From the Wonca President
:
World Health Day 2006 - A Celebration
2
or a Global Crises
From the CEO’s Desk
:
Highlights from the February Wonca Core
3
Executive Meeting
From the Editor
:
Make Your Plans NOW to Attend Wonca’s
5
Conferences!
FEATURE STORIES
6
•Register for the 7th Wonca World Rural Health Conference in
Seattle-Anchorage
•Wonca Continues to Grow
•List of Member Organizations of Wonca
Wonca REGIONAL NEWS
12
•Wonca Europe Region to Convene in Florence
•1st Wonca Iberoamerican-CIMF Regional Conference to Meet in
Buenos Aires
•El Primer Congreso Regional de Wonca-CIMF Iberoamericano Realizara
en Buenos Aires
•Come to Bangkok for the Asia Pacific Regional Conference
HEALTH AND HEALTH SYSTEM NEWS
15
•WHO launches Global Alliance Against Chronic Respiratory Diseases
•Wonca Special Interest Group in Psychiatry & Neurology Meets
With WHO Reps in Abu Dhabi
MEMBER AND ORGANIZATIONAL NEWS
16
•Luis Izquierdo Mora - Wonca Global Family Doctor for February 2006
•Fons Sips: Wonca Global Family Doctor for April 2006
•Ethics Special Interest Group Explores Challenges to
Professional Attitudes
RESOURCES FOR THE FAMILY DOCTOR
16
• To Travel Hopefully: An Autobiography by Charles Bridges-Webb
WONCA CONFERENCES 2006-2011 AT A GLANCE
20
GLOBAL MEETINGS FOR THE FAMILY DOCTOR
21
VOLUME 32
NUMBER 2
APRIL 2006
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:
WORLD HEALTH DAY 2006 - A
CELEBRATION OR A GLOBAL CRISES
“The global population is growing, but the number
of health workers is stagnating or even falling in many
of the places where they are needed most. Across the
developing world, health workers face economic
hardship, deteriorating infrastructure and social unrest.
In many countries, the HIV/AIDS epidemic has also
destroyed the health and lives of health workers”
Dr LEE Jong-wook
WHO Director-General
7 April 2006
The programme for World Health Day this year was
billed as an opportunity to celebrate the remarkable
contribution to human health and development made by
health workers globally. The festivities began with a
conference in Washington, DC on 4th April organised by
PAHO and WHO, culminating on the 7th, World Health
Day itself, which was devoted to the health workforce
crisis. On this day around the globe hundreds of
organizations drew attention to the global health
workforce crisis.
And a crisis it is! The serious shortage of health
workers was emphasised in the recently published WHO
World Health Report 2006 - Working together for Health
which stressed how essential life-saving interventions
such as childhood immunisation, safe pregnancy, and
access to treatment for HIV/AIDS, malaria and
tuberculosis were being impaired by this crisis. It
stated, “This shortage, combined with a lack of training
and knowledge, is also a major obstacle for health
systems as they attempt to respond effectively to
chronic diseases, avian influenza and other health
challenges”. More than four million additional doctors,
nurses, midwives, managers and public health workers
are urgently needed to fill the gap in 57 countries, 36 of
which are in sub-Saharan Africa, which has 11% of the
world’s population and 24% of the global burden of
disease but only 3% of the world’s health workers.
Every country needs to improve the way it plans for,
educates and employs the doctors, nurses and support
staff who make up the health workforce and provide
them with better working conditions, the report
concludes. Solutions to this global crisis must be
worked out at local, national and international levels,
and must involve governments, the United Nations,
WONCA
News
FROM THE WONCA PRESIDENT
2
health professionals, non-governmental organisations
and community leaders.
While WHO stresses that the impact of the shortage
of health workers in general is greatest in countries
overwhelmed by poverty and disease, where these
health workers are needed most, there is a relative
shortage of family doctors even in well-resourced
developed countries. In the February edition of Wonca
News, reference was made to a research report from the
Royal New Zealand College of General Practitioners
which indicates that there is a major shortage of GPs
trained in that country, necessitating recruitment of
foreign trained doctors. What is even more worrying was
that the rapidly diminishing and aging GP population
could produce a major crisis within 5 years, since it
appears that a third of GPs would have left practice by
then. Reports from Canada indicate that more than 4
million of the country’s population cannot find a family
physician to care for them. They are short of some 3000
family physicians and in 2004 they estimated that a
further 1400 family doctors would retire in the following
two years. Sixty percent of those in practice have a
workload of more than 75 hours per week. People who
don’t have a family doctor have no personal physician
to look after most of their medical problems or to
coordinate their care. Many other developed countries
have well established planning programmes.
Why is it happening?
Obviously, each country has its own precipitating
factors for the crisis. Are medical schools training
insufficient physicians of all types, possibly due to
enrolment cutbacks? Fewer graduates are selecting
family practice as their first career choice. In many
countries, the differential rewards for primary care
doctors, and those graduating with increased debt loads
see greater opportunity to overcome their financial
burdens by entering specialist practice. During my
recent visit to Nigeria, it was clear that the population
did not value the generalist but felt that ‘specialist was
best’!
Doctors from poorer countries can easily be attracted
by the market forces of lucrative salary packages offered
by developed countries, but since it is a global problem
one would hope that this migration can be curbed in
some way. Our young students and graduates in Africa
are continually bombarded by recruiting agencies from
developed countries, offering them lucrative salaries to
work in areas unattractive to their own graduates. Tim
Evans, WHO Assistant Director-General Evidence and
WONCA
News
FROM THE WONCA PRESIDENT / FROM THE CEO’S DESK
3
FROM THE CEO’S DESK:
HIGHLIGHTS FROM THE
FEBRUARY WONCA CORE
EXECUTIVE MEETING
A Wonca Core Executive Meeting
was held in Singapore from 16th -
18th February 2006 to cover issues
that needed Executive attention in
the period between the last Full
Executive Meeting in Kyoto in May
2005 and the next one in Buenos
Aires in October 2006. Present for
the meeting were the Wonca World
President, President-Elect and
Honorary Treasurer with the Wonca
CEO and the Administrative Manager
in attendance. Prior to this, the
Wonca Bylaws and Regulations
Committee held its two-day meeting
also in Singapore. Following that,
Drs Geoff Martin and Dan
Ostergaard, who are Members of
Executive, stayed to attend the Core
Executive Meeting.
Some of the key issues covered
by the Core Executive Meeting
included :
Role of Honorary Treasurer
As part of the process of
restructuring Wonca along corporate
lines, Wonca Executive has had
several discussions on how best to
institutionalize the role of the
Honorary Treasurer and the Finance
Committee within the Organisation.
In their extensive discussions, Core
Executive felt that the Honorary
Treasurer’s role was not to micro-
manage the finances of Wonca, nor
to hinder the financial functions of
the CEO. Rather, the Honorary
Treasurer and the Finance
Committee were to act as a
sounding board and to be part of a
larger group with which the CEO
could consult and share ideas.
Core Executive also suggested
the need for a more explicit and
structured process of financial
reporting and circulation and that
quarterly financial reports from the
Secretariat could be submitted to
the Honorary Treasurer and Finance
Committee member for their
comments. This proposed
procedure would involve the Finance
Committee Members as well as the
Wonca regional treasurers (where
they existed) or the person
performing the treasurer’s duties.
Proposal for a Wonca Working
Party on Education
At the last Wonca Executive
Meeting in Kyoto, Dr Michael Kidd
was requested to look into the
possible re-establishment of a
Wonca Working Party on Education.
Executive felt this to be important
given that education is a core
business for each of the member
organisations of Wonca, and given
the increase in interest at an
international and regional level in
family medicine education.
Core Executive discussed at
length the proposed mission, terms
of reference, possible membership
and proposed initial activities
submitted by Dr Kidd. It was
decided that the Working Party on
Education be established with the
following :
Information for Policy in his
message for World Health Day,
reports that, “some developed
countries have put policies in place
to stop active recruitment of health
workers from severely understaffed
countries. Some developing
countries have revised their pay
scales and introduced non-monetary
incentives to retain their workforce
and deploy them in rural areas”.
What is to be done?
From my studies of the global
situation and readings around the
topic I am convinced of the urgency
and importance of physician human
resource research, to determine the
demographics of our family doctor
populations and the trends likely to
affect the future of the discipline,
and then to plan for the future! If
the process has not yet begun in a
country, I would recommend that
Member Organisations of Wonca
initiate such surveys in their
countries. This is made all the more
urgent since it takes at least seven
to twelve years of medical school
and residency to train a family
doctor. So decisions made today
will only impact on the delivery of
health care more than a decade
from now.
A colleague and I have initiated
such base-line research in South
Africa, but I fear we may already be
too late. Trends may only become
apparent after repeating surveys
over a number of years. I am happy
to share our protocols and survey
methods with member organisations
who wish to embark on similar
studies. I believe the matter is
urgent! We need to understand the
status and nature of our existing
practitioners. We need to plan how
to recruit and retain new family
doctors in our health care systems.
We need to develop appropriate
evidence-based training
programmes, which indicate the
richness and diversity of the
discipline, and engender self worth.
We need to lobby for equity in the
market for family doctors. We need
to do a lot of hard work.....! We
need to save our discipline......!
Professor Bruce Sparks
President
World Organization of Family
Doctors
WONCA
News
FROM THE CEO’S DESK
Mission:
The Wonca Working Party on
Education will support high quality
education, training, assessment and
continuing professional
development in general practice /
family medicine for medical
students, doctors in training, and
established general practitioners
and family doctors
Terms of reference:
1.Support quality education,
training, assessment and
continuing professional
development in general practice /
family medicine.
2.Support the setting and
maintainance of standards for
education, training, assessment
and continuing professional
development in general practice /
family medicine both nationally
and internationally.
3.Develop education, training,
assessment and continuing
professional development policy
for Wonca.
4.Provide links to education,
training, assessment and
continuing professional
development resources and
people for the member
organisations of Wonca.
5.Support high quality education
at Wonca conferences by acting
as a resource, if invited, for Host
Organising Committees of Wonca
World and Regional conferences.
6.Act as a resource on education,
training, assessment and
continuing professional
development for the Wonca
Executive, World Council and
Regional Councils.
Membership of the Working Party:
This will include a Chair
appointed by Wonca World Council,
a representative from each Wonca
Region, appointed by the respective
Wonca Regional Councils, and
perhaps a small number of
4
international experts in medical
education in family medicine /
general practice.
Planned Initial Activities:
1.Survey of member organisations
of education, training,
assessment and continuing
professional development
resources and education
standards and policies which can
be freely shared with other
member organizations.
2.Establish listserver with
GlobalFamilyDoctor on education,
training, assessment and
continuing professional
development in general practice /
family medicine and invite
member organisations and
Wonca Direct Members to sign
up.
3.Invite Wonca Direct Members to
join a web-based register of
external experts in aspects of
education, training, assessment
and continuing professional
development in general practice /
family medicine, which can be
used by member organisations
and universities seeking support
for examinations, course
development, training and
standards development.
4.Meetings of working party
members to be held in 2006, in
conjunction with a Wonca
Regional Conference and also in
2007 in conjunction with the
Wonca World Conference in
Singapore.
Contract Document Between
Wonca World and Member
Organization Hosting a Wonca
Conference
This issue, which had been on
the agenda over several Executive
Meetings, was finally settled at this
Core Executive Meeting with all
amendments suggested during past
meetings incorporated into the final
document. Core Executive decided
that the final version of the
Conference Agreement shall be sent
to all bidders as part of the package
of documents on ‘Information on
Bidding for a Wonca Conference’.
On a procedural level, the
Agreement shall be signed before
the bid takes place on the
understanding that should the bid
be successful, the terms and
conditions as set out in the
Agreement shall be binding. On an
operational level, the final version
of the contract would be the basis
from which the CEO could negotiate
with the bidder if the bidder did not
accept in full the conference
contract as it was presented.
Regional Issues
1. Wonca Region Africa.
Dr Abra Fransch has tendered her
resignation as Regional President of
Wonca Africa as she had emigrated
from Zimbabwe to Australia. The
Wonca Executive noted with much
appreciation Dr Fransch’s significant
contributions to her region and to
Wonca as Africa Region President.
An official call was made to all
Member Organizations in Wonca
Region Africa for nominations for a
Regional President. Two candidates
have been nominated by Member
Organisations of the region. The
election is now in progress.
In the absence of a report from
the Regional President, Prof Sparks
reported that there had been some
exciting developments in Family
Medicine in East Africa. The
consortium FAMEC (South Africa),
and the medical faculties of Kenya,
Tanzania, Uganda, Democratic
Republic of Congo, with input from
GHETS (Global Health through
Education Training and Service),
together with the departments of
WONCA
News
FROM THE CEO’S DESK / FROM THE EDITOR
5
FROM THE EDITOR:
MAKE YOUR PLANS NOW
TO ATTEND WONCA’S
CONFERENCES!
Do not wait to finalize your travel
plans to attend one or more or
Wonca’s upcoming four world and
regional conferences taking place
during the summer and fall! All are
featured in this April issue of Wonca
News.
Wonca’s Rural Health Working
Party is proud to host the 7th World
Rural Health Conference in Seattle,
Washington and Anchorage, Alaska
from September 8-15, 2006. The
Seattle portion of the meeting
(Sept 8-13) will include two linked
major conferences, one dedicated to
rural health scientific, health policy,
and medical education and the other
to continuing clinical education for
rural physicians. Participants will
then be able to travel to the
majestic Alaska wilderness to ponder
actual rural health systems and the
surrounding natural beauty at
Talkeetna Lodge near Denali
National Park.
The 7th Wonca World Rural
Health Conference is sandwiched
between three similarly exciting
Wonca Regional Conferences held in
three similarly magnificent cities and
countries. Before the World Rural
Health Conference, the 12th Wonca
Europe Regional Conference will be
held in Florence, Italy on August
27-30, 2006. Following the World
Rural Health Conference, the 1st
Iberoamerican Wonca-CIMF Regional
Congress will be held in Buenos
Aires from October 11-14, 2006 and
the 15th Wonca Asia Pacific Regional
Conference will be held in Bangkok,
Thailand from November 5-9, 2006.
These four Wonca world and
regional conferences lead up to the
family medicine of the Flemish universities have been successful in
obtaining a grant of Euro 310,000 for a project to develop family medicine
in Southern and Eastern Africa. This development is good for the future of
Family Medicine / General Practice in the East Africa Region.
2. Wonca Americas
At a meeting of representatives of Member Organisations of Wonca
Americas Region held in Vancouver in December 2005, it was decided that a
name change be made for the region from Wonca Americas to Wonca North
America to better reflect the developments that have taken place in Wonca
in that part of the world. With the new Iberoamericana-CIMF Region now in
place, the Americas Regional Council recommended that it was no longer
appropriate to use the name Wonca Americas.
The Core Executive agreed to the change to Wonca North America, which
now needs the endorsement of the Full Executive at the Buenos Aires Full
Executive Meeting.
Better Gender Balance in Wonca
Dr Cheryl Levitt, Chair of the Wonca Working Party on Women and Family
Medicine, in a meeting in Vancouver in December 2005 with the Wonca CEO,
drew attention to the fact that women were not well represented in the
Wonca Executive, Council and its various sub-agencies. This issue was
discussed at length at the Core Executive Meeting.
Core Executive agreed that there needed to be increased female
representation and gender balance in Wonca. The Meeting agreed that there
was need for focused discussions and further input from the Working Party
on Women and Family Medicine, and also from Wonca Member
Organizations. Core Executive also felt that it was necessary to make
changes in the Wonca’s Bylaws and Regulations on gender balance to
encourage the change. There will be a specific item on gender balance on
the agenda of the Full Executive Committee Meeting at its next meeting in
Buenos Aires in October 2006.
Dr Alfred Loh
Chief Executive Officer
World Organization of Family Doctors
WONCA
News
FROM THE EDITOR / FEATURE STORIES
FEATURE STORIES
REGISTER FOR THE 7TH WONCA WORLD
RURAL HEALTH CONFERENCE IN SEATTLE
- ANCHORAGE SEPTEMBER 8-13
It is a great pleasure for me, on behalf of the Wonca
Working Party on Rural Practice, the University of
Washington School of Medicine’s Department of Family
Medicine and WWAMI program, the American Academy
of Family Physicians, and our State Academies, to invite
you to participate in the exciting experience of the 7th
WONCA World Rural Health Conference. This meeting will
be held in Seattle, Washington, USA from September
8-13, 2006.
Since Seattle and the University of Washington
School of Medicine are the home of the WWAMI medical
education program (Washington, Wyoming, Alaska,
Montana, Idaho), we have established the conference
theme of Transforming Rural Practice Through Education.
Education plays many roles for rural physicians. From
preparing them to practice, to offering opportunities to
teach in their practices, education permeates our lives
and is very important for rural physicians. The thirty-five
year old WWAMI program allows the University of
Washington School of Medicine to serve as the medical
school for five states that comprise 27% of the land
mass of the US, yet contain only 3% of the population-
this is truly a rural region, and decentralized community
based medical education is at the heart of the WWAMI
program. Much of our educational process is dependant
on the participation of community based volunteer
faculty physicians located throughout our area-education
and practice are inextricably tied to each other.
The Seattle portion of the meeting will include two
linked major conferences, one dedicated to the
scientific, health policy, and medical education aspects
of global rural health, and the other dedicated to
continuing clinical education for rural physicians. Our
international program and scientific committee is
looking forward to developing a comprehensive program
of posters and presentations that will be both
stimulating and interesting.
More information on our fascinating city can be
found at the website of the Seattle Convention and
Visitors Bureau. In addition to a very strong scientific
and clinical educational program, we will provide a
cultural and social experience that will be very
enjoyable. We will focus the cultural program on the
native peoples of the Northwest and Alaska. Our social
functions will create an opportunity for you to meet
other rural physicians from around the world, have
some fun, and get to know our region better.
Seattle is the largest city in the Pacific Northwest
region of the United States. Founded in 1869, the City
of Seattle is located in the State of Washington on
Puget Sound, 113 miles (182 km) from the U.S.-Canadian
border. It is a beautiful multi-cultural metropolis located
between Puget Sound and the Cascade Mountains,
interspersed with large lakes. The city is rich in history
and has long served as a major port and as the gateway
to the Northwest and Alaska. Surrounded by mountains
and water, the greater Seattle area features picture-
perfect views and abundant recreational opportunities
year-round. Room blocks will be reserved for conference
attendees. Additionally, economical room and board
packages will be available in dormitory facilities on the
University of Washington campus near the conference
venues. Cuisine in the Seattle area is famous for fresh
seafood, local farm produce, and other Northwest
specialties. The areas cultural diversity has produced a
wide variety of ethnic restaurants.
6
18th Wonca World Conference to be held July 24-27,
2007 in Singapore, also home of the Wonca World
Secretariat. This triennial Wonca World Conference
traditionally is the largest global gathering of the Wonca
family every three years and a wonderful way to reunite
with old friends and meet new family doctors.
So, using this April issue of Wonca News and with a
bit of advanced planning, you can finalize your travel
itinerary to attend all four Wonca conference in 3
continents over the next 6 months and then register to
come to Singapore for the 18th Wonca World Conference
in July 2007 to reunite with all those family doctors you
just met! Think about it !!
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)
WONCA
News
FEATURE STORIES
7
Following the Seattle conferences, we are very
pleased to offer a post-conference session to consider
actual rural health systems at Talkeetna Lodge near
Denali National Park in Alaska. The Talkeetna Alaskan
Lodge offers the premier lodge experience with
spectacular views of Mount McKinley (Denali as it is
known locally), Denali National Park and the Alaska
Range. The Talkeetna Alaskan Lodge is Alaska Native
owned and operated, offering a resort style setting with
unique and awe-inspiring Denali and Alaska Range
views that are simply unmatched. Located just outside
the heart of Talkeetna, it is easy to treat yourself to the
many local activities, including favorites like flightseeing
- where you can even land on a glacier in Denali
National Park.
Registration, educational and scientific program
information, accommodations and sightseeing for both
the main and post-conference may be found at
www.ruralwonca2006.org.
We hope that you will plan to join us and be part of
our exciting program.
Tom E. Norris, MD
Chair, Organizing Committee
tnorris@u.washington.edu
Wonca Continues to Grow
At the Wonca Executive meeting in Singapore in
February two new members were added to the Wonca
membership list. This brings us now to 107
organisations in 90 countries.
The Emirates Medical Association-Family Medicine
Society has 52 members and represents family doctors
throughout all the Emirates. Their headquarters is in
Dubai and they are an active and growing organization.
New members from the Arab region has been a high
priority for Wonca and there are other organizations
from this part of the world which are eligible for
membership. As we grow in this region the Executive
has been interested in the creation of a new Arab region
within Wonca.
The Network / TUFH (Towards Unity for Health) has a
long history of networking among its members and
externally with organizations such as the WHO and its
regional organizations. TUFH / The Network has enjoyed
collaborative success and renown primarily among
academic circles. It is also an organization of
organizations and has some 140 member organizations.
The majority are medical schools with an interest in
problem based, student and community oriented
medical education. This ability has just been enhanced
as the Network was accepted as a member in
collaborative relations of Wonca.
The Network and Wonca have already enjoyed some
collaborative relationships. In 2001 when TUFH was a
program in the WHO the Network and Wonca officers
met in Durban, South Africa with Dr Charles Boehlen to
plan for continuation of the program after his
retirement. This directly let to the Network assuming
leadership in this role and continuation of this
important program and an addition to the name of the
Network.
Both organizations have already had cooperative
efforts in the advancement of primary care and student
centered medical education in East Africa and multiple
countries in Southern Africa. This collaboration is
currently leading to the establishment of some
departments of family medicine and collaborative
teaching programs. Several physicians are active
members of both organizations and this has helped
bring the two organizations closer to work together.
This new relationship should help both organizations
work more effectively through collaboration on programs
for education for health in the future. This also opens
up new opportunities for communication through
linkages through each other’s web sites and new
projects in which we all work together for common
goals.
Warren Heffron, MD
wheffron@salud.unm.edu
List of Member Organizations of Wonca
The following is a list of Wonca’s&nb
