for the accreditation of
Residency Training Programs, CME
activities and Certification of
Specialists in Family Medicine. This
initiative concluded with the
publication of recommendations
contained in the Declaration of
Margarita, “Improving the
Professional Quality of Family
Doctors in Ibero America”.
At the Cumbre Iberoamericana de Medicina
Familiar – Iberoamerican Summit on Family
Medicine in Santiago, Chile from October 4-5,
2005. From left to right: Dr Bruce Sparks
(Wonca President), Dr Adolfo Rubinstein
(Wonca Iberoamericana-CIMF Regional
President)
)
, Dr. Pedro Garcia Aspillaga
(Minister of Health of Chile), Dr. Oscar
Fernandez (Chair of the Summit ), Dr. Hernan
Montenegro (Chief of the Unit of Health
Services, PAHO/WHO)
Finally, and continuing the
process of “sensitization” of
decision makers from the region
towards the development of Family
Medicine initiated in the first
Summit held in Seville in May, 2002,
Wonca-Iberoamericana-CIMF
organized its second Summit that
took place in Santiago de Chile in
October 4-5, 2005. This meeting
was chaired by the Minister of
Health of the Republic of Chile and
with the presence of several
ministers and deputy ministers of
the Region, the President of Wonca,
the President elect and the CEO,
high officers of PAHO/WHO and
Barbara Starfield as a keynote
speaker. Participants included more
than 200 Iberoamerican policy
makers, primary care academicians
and representatives and delegates
of the national associations of the
Wonca Iberoamericana-CIMF After
two hard working days of con-
ferences, workshops, networking,
cultural activities and also
“productive leisure”, participants
agreed upon a document containing
10 recommendations to foster family
medicine and primary care as the
central level of health care systems
in Latin America. The 10 recommen-
dations were signed under the
“Compromisos de Santiago de
Chile”.
This Report represents a major
advance for family medicine in Latin
America. Starting from a very weak
position, family physicians
constitute much less than 50% of
the physician supply in most
countries. The financing and
organization of health services work
against rather than for primary care
principles. Given that situation, the
“Compromisos de Santiago de
Chile” represent consensus,
commitment (‘compromisos’) and
promises to place primary care in a
central role in order to enhance the
effectiveness, equity, and efficiency
of health services.
Adolfo Rubinstein M.D, MSc, PhD
Professor and Director of the
Department of Family Medicine
Faculty of Medicine. University of
Buenos Aires
President, Wonca Iberoamericana-
CIMF Region
adolfo.rubinstein@hospitalitaliano.org.ar
(Editor’s note: The complete
Spanish text of the 10
recommendations to foster family
medicine and primary care from the
“Compromiso de Santiago de Chile
– Octubre 2005” may be found on
the Wonca Iberoamericana-CIMF
website at http://www.cimfweb.org)
WONCA
News
FEATURE STORIES / REGIONAL NEWS
9
WONCA REGIONAL NEWS
MEET DR ADOLFO
RUBINSTEIN:
IBEROAMERICANA-CIMF
REGIONAL PRESIDENT
I graduated as a physician from
the Faculty of Medicine of the
University of Buenos Aires (UBA) in
1982. After a 6-month student
clerkship in Internal Medicine and
Cardiology at the Brigham and
Women’s Hospital, Boston, I
returned to Buenos Aires to
complete a four-year residency
training Program in Internal
Medicine at the Hospital Italiano de
Buenos Aires, a major teaching
hospital of the UBA School of
Medicine. In 1989, I was appointed
as chief resident for an additional
year of clinical training in Primary
Health Care and Family Medicine.
Subsequently, I was offered the
position of Director of the new
Family Medicine Program that was
created at that time, and in 1993,
the position of Chief of the Division
of Family and Preventive Medicine
at this Hospital. In 1994, I started
the Summer Program in Clinical
Effectiveness at Harvard School of
Public Health where I received a MS
degree in Epidemiology in 1996. In
1997, I created the Foundation MF,
an NGO devoted to professional
education and research in Primary
Care and Family Medicine. In 2000, I
obtained the PhD (Doctor) in
Medicine with concentration in
Public Health from UBA. In 2002, I
completed a postgraduate program
in Health Economics for developing
countries at the Center for Health
Economics, University of York, UK.
Later that year, I was appointed as
the first Full Professor of Family
Medicine of UBA (and also of
Argentina as Family Medicine is a
rather new specialty in my country).
Since 2004, I am the Director of the
WONCA
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REGIONAL NEWS
10
Department of Family Medicine and also Associate
Professor of Public Health of the Faculty of Medicine
(UBA). In October 2004, I was elected as Wonca
Iberoamericana-CIMF Regional President.
Dr Adolfo Rubinstein
Wonca Iberoamericana-CIMF Regional
President
My professional life is divided between Primary
Health Care (PHC) practice, education and research in
and an academic career in Clinical Effectiveness,
including Health Economics and Health Technology
Assessment. In the field of Primary Care policy and
management, as head of the Division of Family and
Preventive Medicine, I contributed to the development
of a Primary Care community based health network at
the Hospital Italiano which now covers more than
120,000 individuals in the area of Buenos Aires, having
primary care doctors as first contact care in a capitated
system where family doctors have a defined panel of
patients. Since 2000, I have also participated in many
governmental and non-governmental health services
Reform initiatives in the field of Primary Care in
Argentina. More recently, as Iberoamericana-CIMF
Regional President, I am deeply involved with several
Projects oriented to PHC reform across different
countries of the Region.
As a Primary Care academician, I was the editor of
the first Textbook of Family Medicine and Ambulatory
Care in Latin America which has already reached all the
countries in the Region and Spain with more than 6,000
books sold in its first edition. Now, the second edition
is being released. As a professor of Family Medicine, I
have an important teaching load at the University both
at undergraduate and postgraduate level. My
publications over the last few years have been related
to clinical aspects of the practice of PHC as well as
policy research issues in this field, in national and
international peer review journals. My major research
interest is now concentrated on the impact of Health
Reforms on the organization of PHC services in
Argentina and Latin America.
With respect to Epidemiology and Health Policy, I am
the Director of the Master’s Program in Clinical
Effectiveness at the University of Buenos Aires. The
history of this initiative is inextricably linked to Harvard.
In May 1996, when I had almost graduated from the
Master’s Program in Clinical Effectiveness (PCE) at
Harvard, I envisioned the idea of a collaborative venture
with Harvard PCE. I thought about talking this idea over
with my Harvard mentor, Fran Cook. His response was
incredibly supportive and encouraging. Fran became a
inspiring source of ideas, advice and key contacts to
turn this ambition into a real training Program. From
1996 to 1999, I sent three other fellows to be trained at
the Harvard PCE (2 were family doctors). All completed
their degree. Other two had been already trained at
other universities in USA and Canada. They would later
constitute the core group and the Board of the Program.
Our Program, inspired in the Program in Clinical
Effectiveness at Harvard, was co-organized by the
Harvard School of Public Health, with Fran Cook as our
Co-director and with many other Harvard faculties
involved in different teaching activities. To date, more
than 130 students, 20 from different Latin American
countries had graduated since 1999. I am convinced that
the creation of this Program has been an important
leverage to install family medicine as an academic
discipline in Argentine.
As a second generation project, our group created
the Institute of Clinical Effectiveness and Health Policy
(IECS) in 2002. The IECS is a non-profit institution
affiliated to the University of Buenos Aires, devoted to
education, evaluation and research in health services
and policy, specially focused on the evaluation of the
effectiveness, appropriateness and cost-effectiveness of
health services and technologies in Argentina and Latin
America. My research projects in this field have been
focused on Health Technology Assessment and the
influence of economic evidence on health resource-
allocation decision making. I was recently awarded with
a grant from the Ministry of Health to make a sectoral
Cost-Effectiveness analysis of a package of preventive
cardiovascular interventions in Buenos Aires, based on
the model developed by WHO .
Last but not least, I am still a practicing family
doctor, though I can not devote the time I would like to
my clinical practice. Nevertheless, I dedicate about 10 to
12 hours a week to take care of 200 families (about 600
patients) who are under my personal care.
As a Regional President of Wonca Iberoamericana
CIMF, I feel very proud of being part of the global Wonca
family. In case you still don´t know, the first Regional
conference of Wonca Iberoamericana CIMF will be held
in Buenos Aires, Argentina, from October 11th through
October 14th. I hope all the global community of family
doctors can be here. I promise you won´t regret it!!
WONCA
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REGIONAL NEWS
11
Adolfo Rubinstein M.D, MSc, PhD
Wonca Iberoamericana-CIMF
Regional President
adolfo.rubinstein@hospitalitaliano.org.ar
First Lady of Timor-Leste
Addresses RACGP: Asks
for Help for Mothers and
Children
The Royal Australian College of
General Practitioners (RACGP) was
recently honoured when Her
Excellency Kirsty Sword Gusmao,
First Lady of the Democratic
Republic of Timor-Leste addressed
the 48th Annual Scientific
Convention. Her Excellency
addressed the convention in her
role as Chairwoman of the Alola
Foundation, a role which receives no
official recognition or government
sponsorship. She spoke not as a
representative of her government,
but as a woman and a mother
about the plight of the mothers and
children in Timor-Leste, and what we
can do as general practitioners and
general practices to help. The
following is excerpted from Her
Excellency’s address to the RACGP.
Timor-Leste has one of the
highest infant and maternal
mortality rates in the world. With an
average of 8 children per family, we
also have one of the highest fertility
rates in the world.
Birth spacing and birth limiting
are virtually unknown. There is a
high prevalence of TB, malnutrition
and iodine and vitamin A deficiency.
Malaria is endemic across the
country and there is a high
incidence of childhood respiratory
infections, diarrhoeal diseases and a
rising incidence of non-
communicable diseases. Timor-Leste
is endemic for leprosy.
At least 70% of all households
do not have access to safe water.
Less than 50% of our population
are literate and the average daily
income is 50 US cents per day.
Health services were brought to a
complete standstill in the wake of
the violence of 1999, and virtually
all health infrastructure was either
partially or completely destroyed.
Primary care encompasses
activities in the area of promotion of
a healthy lifestyle, disease
prevention and basic curative care,
provided at each of the nation’s 63
Community Health Centres and 175
Health Posts. The main providers of
primary care are “general” nurses,
midwives and clinical nurses posted
in every community health centre
and HP and numbering between 6
and 10, depending on the size of
the population they serve. Medical
doctors are posted in every district
to support the efforts of primary
care workers.
Her Excellency Kirsty Sword Gusmao,
Chairwoman of the Alola Foundation and First
Lady of the Democratic Republic of Timor-
Leste, presents Wonca Executive Member and
RACGP President Michael Kidd with a
traditional woven shawl known as a
selendang as a token of friendship
The Alola Foundation was
established in 2001 to raise
awareness of and campaign against
the sexual and gender-based
violence inflicted on women in East
Timor. The Alola Foundation works
proactively in direct partnership with
individual citizens and non-profit
organizations from within this new
nation and around the world to
improve the lives of East Timorese
women.
Since we are an organisation
focused upon addressing the needs
of women and children, our work in
the health field has to date been
limited to maternal and child health
and specifically to the promotion of
breastfeeding. Being the mother of
three small children aged under 5,
all of whom were born at Dili
National Hospital, I am passionate
about breastfeeding.
Our resources are small and our
needs are great. For example, the
Foundation was recently told that an
increasingly large number of rural
women are checking into the
hospital to give birth with, not only
not a single item of clothing for
their newborns, but without cloth to
wrap their babies, nor a change of
clothes for themselves. The hospital
was running out of sheets for the
beds since, desperate to help these
new mums, the staff of the hospital
were ripping up the hospital bed
linen to make simple wraps for the
new bubs. Many new mothers, for
lack of sanitary napkins and even
underwear in some cases, often
leave the hospital dripping blood.
In response, the Alola
Foundation started raising money to
put together maternity packs to
distribute through the Dili and
Baucau hospitals. Home births are
the norm in Timor-Leste and it is our
hope that the packs will serve as an
incentive to women to give birth in
a health facility, giving them access
to skilled assistance and care and
therefore contributing to a reduction
in infant and maternal mortality.
What can medical practitioners in
Australia do to be of assistance and
support within the health sector in
Timor-Leste? Firstly, it is our belief
that every form of assistance should
be sustainable and should
complement existing inputs. The
Minister of Health of Timor-Leste has
recommended that one likely and
practical form of assistance might
be to have Australian GPs “adopt” a
community health centre or health
12
WONCA
News
REGIONAL NEWS / HEALTH AND HEALTH SYSTEM NEWS
post to better support the
implementation of the BPS. From
this entry point, several other inputs
could be identified, for example,
training, coaching, mentoring of
primary health care workers etc. In
addition, any initiative or
intervention which supports
educational opportunities and the
economic empowerment of women
clearly has positive outcomes in
terms of the health status of the
women of Timor-Leste.
And so I would encourage any of
you who are interested to contact
the Alola Foundation at
www.alolafoundation.org to learn
how you can help to build a better
future for the women and kids of
our little nation.
Submitted by
Dr Ronald McCoy
Royal Australian College of General
Practitioners
Email: ron.mccoy@racgp.com.au
(Editor’s note: Additional
information on the First Lady’s
presentation on Timor-Leste to the
RACGP is available in Wonca’s
Global Resource Directory at
www.GlobalFamilyDoctor.com via
the Global Family Doctor homepage:
Left Menu Quick Links > Global
Directory, or Top Menu > Education >
Global Resource Directory)
HEALTH AND HEALTH SYSTEM NEWS
AVIAN FLU SPREADS: COUNTRIES PREPARE FOR A
PANDEMIC
Countries around the world are bracing themselves to deal with the
transmission of avian flu, which has begun to spread from its origins in
South East Asia. Outbreaks of the H5N1 strain among birds were first
spotted in Vietnam and Thailand in 2003. The H5N1 Avian flu strain
remained largely in South-East Asia until this summer, when Russia and
Kazakhstan both reported outbreaks. Its emergence in Turkey, Croatia and
Romania in Eastern Europe this fall has raised fears of a pandemic,
prompting the WHO to urge heightened surveillance and vigilance.
Scientists fear it may be carried by migrating birds to Europe and Africa but
say it is hard to prove a direct link with bird migration.
The World Health Organization puts the number of human deaths at 68
out of a total of 132 human cases. The disease generally still does not
transmit easily to humans. Concern is mounting that it may combine with a
human strain to produce a mutation that is more dangerous and difficult to
combat. The WHO warns, “Each additional human case increases
opportunities for the virus to improve its transmissibility, through either
adaptive mutation or re-assortment. The emergence of an H5N1 strain that
is readily transmitted among humans would mark the start of a pandemic.”
Cumulative Number of Confirmed Human Cases of Avian Influenza A/
(H5N1) Reported to WHO as of November 25, 2005
Note: Total number of cases includes number of deaths. WHO reports only laboratory-confirmed
cases.
Currently, WHO does not recommend travel restrictions to areas
experiencing outbreaks of highly pathogenic H5N1 avian influenza in birds,
including countries which have reported associated cases of human
infection. Local authorities may, however, usefully provide information to
travelers on risks, risk avoidance, symptoms, and when and where to report
should these symptoms develop.
WHO advises travelers to avoid contact with high-risk environments in
affected countries. Travelers to areas affected by avian influenza in birds
are not considered to be at elevated risk of infection unless direct and un-
protected exposure to infected birds (including feathers, feces and under-
cooked meat and egg products) occurs.
Indonesia
cases deaths
0
0
11
7
11
7
Viet Nam
cases deaths
27
20
66
22
93
42
Thailand
cases deaths
17
12
4
1
21
13
Cambodia
cases deaths
0
0
4
4
4
4
China
cases deaths
0
0
3
2
3
2
Total
cases deaths
44
32
88
36
132
68
Date of onset
12-03 to
12-04
01-05 to date
Total
WONCA
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HEALTH AND HEALTH SYSTEM NEWS
13
The Global Spread of the Avian Flu: November, 2005
Avian Flu Deaths by Country: November, 2005
Direct contact with infected poultry, or surfaces and
objects contaminated by their droppings, is considered
the main route of human infection. Exposure risk is
considered highest during slaughter, defeathering,
butchering, and preparation of poultry for cooking.
WHO continues to recommend that travelers to affected
areas should avoid contact with live animal markets and
poultry farms, and any free-ranging or caged poultry.
Large amounts of the virus are known to be excreted in
the droppings from infected birds. Populations in
affected countries are advised to avoid contact with
dead migratory birds or wild birds showing signs of
disease. There is no evidence that properly cooked
poultry or poultry products can be a source of infection.
Many countries are developing plans to protect
against the possibility that the virus will start to spread
between humans. The World Health Organization
recommends countries should stockpile enough anti-
viral drugs to cope with a pandemic, which it estimates
would affect 25% of the population, but warns that
developing countries in particular are likely to fall well
short.
Pending the availability of vaccines, several antiviral
drugs are expected to be useful for prophylaxis
(prevention of illness) or treatment purposes. Two drugs
(in the neuraminidase inhibitors class), oseltamivir
(commercially known as Tamiflu) and zanamivir
(commercially known as Relenza), have been shown, in
laboratory studies, to reduce the severity and duration
of illness caused by seasonal influenza. The efficacy of
the neuraminidase inhibitors depends on their
administration within 48 hours after symptom onset. For
cases of human infection with H5N1, the drugs may
reduce the severity of disease and improve prospects of
survival, if administered early, but clinical data are
limited.
Another class of antiviral drugs, the M2 inhibitors
amantadine and rimantadine, could potentially be used
against pandemic influenza, but resistance to these
drugs may develop rapidly and this could significantly
limit their effectiveness. Some currently circulating avian
H5N1 strains are fully resistant to the M2 inhibitors,
while others remain fully susceptible.
For the neuraminidase inhibitors, the main
constraints - which are substantial - involve limited
production capacity and a price that is prohibitively high
for many countries. Because of the complex and time-
consuming manufacturing process, the sole
manufacturer of oseltamivir is unable fully to meet
demand and faces a backlog of orders. At present
manufacturing capacity, which has recently quadrupled,
it will take a decade to produce enough oseltamivir to
treat 20% of the world’s population.
Since supplies are severely constrained, countries
now stockpiling antiviral drugs need to decide in
advance on priority groups for administration. Frontline
health care workers would be an obvious first choice,
but such decisions are the responsibility of
governments. While antiviral drugs can confer some
measure of protection pending the availability of
vaccines, these drugs should not be used to perform
the same public health function as vaccines - even if
supplies would permit. The mass administration, for
prophylactic purposes, of antiviral drugs to large
numbers of healthy people for extended periods is not
recommended, as this could accelerate the development
of drug resistance.
14
WONCA
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HEALTH AND HEALTH SYSTEM NEWS
Following a donation by industry, WHO will have a
dedicated stockpile of antiviral drugs (oseltamivir),
sufficient for 3 million treatment courses, by early 2006.
These drugs are strictly reserved for use in the first
areas affected by an emerging pandemic virus. Recent
studies, based on mathematical modeling, suggest that
these drugs could be used prophylactically near the
start of a pandemic to reduce the risk that a fully
transmissible virus will emerge or at least to delay its
international spread, thus gaining time to augment
vaccine supplies. The drugs will be stored centrally;
WHO has considerable experience in the rapid dispatch
of medical supplies during emergencies.
The success of this strategy, which has never been
tested, depends on several assumptions about the early
behavior of a pandemic virus, which cannot be known
in advance. Success also depends on excellent
surveillance and logistics capacity in the initially affected
areas, combined with an ability to enforce movement
restrictions in and out of the affected area. To increase
the likelihood that early intervention using the WHO
rapid-intervention stockpile of antiviral drugs will be
successful, surveillance in affected countries needs to
improve, particularly concerning the capacity to detect
clusters of cases closely related in time and place.
At the start of a pandemic and for many months
thereafter, all countries will face inadequate supplies of
vaccines and antiviral drugs. WHO has therefore
organized several expert consultations to explore the
role of classic public health measures in reducing
transmission and delaying spread. Evaluation of these
measures has been based on limited experience during
past pandemics and on what is known about the
behavior of normal influenza viruses.
The effectiveness of several measures will depend on
the characteristics of the pandemic virus (attack rate,
virulence, principal age groups affected, modes of
spread within and between countries), and these cannot
be known in advance. After a pandemic is declared,
WHO will monitor its evolution in real-time.
Recommendations about the most effective measures
will therefore become more precise as the
epidemiological potential of the virus unfolds. For all
these reasons, the recommendations below should be
taken as general guidance, and not as formal WHO
advice. Recommended measures are specific to the
phase of alert in the WHO six-phase scale.
The present situation is categorized as phase three
in the pandemic: human infections with a novel virus
subtype (H5) are occurring, but there is no evidence
that the virus is spreading efficiently and sustaining
itself among humans. To date, 132 human cases have
been officially confirmed, despite the infection of tens of
millions of birds over a wide geographical area for
almost two years, in a situation with abundant
opportunities for human exposure. At this phase, WHO
recommends vigilance for human cases in areas
experiencing bird flu outbreaks. Unaffected areas should
undertake measures to prevent entry of the virus via
poultry or wild birds, especially as this virus, once
established in birds, has proved to be especially
tenacious. For humans, no travel restrictions or
screening measures at borders are recommended, as the
risk that the virus will be carried by international
travelers is considered negligible.
Further information is available through the WHO at:
http://www.who.int/csr/disease/avian_influenza/
avian_faqs/en/index.html
(Editor’s Note: Please see Resources for the Family
Doctor for additional web links to clinical information
about the Avian Flu)
Wonca Participates in Millennium
Development Goals Workshop
Representatives of Wonca led a workshop focusing
on the contribution of health professionals towards the
global Millennium Development Goals (MDGs) at the
Commonwealth People’s Forum Workshop held during
the Commonwealth Head of Governments meeting in
Malta on November 21, 2005.
Three presenters - practising physicians also involved
in international activities - provided practical examples
of their personal and their organisation’s net-working
concepts and partnerships. On behalf of Wonca, Dr. Ilse
Hellemann, former Wonca Executive Committee member
and liaison to the World Health Organization, presented
the World Organisation of Family Doctors’ contributions
to health systems’ development. Dr. Jean Karl Soler, a
Family Doctor from Malta and Wonca Council member,
explained about epidemiology and public health aspects
in General Practice / Family Medicine and introduced the
International Classification System of Primary Care (ICPC
-2e) as an appropriate tool to collect and process health
data on the community level. Dr Ganesh Supramaniam,
Pediatrician and Secretary General of the Common-
wealth Association of Mentally Handicapped and
Disabled (CAMHADD) presented CAMHADD as an
excellent example of a Commonwealth related Non-
WONCA
News
HEALTH AND HEALTH SYSTEM NEWS / MEMBER AND ORGANIZATIONAL NEWS
15
Governmental Organization (NGO), net-working with international
governmental organisations and other NGOs, implementing the health
related MDGs.
Presenting on the Millennium Development Goals in Malta -
From left to right, Dr Jean Soler, Dr Ilse Hellemann and Dr Ganesh Supramaniam
Then, all of the participants were invited to explain what they
individually and with their respective organisations could contribute to
partnerships to implement the health related MDGs. The discussion was
lively and fruitful, especially as it turned out that many of the participants
were not health professionals, but ecologists, social service coordinators,
meteorologists and human resource professionals.
The conference participants concluded that health is everybody’s
business, with many different sectors are involved. Six of the eight MDGs
are health related – and it is obvious that the formal health sector alone is
not in a position to achieve these goals. Health is not the product of the
health sector only. A variety of factors determine health. Thus, a need exists
to collaborate and network to improve health.
To be successful will require information sharing, to develop a consistent
documentation system and database, and to develop and distribute health
information tools. Existing networks and partnerships, such as Wonca, WHO,
and CAMHADD, should be strengthened and additional relationships built
with all sectors of society. Emphasis should be on the education of women
and children and on preventive health care.
Participants agreed that the Commonwealth and this forum should
continue to provide an excellent example of networking among 53 nations,
both, on the governmental level and on level of the civil society and NGOs.
Participants recognized the importance of sharing these common goals as a
means to attain mutual understanding, security and peace.
Dr Ilse Hellemann
ilse.hellemann@hosan.at
(Editor’s note: Additional information on the Millennium Development
Goals is available through the United Nations at http://www.un.org/
millenniumgoals/ and the World Health Organization at http://www.who.int/
mdg/en/ )
MEMBER AND
ORGANIZATIONAL NEWS
LEELA DE A
KARUNARATNE: WONCA
GLOBAL FAMILY DOCTOR
FOR NOVEMBER 2005
Dr. Leela De A Karunaratne was
born in 1930 in Sri Landa. She holds
the following medical qualifications:
MBBS (Cey - 1954), DCH (Cey -
1970), MRCGP (UK - 1974) and MD
Family Medicine (SL - 1992). Dr
Karunaratne is a family physician
who has served people and who
has made important contributions to
the profession, academia and
Wonca.
Professionally, she served in Sri
Lankan hospitals from 1954 - 1957.
She embarked on a career in
general practice in 1957 as an
employee and later as a solo
general practitioner from 1965 to
present in a town 10 miles south of
Colombo. She has provided holistic
family care up to four generations
and also wielded a great deal of
responsibility both socially and
medically in the town where she
practices.
Dr Leela De A
Karunaratne:
Wonca Global Family
Doctor for November
2005
Dr Karunaratne became a
member of the College of General
Practitioners of Sri Lanka in 1975
and has served the College
continuously, including as President
of the College from 1989 - 1991.
She was one of the pioneers of
postgraduate education in Family
Medicine at the Postgraduate
16
WONCA
News
MEMBER AND ORGANIZATIONAL NEWS
Institute of Medicine Sri Lanka from
1981 until present, serving as
Secretary to the Board of Study,
lecturer and examiner. She was
invited as external examiner for the
MD General Practice at the
Tribhuvan University, Kathmandu,
Nepal in 1990. She was responsible
for establishing Family Medicine in
the Medical Undergraduate
Curriculum in 1993, and became a
Professor of Family Medicine holding
the Chair and being Head of the
Department of Community Medicine
and Family Medicine at the Faculty
of Medical Sciences, University of Sri
Jayewardenepura where she
developed a model Family Practice
Centre for practice, teaching and
research in Family Medicine. She has
conducted and published or
presented numerous research
studies, books, chapters and
guidelines in family medicine.
Dr Karunaratne has been active
in Wonca for two decades. She was
plenary speaker at the 11th Wonca
World Conference in 1986 and again
at the 13th World Conference held in
Vancouver, Canada in 1992. She
participated at the historic WHO-
Wonca meeting held in 1994 in
Ontario, Canada which led the
adoption of the 1995 World Health
Assembly resolution recognizing the
central role of family doctors in
health systems and in meeting
people’s health needs. She served
as Chairperson of the Scientific
Committee for the 2002 Wonca-
MESA Regional Conference 2002 and
was plenary speaker during its 2005
conference. Dr Karunaratne has
received numerous honours and
awards, including being elected
Fellow of the Royal College of
General Practitioners in 1982; Fellow
of the College of General
Practitioners of Sri Lanka in 1989,
Degree of Doctor of Science Honoris
Causa conferred in 2003; and
Honorary Memberships with the
College of General Practitioners
Lahore Pakistan in 1986 and College
of Family Physicians Canada in 1994.
Dr Karunaratne is married to a
dental surgeon with whom she had
a joint practice. Their family of two
daughters has been extended now
to include two sons-in-law and four
grandchildren who live with them in
perfect harmony. She is very keenly
interested in domestic matters and
the environment, and is a keen
gardener who maintains a tranquil
and attractive garden in their home.
Dr. Leela De A Karunaratne is a
leader in Family Medicine in Sri
Lanka who has pioneered the
course of Family Medicine in her
country since the early 1970s. Her
commitment to uplift the cause of
Family Medicine in Sri Lanka and
around the world through Wonca is
widely recognized and of
immeasurable value.
(Editor’s Note; The “Global
Family Doctor of the Month” Award
is an award to encourage
philanthropy among primary care
practitioners and to honour doctors
giving their time and expertise to
their global colleagues and their
patients. The award is given to
doctors who are recognised by their
colleagues as having contributed
significantly to the community in
which they work by way of their
practice, community involvement,
charity work or other humanitarian
acts.
Each Award winner is given a
letter of congratulations from the
Wonca CEO, an award certificate and
a complete office diagnostic set
from Welch Allyn worth
approximately $400.
Submission Requirements include:
1.Title and Full Name of nominee.
2.Photo of nominee. The winner
and his/her photo would be
featured on Wonca’s website
www.GlobalFamilyDoctor.com
3.Postal address of nominee.
4.Reasons for nomination for the
Award.
5.Brief resume or CV of the
nominee
6.Any other relevant information
that would assist Wonca in the
selection process.
Please submit nominations for
this monthly Award to Dr Alfred Loh,
CEO of Wonca at the Wonca
Secretariat via email to
admin@wonca.com.sg)
Pakistan Family Doctors
Offer Support and Thanks
Following the Earthquake
An earthquake measuring 7.6 on
the Richter Scale struck on 8
October 2005 with the epicentre
about 60 miles north-northeast of
Pakistan’s capital, Islamabad. The
earthquake, which killed over
80,000 people in Pakistan alone,
has left an estimated 3.5 million
survivors homeless in Pakistan,
India and Afghanistan. On October
16, Dr Tariq Aziz, Wonca Council
Member for the Pakistan Society,
sent the Wonca Executive the
following email)
Thanks for your Wonca email of
support. On behalf of the Pakistan
Society of Family Physicians, I really
feel encouraged to know that our
international community has felt
deeply about our problems and
conveyed their concern.
About 26 hospitals and several
hundred clinics or surgeries have
been destroyed by this massive
earthquake. Almost 70% - 80% of
our population along with much of
our infrastructure has been
completely wiped out as if nothing
existed. Some hilly areas in which
20% of the population live are not
accessible as yet to outside relief.
17
WONCA
News
MEMBER AND ORGANIZATIONAL NEWS / RESOURCES FOR THE FAMILY DOCTOR
RESOURCES FOR THE FAMILY DOCTOR
USEFUL WEBSITES ON THE AVIAN INFLUENZA VIRUS
A variety of useful websites contain relevant clinical and public health
information for family doctors. These include:
WHO: http://www.who.int/csr/disease/avian_influenza/avian_faqs/en/
index.html
CDC: http://www.cdc.gov/flu/avian/index.htm
UK Health Protection Agency: http://www.hpa.org.uk/infections/topics_az/
avianinfluenza/menu.htm
Nature: http://www.nature.com/nature/focus/avianflu/index.html
Pandemic Flu: http://www.pandemicflu.gov/
Current Pandemic Phase: http://www.who.int/csr/disease/avian_influenza/
phase/en/
UK DoH Contingency plan: http://www.dh.gov.uk , search with ref 4615.
BMJ Learning Module: www.bmjlearning.com/ and search for “influenza
pandemics: bird flu” for free training programme.
Global Fellows Positions Available
The Ellison Institute for World Health at Harvard University, is currently
seeking distinguished candidates for their two year Global Fellows Program.
Global Fellows will apply their core research skills in the areas of economics,
public health, health policy, demography, and related fields to enhance
international health policy. An MD and/or a PhD in health economics, health
services research, statistics, epidemiology, publlic health, or related field or
equivalent experience is required. Applications will be accepted on a rolling
basis. This fellowship has a flexible start date of January 1, 2006 and a
minimum starting salary of $45,000.
Interested applicants should forward an electronic copy of the following:
•Letter of intent (describing the applicant’s research areas of interest)
•One letter of recommendation
•Curriculum vitae
Please send these documents via email to: global-health@harvard.edu
and include “Ellison Global Fellows Program” in the subject line of your
email. If you are unable to send us your materials via email, you may send
them to us at the following address:
Ellison Institute for World Health at Harvard University - Global Fellows
Program
104 Mount Auburn St., and email to Andrew Colitz at
Andrew_Colitz@harvard.edu
All government agencies,
including 100,000 troops (Army)
along with hundreds of Non
Governmental Organizations, are
working day and night. On average,
80 patients are on daily operating
lists receiving needed surgery in
each field hospital and nearby city
hospitals. We face shortage of even
simple things like sterilized gauze,
bandages, scrubs, disposable
sutures, analgesic and antibiotics.
As much housing is destroyed or
damaged, many people are left
laying in the open. Tents and
blankets are major requirements. In
very large city like Lahore, tents
have been completely out of stock.
The Pakistan Society of Family
Physicians is doing our part to
respond. I am working with
several organizations along with the
Pakistan Society of Family
Physicians. The whole nation has
really jelled together. Every locality
in the country is sending relief
goods available to them. Any help
from Wonca, including your kind
words are most welcome, as they
give us the strength to continue to
work harder day and night.
Thanking you once again.
Dr M Tariq Aziz
Wonca Council Member
Pakistan Society of Family
Physicians
psfp@wol.net.pk
WONCA
News
CONFERENCES 2005 – 2010
19
Information correct as of October 2005.
May be subject to change.
WONCA CONFERENCES 2005 – 2010 AT A GLANCE
See Wonca Website www.GlobalFamilyDoctor.com for upates
2005
Region
Venue
Theme
8 – 11 Dec
Americas
Vancouver
Preparing For Tomorrow
Regional Conference
CANADA
The Way Forward
2006
27 – 30 Aug
European
Florence
Towards Medical Renaissance:
Regional Conference
ITALY
Bridging the Gap Between Biology
and the Humanities
8 – 15 Sept
7th Rural
Seattle
Transforming Rural Practice
Health
Washington
Through Education
Conference
USA
11 – 15 Oct
Iberoamericana -
Buenos Aires
Pursuing Equity and Efficiency in
CIMF Regional
ARGENTINA
Healthcare: the Role of the Family Doctor
Conference
5 – 9 Nov
Asia Pacific
Bangkok
Happy and Healthy Family
Regional Conference
THAILAND
2007
24 – 27 July
18th WONCA
SINGAPORE
Genomics and Family Medicine
World Conference
17 – 21 Oct
European
Paris
Re-Thinking Primary Care in the European
Regional
FRANCE
Context: A New Challenge for General
Conference
Practice
2008
1 – 5 Oct
Asia Pacific
Melbourne
Theme to be confirmed
Regional
AUSTRALIA
Conference
2009
5 – 8 June
Asia Pacific
Hong Kong
Building Bridges
Regional
Conference
2010
26 – 30 May
19
th
WONCA
Cancun
Millennium Development Goals:
World Conference
MEXICO
The Contribution of Family Medicine
2011
February 2011
Asia Pacific
Cebu
Paradigms of Family Medicine:
Regional
PHILIPPINES
Bridging Old Traditions with
Conference
New Concepts
20
WONCA
News
GLOBAL MEETINGS FOR THE FAMILY DOCTOR
GLOBAL MEETINGS FOR THE FAMILY DOCTOR
WONCA WORLD AND REGIONAL
CONFERENCE CALENDAR
Wonca Europe Regional Conference, Florence 2006
Host:CSERMEG
Theme:Towards Medical Renaissance
Date:27-30 August, 2006
Venue:Florence, Italy
Contact:OICsrl
Viale Matteotti 7
50121 Florence, Italy
Tel:+39 0555 0351
Fax:+39 0555 001912
Email:wonca2006@oic.it
Web:http://www.woncaeurope2006.org
Wonca 7th Rural Health Conference, Seattle-Anchorage
2006
Host:Wonca Rural Health Working Party
Theme:Transforming Rural Practice Through Education
Date:8-15 September, 2006
Venue:8 -10 September – Wonca Rural Conference
University of Washington campus
11-13 September, 34th Annual Advances in
Family Practice
University of Washington campus
13-15 September, Post Conference
Talkeetna Alaskan Lodge
Anchorage, Alaska
Contact:Tom E Norris, MD
Chair, Host Organizing Committee
Department of Family Medicine
University of Washington School of Medicine
Box 356390
Seattle, WA 98195-6390, USA
Fax:206-543-3101
Email:tnorris@u.washington.edu
Web:http://www.ruralwonca2006.org/
Wonca Iberoamericana-CIMF Region, Buenos Aires, 2006
Host:Federacion Argentina De Medicina Familiar y
General
Theme:Pursing Equity and Efficiency in Healthcare:
The Role of the Family Doctor
Date:11-15 October, 2006
Venue:Sheraton Hotel, Buenos Aires
Contact:Federacion Argentina De Medicina Familiar y
General
Tel:54 11 4958 5079
Email:famfyg@aamf.org.ar
Web:www.famfyg.org.ar
15th Wonca Asia Pacific Regional Conference, Bangkok
2006
Host:General Practitioners/Family Physicians
Association of Thailand
College of Family Physicians of Thailand
Theme:Happy and Healthy Family
Date:5-9 November, 2006
Venue:Miracle Grand Convention, Hotel Bangkok
Contact:Dr Kachit Choopanya, Chairman, Host
Organizing Committee
10th Floor, Royal Golden Jubilee Building
2 Soi Soonvijai, New Petchaburi Road
Bangkok, Thailand 10320
Tel:66(0) 2716 6651
Fax:66(0) 2716 6653
Web:www.thaifammed.org
18th Wonca World Conference, Singapore 2007
Host:College of Family Physicians, Singapore
Theme:Genomics and Family Medicine
Date:24-27 July, 2007
Venue:Singapore International Convention and
Exhibition Centre
Contact:Dr Tan See Leng, Chairman,
Host Organizing Committee
College of Family Physicians, Singapore
College of Medicine Building
16 College Road #01-02
Singapore 169854
Tel:65 6223 0606
Fax:65 6222 0204
Email:contact@cfps.org.sg
Web:www.wonca2007.com
21
WONCA
News
GLOBAL MEETINGS FOR THE FAMILY DOCTOR
Wonca Europe Regional Conference, Paris, 2007
Host:French National College of Teachers in General
Practice
Theme:Rethinking Primary Care in the European
Context
Date:17-21 October, 2007
Venue:Palais des Congres
Paris, France
Contact:French National College of Teachers in General
Practice
6 rue des Deux Communes
94300 Vincennes, France
Tel:33-153 669 180
Emailcnge@cnge.fr
Web:www.cnge.fr
19th Wonca World Conference, Cancun 2010
Host:Mexican College of Family Medicine
Theme:Millennium Develop Goals:
The Contribution of Family Medicine
Date:26-30 May, 2010
Venue:Cancun Conventions and Exhibition Center,
Cancun Mexico
Contact:Mexican College of Family Medicine
Anahuac #60
Colonia Roma Sur
06760 Mexico, D.F.
Tel:52-55 5574
Fax:52-55 5387
Email:javier.dominguez@unfpa.org.mx
MEMBER ORGANIZATION AND RELATED MEETINGS
5th Austrian Winter Conference on General Practice and
Family Medicine, Austria
2006
Date:January 14-21, 2006
Venue:Hotel Rote Wand in Lech am Arlberg, Austria
Contact:Vienna Medical Academy
Attn. Hedwig Schulz
Alser Strasse 4,
1090 Vienna, Austria
Tel:+43 1 405 13 83-10
Fax:+43 1 405 13 83-23
E-mail:h.schulz@medacad.org
Web:www.oegam.at
13th World Conference on Smoking or Health,
Washington, DC 2006
Theme:Building Capacity for a Tobacco-Free World
Date:12-15 July, 2006
Venue:Renaissance DC Hotel
Washington, D.C., USA
Contact:John Seffrin, PhD
Chief Executive Officer
American Cancer Society
Email:secretariat2006@cancer.org
Web:http://www.2006conferences.org/
International Society for Quality in Health Care
23rd International Conference, London 2006
Date:22-25 October, 2006
Venue:London, United Kingdom
Contact:ISQua Secretariat
212 Clarendon Street
East Melbourne 3002 AUSTRALIA
Phone: +61 3 9417 6971 ..
Fax: +61 3 9417 6851
Email:isqua@isqua.org
Web: http://www.isqua.org
