From the Wonca President
How Does One Care for People in
:
2
Region’s of Military Conflict?
From the CEO’s Desk
:
Family Doctors Helping Family
3
Doctors in Disasters
From the Editor
:
Family Doctors – Responding to
4
Community Health Threats
FEATURE STORIES
5
•Professor Khaya Mfenyana Elected Wonca Africa Region President
•Women Physicians: Caring for Themselves and Their Families
•Register for the 7th Wonca World Rural Health Conference in Seattle
Wonca REGIONAL NEWS
8
•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
9
•More than 20,000 Review AIDS Epidemic at XVI International
Conference
•How Hong Kong and Toronto’s Family Doctors Responded to the
SARS Epidemic
MEMBER AND ORGANIZATIONAL NEWS
12
•Professor Nandani de Silva Appointed Vice Chancellor
•Isabelita Morales Samaniego – Wonca Global Family Doctor for June
•Call for Papers for Special Issue on Global Family Medicine Education
•‘Education for Health’ Call for Papers Deadline September 30th
• Wonca Veterans Reunite in Alaska
RESOURCES FOR THE FAMILY DOCTOR
15
•New Report: Tobacco Deaths May Exceed One Billion in the 21st
Century
•Avian Influenza Web Resources for the Family Doctor
WONCA CONFERENCES 2006-2011 AT A GLANCE
17
GLOBAL MEETINGS FOR THE FAMILY DOCTOR
18
VOLUME 32
NUMBER 4
AUGUST 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
Prof Khaya Mfenyana, 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:
HOW DOES ONE CARE
FOR PEOPLE IN REGIONS
OF MILITARY CONFLICT?
“Every gun that is made, every
warship launched, every rocket fired
signifies, in the final sense, a theft
from those who hunger and are not
fed, those who are cold and not
clothed.”
Dwight D. Eisenhower
Local and regional conflict
around the world has once again
highlighted the devastating
humanitarian and health modifying
effects that military conflicts have
on ordinary people. Modern wars
tend to target whole communities
and their support systems. In recent
military conflicts around 90% of the
casualties are civilians. Apart from
the loss of life, the military action
deeply traumatises and disrupts
healthy psychological and emotional
development, leaving deep wounds
and scars that could last for
generations.
The world has recently focused
on the Israeli - Hezbollah conflict.
The immediate consequences of the
devastation are profound with
estimates of more than a million
people displaced in both Southern
Lebanon and Northern Israel.
Diplomatic efforts are underway to
limit the conflict’s impact on
peoples’ overall health throughout
the Middle East region.
While the world focuses on the
drama in the Middle East, another
deadly conflict of a far greater
duration and magnitude continues
to elude diplomatic solution. The
people in Sudan’s Darfur region
have endured more than three years
WONCA
News
FROM THE WONCA PRESIDENT
2
of displacement, violence and
death. At least 180,000 people may
have died from illness and
malnutrition in Darfur over the past
18 months, according to the United
Nations’ top emergency relief
official, Jan Egeland. More than a
million refugees have been
permanently displaced from the
violence as their villages have been
burned and completely destroyed.
On a smaller but equally
devastating scale, over 65,000
people in Timor Leste in South East
Asia, with a total population of just
less than a million, have recently
been internally displaced in the
capital, Dili, due to civil unrest. The
difficulty of delivering basic needs
such as clean water, temporary
shelter, food, and health care in
over 40 temporary camps is of great
concern, and could get worse if the
security situation deteriorates
further.
Military conflicts such as these
and others across the globe have
many unfortunate consequences in
common. Those displaced internally
and in neighbouring countries need
support to access safe drinking
water, health care, warmth, vaccines
and life-saving medications.
Destruction of infrastructure further
affects the health system’s capacity
to deliver care. There is an increase
in communicable diseases because
of the concentration of displaced
persons and the lack of access to
clean water and sanitation. There is
also an increased risk of morbidity
and mortality in those already living
with chronic diseases such as
hypertension, diabetes, heart failure,
malignancies, HIV/AIDS, psychiatric
illness and epilepsy because of the
lack of life-preserving medications,
specialised care and support
services. This applies too, to
pregnant women about to deliver
and other in need of similar vital
care. The elderly are also particularly
at risk.
Diminishing fuel supplies, food
insecurity, precarious hygiene and
temporary over-crowded shelters
further exacerbate the situation.
And yet it is often impossible or
extremely difficult for relief
organisations and agencies to
access areas of conflict, thus making
comprehensive assessment
impossible. So reliable information
of numbers affected and the
magnitude and scope of the impact
and needs are often unavailable to
aid organisations.
I am always in awe of the health
and relief workers who are
interviewed on TV from the battle
zones around the world. Their
courage and dedication in the face
of personal danger and hardship is
to be admired. While specialist
services are necessary for acute
trauma and the management of
major medical emergencies, a large
proportion of the care in these
situations falls on the family
doctors, primary care physicians and
other professionals in the primary
care sector. Apart from offering all
the usual primary care services they
must also ensure effective
immunisation services, post-
traumatic stress counselling,
nutritional care, management of
infective conditions such as typhoid
fever, typhus, and cholera, and also
run surveillance and monitoring
programmes.
Apart from collateral deaths and
injuries of civilians, family
disruption, and destruction of
homes and property, the impact of
wars and military conflict on
children must be devastating,
particularly those who witness
deaths and mutilations of family
and community members. These
images must have lasting and
detrimental effects. Croesus, King of
Lydia in the 6
th
century BC stated,
“In peace the sons bury their
fathers, but in war the fathers bury
their sons.”
WONCA
News
FROM THE WONCA PRESIDENT / FROM THE CEO’S DESK
3
FROM THE CEO’S DESK:
FROM THE CEO’S DESK: FAMILY DOCTORS HELPING
FAMILY DOCTORS IN DISASTERS
In the past two to three years, the world has experienced several natural
disasters of significant magnitude. These would include the West Sumatra-
Aceh Tsunami, the North Pakistan Earthquake, Hurricane Katrina in the USA
and the recent Yogjakarta Earthquake in the Indonesian Island of Java. These
events were well covered by the media globally and we were all well
informed of the toll in human lives and property damages. Added to these
were the hardship and death inflicted on the civilian population in some
countries by man-made destruction like wars and civil unrest as the case in
the Darfur Region of Sudan, Timor Leste, Sri Lanka, Iraq, Afghanistan and
more recently in Lebanon and Israel.
While most of us know of the cost to human lives and property of these
events, few realize that among those who died and suffered are also the
family doctors living and working in the midst of these areas of calamity.
Some have died in the process of carrying out their professional duties
attending to patients while others died with their families at home. Little in
terms of publicity is given to these individual tragedies suffered by family
doctors.
In the case of the West Sumatra tsunami for example, about 28 family
doctors in Indonesia’s Aceh Region died instantly when the giant waves
struck land. Over 320 family practice clinics were completely destroyed
leaving the family doctors with no means to help the survivors or to make a
living after the event. Immediate and significant help and moral support
came from a large number of Indonesian family doctors from the distant
island of Java. These doctors managed with their own funds to buy daily
necessities and travel over eight
hundred kilometers to help their
fellow colleagues in distress.
The casualties and sufferings in
the North Pakistan Earthquake
would probably be equally
staggering among the local family
doctors, their families and their
practices.
Immediately following the
tsunami, appeals for help were
made by the Wonca Secretariat to
all member organizations globally
via e-mails. We did receive prompt
and positive responses from
individuals and member
organizations informing the
Secretariat of the many ways help
was being extended. The Dutch
College together with the University
of Nijmegen collected a total of
US$24,000 for the victims of the
disaster. These were given to the Sri
Lanka College to help rebuild the
homes of fishermen whose seaside
homes were completely destroyed.
Individual family doctors from
some countries like Switzerland,
Canada, United Kingdom and France
responded by traveling to Northern
Pakistan following the earthquake to
help with medical relief work. Some
of them received their contacts
through the Wonca World
Secretariat.
Whilst these efforts were all very
credible and praiseworthy, the help
extended was not directed
specifically to the family doctors
and their families affected by the
natural and war-related disasters.
As a world organization
representing over 250,000 family
doctors in over 90 countries
globally, Wonca should at this time
perhaps look at how it may play a
role to alleviate the hardship of
fellow family doctors affected by
such natural and man-made
disasters. The need to help our
friends and colleagues in such
Our colleagues and Wonca members in countries of the Middle East; in
the Darfur region of Sudan; in Timor Leste; caring for the communities
devastated by the recent Tsunami in Central and West Java, or the starving
masses in the Horn of Africa, in Iraq, Afghanistan, Kashmir and other areas
of humanitarian need, deserve our praise and support, not only during the
acute phases of need but also during those of early and sustained recovery
and reconstruction. They often work with very limited resources and under
stressful and dangerous conditions. The question we must ask is, “Are our
family doctors adequately trained to deal with natural, environmental or
man-made disasters?” I fear that in general they are not. But I believe that
most well trained generalists can soon adapt and learn in the face of
urgency and need. However disaster management should be a necessary
part of every doctor’s medical training.
Professor Bruce Sparks
President
World Organization of Family Doctors
WONCA
News
FROM THE CEO’S DESK / FROM THE EDITOR
4
difficult situations should be a
priority for the Organization. There
could be some mechanism set in
place that would allow this world
body to respond quickly and
effectively to the personal suffering
of its members. The avenues to
extend such help may be the
various colleges and academies of
family doctors present in the
affected country or a neighboring
country.
In the long term financial
planning of Wonca, it may not be
premature to set aside funds for
such aid. Besides setting aside a
certain percentage of Wonca’s net
income each year for this purpose,
contributions may be invited from
the larger and richer member
organizations or individuals within
Wonca. Appropriate appeals for
contributions from well-meaning
pharmaceutical and medical-related
multinational companies may also
be made to ensure an aid fund that
is significant and effective.
Wonca Executive and Council
may want to deliberate on this idea
when they next meet and perhaps
set in motion plans for such a relief
fund. Perhaps some of Wonca’s
larger member organizations could
kick-start the establishment of such
an aid fund with some initial
contributions to help persuade the
others to do the same. Some form
of recognition would of course have
to be put in place to record the
generosity of the contributors.
The way these disasters have
occurred in the recent past, it may
not be too soon to have the aid
funds available at the earliest
possible opportunity.
Dr Alfred Loh
Chief Executive Officer
World Organization of Family
Doctors
FROM THE EDITOR:
FAMILY DOCTORS – RESPONDING TO COMMUNITY
HEALTH THREATS
This issue of Wonca News highlights some of our old and new global
health threats and how family doctors play a central role on the front lines
of community health care systems in prevention, early detection and
treatment.
An article on the status of the HIV-AIDS epidemic indicates that an
estimated 40 million people are living with HIV-AIDs and almost 3 million
have died since its emergence 25 years ago. Much progress in AIDS
research, prevention and treatment has given hope and life to millions of
people around the world. The same cannot yet be said about the global
impact of tobacco related illness and death. A new report indicates that
1.25 billion people, a quarter of the world’s population, currently smoke,
and approximately half of them will die because of it. If present trends
continue, tobacco related illness may account for over one billion deaths in
the 21
st
century.
An article on the SARS epidemic in Hong Kong and Toronto
demonstrates that family doctors can and do play a central role in each
country in the prevention, early detection and effective treatment of
community health threats. In their President and CEO Column, Professor
Bruce Sparks and Dr Alfred Loh compel family doctors to be healers in the
face of human conflict and natural disasters. An article in a continuing
series from the Wonca Working Party on Woman and Family Medicine
highlights the additional challenges that women physicians must overcome
to be effective caregivers and healers.
Wonca provides numerous opportunities for family doctors to remain
informed and prepared as community health physicians and leaders. The
Resources Section provides family doctors useful information on the latest
on the Avian Flu, cancer, cardiovascular disease and tobacco related illness.
In the upcoming year, tens of thousands of family doctors around the globe
will share experiences and ideas in Wonca Regional meetings in Florence,
Buenos Aires and Bangkok, in member organization scientific and political
meetings and in the 7
th
Wonca World Rural Health Conference in Seattle and
18
th
Wonca World Conference in Singapore. Wonca’s website,
GlobalFamilyDoctor.com, provides family doctors a wealth of relevant
resources and links to all of the above and much more.
Please continue to send me relevant and useful information you would
like to share with your fellow family doctors through Wonca News.
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
FEATURE STORIES
PROFESSOR KHAYA MFENYANA ELECTED
WONCA AFRICA REGION PRESIDENT
Professor Khaya Mfenyana has been elected as
President of the Wonca Africa Region. He will serve the
remainder of the three year term of Dr Abra Fransch,
who served with great distinction as Africa Region
President since assuming the role at the 2001 Wonca
Council meeting in South Africa. Dr Fransch moved from
Zimbabwe to Australia and was no longer able to
continue to serve in the role. Professor Khaya
(pronounced KY-A) Mfenyana will serve the remainder of
the three year term as Regional President until the
2007-2010 triennium elections at the Africa Regional
Council meeting to be held just prior to the Wonca
World Council in Singapore in July 2007.
Professor Khaya Mfenyana
President,
Wonca Africa Region President (2006-)
Doctor Abra Fransch
President,
Wonca Africa Region President (2001-2006)
Professor Mfenyana, a member of the South Africa
Academy of Family Practice, is a humble and jovial man
with grassroots origins in the Transkei who has risen to
numerous leadership positions in academia, practice
and his profession. Khaya is Founder and Chair of the
Department of Family Medicine at the University of
Transkei, Director of several primary care clinics in the
area, and President of FAMEC, the Consortium of
Departments of Family Medicine in South Africa. He also
has a leadership role in the East African Project, a major
Wonca collaborative project to improve family medicine
education, practice and health care delivery in East
Africa. He was a Kellogg Foundation Fellow and was on
the Executive Committee of The Network – Towards
Unity for Health.
With his roots in the Transkei, Professor Mfenyana
brings to Wonca his emphasis on serving the
5
underserved, his perspective of caring, and his
experience with community oriented, academic based
family medicine education, research and service.
Professor Khaya Mfenyana may be contacted at
mfenyana@getafix.utr.ac.za
Women Physicians Caring for
Themselves and Their Families
An examination of the health and well-being of
women doctors reveals many contradictions. When
compared to the general population, women doctors
have better health, perhaps because of our
socioeconomic status. In addition we have healthier
lifestyles than men physicians in the areas of smoking,
drinking, exercise, sleeping habits, and body weight. At
the same time, women physicians (at least those in
Canada and Sweden) report more chronic health
problems, acknowledge more impairment of health, and
use more physical and health services than do their
men colleagues. How can we explain these disparate
findings?
Perhaps the tensions between our work, our
personal lives and our role in society have something to
do with it. Among U.S. women physicians, more than
three-quarters report moderate to severe work stress.
While men physicians also experience work stress,
women’s stressors often relate to traditional role
relationships and family responsibilities, compared to
men who report more stresses relating to relationships
with patients and clinical pressures. Women’s unique
work-related stresses include role conflict with marriage
and parenting, prejudice and discrimination, token
status, sexual harassment, social isolation, lack of
women role models, and inadequate family and
institutional support. These issues might underlie
women physicians’ stress in comparison to men, but
then how can we explain the next contradiction: Women
physicians report a high level of life and work
satisfaction!
The persistent finding of women physicians’
satisfaction—despite high-level stressors—concurs with
results from studies of other women professionals that
describe a “paradox of the contented worker.” Although
women professionals generally have lower pay, status,
and authority than men, they consistently describe
themselves as more satisfied. Perhaps this discrepancy
is due to different career expectations, different values
regarding job and career, or greater interest in intrinsic
versus extrinsic rewards (e.g. intellectual stimulation
WONCA
News
FEATURE STORIES
6
and relationships over pay and
prestige). Or perhaps women
physicians value the combined
rewards of family and career over
the singular rewards of career,
despite the challenges posed.
Other sources of stress may
derive from women’s sense of guilt
and, sometimes excessive, sense of
responsibility. While these traits
may lead to personal distress, they
may also underlie women
physicians’ high motivation to
succeed in all that we undertake. As
physicians we maintain high
expectations of ourselves and push
ourselves to perform and excel in all
areas. When we do not meet all our
perceived responsibilities, we tend
to feel frustrated and inadequate,
perhaps explaining why we are more
likely to experience burnout and
depression than our men
colleagues. The evidence on why
women physicians have higher
suicide rates than the general
women population is inconsistent;
however it is clear that career stress
and other life stressors contribute
significantly to suicide in women
physicians. Balancing professional
and personal obligations means
dividing our time and energy
between our work and private lives,
resulting in divided loyalties and a
sense of guilt. If we work less, we
let our colleagues down and
advance more slowly; if we cut back
on family time, our relationships
suffer. Women physicians feel under
pressure to be good mothers, good
housekeepers, and good partners in
addition to performing our
professional duties. Some of us feel
a great deal of guilt, sadness and
regret about what feels like
abandonment of our children and
families at times to perform our
professional duties. Frequently we
claim little time for ourselves,
despite our strong encouragement
to our women patients to make time
for themselves! Such role conflict
can cause decreased self-esteem, as
well as fatigue and depression. If
this is true, how come we like our
work so much?
Certainly, the workplace is not
always a welcoming environment for
the advancement of women.
Training environments have
traditionally expected us to
suppress our emotions in favor of a
stiff upper lip. In the work
environment we often experience
competitiveness, power politics, lack
of autonomy, lack of control over
work hours, lack of role models,
discrimination (either due to gender
or due to family responsibilities)
and persistent “minority” status. Not
surprisingly, such dynamics
contribute to women physicians’
lower self-confidence. Moreover,
parenting and family responsibilities
have a different impact on our
career choice and advancement,
compared to men physicians. So
why do it all?
Maybe the challenges are
balanced by the rewards. Many
women physicians feel that being a
parent makes us better doctors to
our patients. Juggling work and
family can lead to a full rewarding
life, as reflected by the lower rates
of depression and increased life
satisfaction married women
physicians with children report
compared to single women
physicians without children. (Or
perhaps not even a woman’s good
career can make up for not pursuing
the socially approved roles of
marriage and motherhood.)
Although women physicians are
more likely than men physicians to
be divorced or single, women
physicians are very likely to marry
other physicians and to work part-
time while their partners work full-
time. These dual doctor marriages
seem to endure as well as any other
marriages in today’s world. Or
perhaps our shared interests and
our involvement in work keep these
relationships vibrant and interesting!
Many women physicians have
found creative ways to get
psychological and emotional
support in their personal lives, and
in their work settings. We learn to
negotiate more effectively the
division of labour in domestic duties
with our spouses, and we develop
new strategies to share call with our
colleagues. We find ingenious ways
to network among one another. In
medical school and residency we
learn how to work within the system
to balance our many conflicting
priorities, and once in practice we
put these coping mechanisms into
practice for the long-term. We can
attend workshops on assertiveness
training and leadership skills, and
we can develop mentoring programs
for those who come after us. We
gain enormous satisfaction from
working for broader solutions for
women physicians’ concerns, for
instance lobbying for work equity
policies, parental leave policies, and
flexible hours. Our work on behalf
of our patients, our colleagues and
our learners nourishes us and
enables us to further the health and
wellbeing of members of our
community.
Currently most of the studies on
women physicians come from
Europe and North America. With the
increasing representation of
developing nations in Wonca, and
the increasing numbers of women
physicians represented in Wonca
member organizations, we will soon
be able to understand whether
women physicians around the world
share the same challenges in caring
for themselves and their families as
we have described above. We
suspect that women in the newly
represented regions will face even
greater contradictions, as so many
other women in their communities
lack even basic health care, safety
and respect. Their tasks will seem
much greater, but then again, the
rewards of their success will be
huge. At the next Wonca Triennial
in Singapore in 2007 we will dedicate a symposium to
looking at how women family physicians from each
region maintain their balance, using video clips from a
day in the life of women family doctors from around the
world. We look forward to networking with women
physicians from all over the world as a way of building
supportive systems that foster our ability to take better
care of ourselves and one another.
Lucy Candib MD
Barbara Lent MD
Michelle Howard MSc
Cheryl Levitt MBBCh
Wonca Working Party on Women and Family Medicine
(Editor’s Note: This is the second of a series of
monographs published by the Wonca Working Party on
Women and Family Medicine. Please see the June 2006
issue of Wonca News for an overview of the series and
an article from the first monograph. Readers may go to
www.womenandfamilymedicine.com for the full
monograph, literature review, summary and annotated
bibliography on women family physicians caring for
themselves and their families)
Register for the 7
th
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
