From the Wonca President:
Health Professionals Unite on
2
Patient Safety
From the CEO’s Desk
:
:
Gender Equity in Wonca
3
4
From the Editor
:
Examining the Roles of Women Family
Doctors
FEATURE STORIES
4
•Working Party Seeks to Enhance Role of Women Family Doctors
in Wonca and Health Systems
•Working Party Releases First of a Series: Women in Organizational
Medicine
Wonca REGIONAL NEWS
8
•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
10
•Wonca Representatives Attend the World Health Assembly
•Wonca Mourns the Death of WHO Director General, Dr LEE Jong-wook
MEMBER AND ORGANIZATIONAL NEWS
13
•Register for the 7
th
Wonca World Rural Health Conference in Seattle
•Tomlin Paul - Wonca Global Family Doctor for May 2006
RESOURCES FOR THE FAMILY DOCTOR
15
•The World Health Report 2006: Working Together for Health
•Lifting the Smoke-screen - 10 Reasons for a Smoke-free Europe
•Call for Papers Issued by Education for Health Editors
WONCA CONFERENCES 2006-2011 AT A GLANCE
19
GLOBAL MEETINGS FOR THE FAMILY DOCTOR
20
VOLUME 32
NUMBER 3
JUNE 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:
HEALTH PROFESSIONALS
UNITE ON PATIENT
SAFETY
“Health workers are a positive
asset, not a cost item”
Dr Tim Evans
Assistant Director-General
Evidence & Information for Policy,
WHO
Geneva, May 2006
I had the pleasure of attending,
as an observer, the World Health
Professions Alliance (WHPA) Leaders
Forum: Working Together for Safe
Health Care in Geneva from 20 – 21
May 2006. The main theme of the
meeting related to patient safety,
but the global shortage of health
personnel was also addressed. The
WHPA is an alliance of nurses,
pharmacists, physicians and dentists
represented by their respective
organisations, namely the
International Council of Nurses,
International Pharmaceutical
Federation, World Medical
Association, and the World Dental
Federation. These organisations thus
represent millions of health
professionals globally, seated jointly
in country delegation clusters.
The unfortunate and sudden
collapse and death of the Director-
General of WHO, Dr LEE Jong wook
that weekend placed a major pall
over the later proceedings of the
meeting. His major contributions to
polio eradication, access to
medication, support for treatment of
HIV/AIDS patients globally, health
human resource development and
preparation for a possible avian flu
pandemic were acknowledged and
praised.
WONCA
News
FROM THE WONCA PRESIDENT
2
Despite the sad news about Dr
Lee, the gathering of world leaders
contributed actively to discussions
around patient safety, combating
counterfeit medicine and materials,
developing inter-professional teams
for safer health, and the crisis in
health professional resources
globally. What impressed me was
the collaborative and mutual respect
demonstrated by the representatives
of the four major professions to
each other. There were some
statements about turf issues,
especially the concern from
pharmacists about their limited
clinical roles in patient care.
Dr Yoram Blacher, a WMA
executive member from Israel set
the scene on patient safety and
medical errors. He indicated that it
is estimated that 10% of the world’s
population who receive health care
have had their health affected by
errors. This figure pales in the wake
of the number of ‘near misses’. The
usual response is unfortunately to
find the guilty parties rather than
attempts to improve the system. He
indicated that studies had shown
that many health professionals were
pushed out of medicine altogether,
or into ‘safer’ professions and
disciplines. Defensive medicine
practices were often a natural
response to threatened litigation.
While defensive medicine has
negative consequences such as
reluctance to manage high-risk
populations and domains,
unnecessary over-investigation, and
allegiance to legal considerations
rather than necessary clinical
decisions, there can also be positive
spin-offs for patients. These include
increased adherence to clinical
guidelines and screening protocols,
improved record keeping, and also
more frequent consideration of
patient consent.
The delegates concluded that
there was a need for a blame-free
responsible healthcare environment,
which would encourage confidential
self-reporting of near misses. There
were also calls for system and
working environment changes, and
the nurturing of a culture of safety
to replace the culture of blame.
My concern with these broad
statements of intent was that self-
reporting would probably not be
acceptable to our medical protection
insurers and could possibility even
result in increased litigation, unless
reporting is protected by legislation
such as the Patient Safety and
Quality Improvement Act in the USA.
Reporting such errors in some
countries could jeopardise the
practitioner’s employment and
possible safety. But in Geneva, of
greater concern to me was that
there was the limited stress placed
on preventing health-worker errors.
As professionals, we should take
steps to pre-empt such mistakes,
and aim to improve the quality of
patient care through enhanced
clinical competence & expertise. In
family practice, this can be
encouraged through programmes of
self-audit, chart review, self-
reflection, observed consultations
and formal morbidity and mortality
discussions. The challenge would be
how to attract the doctors who
really need such programmes - a
problem faced by all voluntary
educational programmes.
How often have we heard the
statement, “In medicine mistakes
happen - doctors are only human?”
A 1999 report, To Err is Human,
revealed that one million people in
the United States suffer from
preventable medical injuries with
estimates from 44,000 to 98,000
deaths from them every year. Some
Wonca Member Organisations have
developed initiatives and
programmes on patient safety, and
have stressed the importance of
minimising doctor-initiated errors.
Such initiatives usually involve
WONCA
News
FROM THE WONCA PRESIDENT / FROM THE CEO’S DESK
3
FROM THE CEO’S DESK:
GENDER EQUITY IN WONCA
At its first meeting following World Council elections in Orlando in
October 2004, members of the new Wonca Executive noted the gender
imbalance in the Executive Committee. Only one woman, Regional President
of Wonca Africa Dr Abra Fransch, was represented. In addition to Dr Fransch,
the previous Executive Committee was represented by Member at Large and
immediate past WHO-Wonca Liaison Person, Dr Ilse Hellemann.
Gender imbalance did not escape the notice of members of the Wonca
Working Party on Women and Family Medicine (WWPWFM). At the meeting I
had with the WWPWFM President, Dr Cheryl Levitt, in Vancouver in late 2005
on the occasion of the First Regional Council Meeting of Wonca Region North
America, this issue was extensively discussed. Dr Levitt indicated to me then
that her Working Party was keen to help address this situation. I welcomed
the idea and initiative. I felt that proposals from the Working Party would
help Wonca Executive in its deliberations on this issue at its future
meetings.
A quick review of the data and documents available in the Wonca World
Secretariat showed that gender imbalance in this world organization is
significant and initiating constructive actions is long overdue. At the member
organizational level, a quick count revealed that only 15 (17%) out of 89
current Presidents of Wonca Member Organizations are women.
At the global level, a quick look at the compositions of Wonca World
Councils revealed that female Council Members in the various past Councils
were also very small in numbers. The 1998 World Council had 8 (17%)
female representatives out of 47 total Council Members. In 2001, 7 (14%)
out of 49, and, in 2004, 15 (21%) of
69 were women.
So it could be safely concluded
that the issue of gender imbalance
needs to be addressed at both
national and global levels
At the Core Executive Meeting in
Singapore in February 2006, this
issue of gender imbalance in Wonca
was discussed at length. Core
Executive agreed then that there
needed to be increased female
representation and better gender
balance or equity in Wonca.
Executive felt however that the issue
needed focused discussions and
also input from the Working Party
on Women and Family Medicine, as
well as input from Wonca Member
Organizations. Core Executive felt
that Member Organizations should
be encouraged to send more female
representatives to Wonca meetings.
Executive also felt it necessary that
there be changes in the Wonca
Bylaws and Regulations to promote
gender balance or equity as
otherwise there may be no
significant change within the world
organization. For example, under the
section on the Election of Members
at Large, the Bylaws could specify
that at least one Member at Large
should be a female member. In the
section on the creation of
Committees and Working Parties, a
clause on gender balance /
representation could be added.
It was also suggested that there
should perhaps be mechanisms
such as mentorship and leadership
development programs in Wonca
Member Organizations to promote
gender equity at Wonca events and
in the various Wonca-office
positions. Arising from these
discussions, Core Executive decided
that there would be a specific item
on gender balance on the agenda of
the Full Executive Committee
Meeting in Buenos Aires in October
2006.
voluntary reporting, creating an environment of safety, protected
confidentiality, a system for comprehensive analysis of errors to identify
actions that would minimize the risk that reported events recur, the sharing
of patient safety information among healthcare organisations and fostering
confidential collaboration with other healthcare reporting systems.
However, the challenge to many practitioners in developing areas of the
world where systems and organisational structures do not exist for such
programmes is “how do I ensure the safety and optimal care of my
patients”. We need to continually ask ourselves, “Am I doing the best I can
for my patient, using the best available evidence and most effective
measures at my disposal, and am I being honest about what I can and
cannot do.”
Professor Bruce Sparks
President
World Organization of Family Doctors
FEATURE STORIES
WORKING PARTY SEEKS TO ENHANCE ROLE OF
WOMEN FAMILY DOCTORS IN WONCA AND HEALTH
SYSTEMS
Increasing numbers of women are entering family medicine and general
practice around the world. In some countries (for instance, Russia or the
Philippines) women became the major providers of general practice and
family medicine during the 20th century; in some (e.g., Canada and the
United States), women have increased in numbers recently; and in others
(parts of Asia, Africa and the Middle East) still only a few women are family
physicians. Although women family physicians play an increasing role in
both developing and developed countries, they frequently face societal,
cultural and institutional barriers, including limitations on their scope of
practice.
FROM THE EDITOR:
EXAMINING THE ROLES
OF WOMEN FAMILY
DOCTORS
This issue of Wonca News
contains the first of a series of six
significant articles to be published
by the Wonca Working Party on
Women and Family Medicine
(WWPWFM) examining the role of
women physicians and family
doctors in Wonca and throughout
the world. The articles are excepted
from a monograph coauthored by
WWPWFM Chair Cheryl Levitt, Lucy
Candib, Barbara Lent, and Michelle
Howard. The first article, published
in this issue, examines the role of
women in organized medicine.
Subsequent articles will examine
women in training, practice and
academia, as well as women
physicians caring for patients and
themselves.
WONCA
News
FROM THE CEO’S DESK / FROM THE EDITOR / FEATURE STORES
4
Members of the WWPWFM are
currently holding extensive
discussions among themselves on
how best to correct the gender
imbalance in Wonca. The Working
Party will shortly be submitting a
set of recommendations to Wonca
Executive for its consideration. This
will hopefully in time lead to
changes in the Wonca Bylaws and
Regulations that will promote
gender equity.
The process may be a long one
but then any journey must start with
the first step.
Dr Alfred Loh
Chief Executive Officer
World Organization of Family
Doctors
In their introduction to this important series, the authors state that,
when the role of women family doctors is optimized in all of these settings,
then the health of the people are optimized. Readers are encouraged to
contribute their knowledge and perspectives to the coauthors in the
WWPWFM, particularly from Wonca member organizations where published
information on the role of women family doctors is limited.
This issue also reports on relevant news to Wonca Member Organizations
and Direct Members regarding the World Health Organization. Wonca
Executive member, Michael Kidd, reports on the 58th World Health Assembly
in Geneva, Switzerland. The World Health Report 2006: Working Together for
Health is reviewed in the Resources for the Family Doctor section. The vital
global work of the WHO took second stage as Wonca joined many
organizations around the world in mourning the sudden death of WHO
Director General, LEE Jong-wook, also reported in this issue.
Finally, this issue reports on the upcoming World Rural Health Conference
and Wonca Regional Conferences in Florence, Buenos Aires and Bangkok
which are rapidly approaching. As we move towards the final year of the
Triennium leading up to the Wonca World Conference in Singapore in July,
2007, I welcome reports from Wonca’s Working Parties, Task Forces and
Special Interest Groups and Member Organizations that examine and
promote the role of Wonca and its family doctors around the 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)
WONCA
News
FEATURE STORIES
The health of a population depends, among other
things, on the ability of the healthcare workforce to
deliver the best possible care. Barriers preventing
women physicians from meeting their full potential
occur in training, in practice, in organizational medicine
and in academia. When women form a part of the
workforce but are limited in how they contribute, the
whole society loses out. All medical organizations
around the world that are committed to the highest
quality family medicine should endeavour to remove
institutionalized gender barriers that limit the full
participation and contribution of women members.
Women physicians’ enormous contributions to the
profession have benefited both physicians and their
communities. They bring a variety of life experiences,
work in many different practice settings, both urban and
rural, and participate in academic and medical
organizations. Women physicians have been leaders in
advocating for all aspects of women’s health: for
appropriate use of power within the doctor-patient
relationship, for research in areas of importance to
women, for reproductive health and choice, and for
recognizing the importance of gender as a determinant
of health for both men and women. Women integrate an
understanding of women’s lives into their professional
work. They have been leaders in stressing the
importance of a balance between career and family - an
issue that is of importance to both men and women in
medicine. Women physicians have highlighted the need
for enhanced interpersonal skills for all practitioners,
including non-hierarchical relationships with patients
and peers.
From R to L - Cheryl Levitt, Barbara Lent, Lucy Candib, meeting at
Langdon Hall in Ontario, Canada, in February 2002 to develop the
Working Document on Women and Family Medicine
Wonca provides a forum for exchange of knowledge
and information between member organizations of
general practitioners/family physicians. Wonca also
5
represents the interests and promotes the educational,
research and service activities of general practitioners/
family physicians at other world organizations
concerned with health and medical care. Decisions
adopted by Wonca have a large symbolic and potentially
practical influence on family medicine and general
practice in all parts of the world. Wonca formally
endorsed the Beijing Declaration and Platform for Action
from the Fourth World Conference on Women in 2001
and 2002, with its far reaching vision of women’s rights
to all aspects of health including reproductive freedom.
Women family physicians have worked within the Wonca
member organizations around the world to develop
approaches to the systematic discrimination against
women and to promote the full development and
wellbeing of women as patients and doctors. Initially
informally, and later formally, women physicians have
organized working parties, standing committees, and
sometimes separate organizations, nationally and
internationally, to address cultural and structural barriers
to their full professional development, and to working
with and on behalf of their patients. At the 16th
International Conference of Wonca in Durban, in 2001, a
group of women participants established the Wonca
Working Party for Women and Family Medicine
(WWPWFM).
As one of the activities of the WWPWFM, we
undertook an international literature review to collect
evidence, documentation, reports, and media coverage
about the barriers facing women family physicians. We
developed a monograph to provide this material in a
variety of formats, including a point-form summary, a
narrative descriptive report and an annotated
bibliography, all available on our website at
www.womenandfamilymedicine.com. Briefly the chapters
are:
Women in Organizational Medicine-Covers issues of
under-representation of women and barriers,
importance of women’s contributions, and examples
of women’s caucuses and projects.
Women Family Physicians In The Doctor-Patient
Relationship-Discusses women’s practice patterns,
the medical encounter, communication style, patient
satisfaction, gender differences in activity levels, and
a feminist perspective of the medical encounter.
Women Family Doctors Caring For Themselves And
Their Families-Discusses physical and mental health,
stress and burnout, depression and substance
abuse, and the need for flexible practice for women.
WONCA
News
FEATURE STORIES
6
Women In Training (Medical School And Post-
Graduate Training)-Covers issues of gender and
racial/cultural discrimination, sexual harassment,
decisions about marriage and parenting, choice of
specialty and gender bias in medical education.
Women In Practice-Covering issues of sexual
stereotypes in practice, personal and professional
role pressures, attitudes, policies and practices
pertaining to women physicians, sexual orientation,
challenges in rural practice, and relationships with
nurses.
Women In Academia-Covering issues of promotion
and tenure, gender differences in compensation,
gender bias in competitive evaluations, role models
and mentorship, research career and tokenism.
Not surprisingly, culture, language and geographic
origin limit the scope of the literature. The experiences
of women physicians from many parts of the world have
not yet reached the published international literature. In
other regions, some of the literature reflects educational
and practice environments that have subsequently
undergone significant change. The world of women
family physicians is in a period of rapid transition.
Thus, the monograph is a ‘work-in-progress’. We hope
to keep it updated by the international literature and by
the ongoing research being undertaken by the
WWPWFM.
This monograph will be summarized in a series of six
articles that will be published by Wonca News over the
next year, beginning with this June issue’s summary of
the chapter entitled, Women in Organizational Medicine.
We encourage readers to write to us with comments
and suggestions. Readers can find further information
about the WWPWFM at the group’s website at
www.womenandfamilymedicine.com, where we post the
group’s Working Document and descriptions of other
activities and reports. We encourage those interested in
subscribing to the listserve to send a message to
Dr. Lucy Candib, the listserve coordinator at
lcandib@massmed.org.
Cheryl Levitt MBBCh
Lucy Candib MD
Barbara Lent MD
Michelle Howard MSc
Wonca Working Party on Women and Family Medicine
Working Party Releases First of a Series: Women
in Organizational Medicine
Although the number of women doctors in family
medicine is increasing, many women continue to face
major barriers at the personal, professional and
structural levels limiting their full participation in
organizational leadership and reducing their impact on
clinical, organizational and social policies. Innovative
strategies to promote equitable participation of women
in leadership positions would result in a strengthened
family medicine workforce
This article on women in organizational medicine
represents a summary of our review of the reported
experiences from peer reviewed and grey literature
(unpublished reports and news-items mostly found on
the internet) of authors from Western and English-
speaking countries and ideas shared with women from
the Caribbean and Europe. Further details, including an
annotated bibliography can be found at
www.womenandfamilymedicine.com.
Women often have a distinct style of practicing
medicine that is likely to carry over to their involvement
in organizational medicine as well. Although, at times,
women face restrictions in their scope of practice, they
also contribute substantially to clinical care by their
particular focus on the health issues facing women and
children. Women physicians have been leaders in
advocating for improved women’s health, safety and
reproductive rights internationally. When they are in
positions of power in public office, they bring more
attention to the issues of women and children. Women
physicians are more likely to practice obstetrics,
preventative care, and counseling than men. They are
also more likely to do research in women’s health and
to draw attention to health issues affecting women and
children. These contributions can potentially be even
greater in less developed countries where women and
girls are more disadvantaged in society.
A primary reason for the disparity between the
involvement of men and women in organizational
medicine is the pressure of balancing career and family
responsibilities, as well as traditional gender imbalances
in domestic and child-rearing responsibilities. Women
report difficulties in taking on the extra responsibilities
involved in being a part of a medical organization, while
maintaining their home lives as well. For instance, most
organizational meetings take place after hours, further
extending the workday and conflicting with women’s
involvement with their children’s lives. Often women in
leadership positions strive to develop policy around
lifestyle and balance beneficial to all individuals.
Lack of mentoring and opportunities for skills
development are often cited as barriers to women’s
involvement in leadership in Western and English-
speaking countries. In the last decade, several medical
organizations in Canada and the United States have
developed specific leadership programs for junior, mid-
career and executive women, while other organizations
have made deliberate efforts to encourage senior
women physicians to mentor more junior women.
Women physicians in senior positions in academic,
clinical and research organizations are important role
models for women medical students and residents, and
can highlight medical leadership as a valuable career
path. Medical organizations need to ensure that their
leadership represents the needs of the members and
reflects inclusive interpersonal styles, so that women
will make a professional commitment to participate in
this important arena.
Organizational bodies need to take responsibility to
ensure equitable representation. Policies and
procedures, bylaws and structures should all be
examined to identify the barriers to women’s
participation and revised to ensure and monitor
equitable participation. Women entering organized
medicine have encountered informal hurdles,
discrimination and sexism resulting in a failure to be
included and/or welcomed into organizational medicine.
This ‘old boy’s network’ mentality can be extremely
destructive and counterproductive. Appointment of a
few isolated women to formal committee positions is
often viewed as a gesture of ‘tokenism’, where women’s
inclusion fulfills appearances of gender equality in
representation but does not recognize or encourage
their distinct and full contributions. Organizations can
undertake to expunge these discriminatory behaviors
through a culture of open and safe discussion,
avoidance of tokenism and through the active
promotion of inclusive and protective policies and
practices.
A preoccupation about the image of the profession
may limit the advancement of women. Some physicians
have expressed concern that if women become visible in
organizational leadership, society might view the whole
profession as “women’s work”, resulting in a loss of
prestige, income and authority. Instead, the increasing
numbers of women in medicine, including family
medicine, offer an opportunity both to draw from a
wider pool of candidates and to bring women’s
strengths to medicine, rather than serving as a problem
for the practice of medicine. As well, women have
significant potential to improve rather than diminish the
image of the profession by demystifying medical skills
and knowledge and practicing in a more collaborative
and less hierarchical manner.
In some countries, although no published English
literature documents the status of women in
organizational leadership, we know anecdotally that
disciplines dominated by women, like family medicine,
have lower perceived status than other specialties. For
example in Latvia, nearly all family physicians are
women; in some South American countries, women
dominate family and community medicine. In contrast,
in the Caribbean, while women family physicians are
prominent in family and community medicine, they still
feel valued and powerful in relation to men and each
other. Caribbean women physicians strongly advocate
for women’s and children’s health and social justice for
the marginalized. They feel an advantage in being
perceived as similar to nurses in their emphasis on
caring. Nevertheless, they acknowledge tensions
between men and women regarding access to powerful
positions.
In many countries, women physicians established
their own medical organizations to serve as their voice.
The Medical Women’s International Association (MWIA)
is an association of medical women representing women
doctors from 70 countries in all five continents. Formed
in 1919, when women were hardly a presence in
medicine, the MIWA still today actively pursues its
goals: to promote the cooperation of medical women in
different countries and to work against gender-related
inequities in the medical profession including bias in
career development and financial rewards. The MWIA
website [http://www.mwia.net/] lists a number of
countries with medical women’s associations active in
addressing these concerns.
Around the world, leaders in organizational medicine
are becoming increasingly aware that the promotion of
equity and gender will have profound benefits to all.
Both men and women of good conscience have
advocated for promoting more inclusive organizations.
In some countries, conventional medical associations,
universities and colleges have established committees
to begin to address the challenges of gender and equity.
In 2002, a group of women within Wonca established
the Wonca Working Party on Women and Family
Medicine (WWPWFM) to work through Wonca to improve
the health of women by enabling family doctors
worldwide to meet their full potential as health care
providers to their communities. The WWPWFM is
determined to remove institutionalized gender barriers,
WONCA
News
FEATURE STORIES
7
WONCA REGIONAL NEWS
WONCA EUROPE REGION TO CONVENE IN FLORENCE -
AUGUST 27-30
It is our pleasure to invite you to the 12th Wonca Europe Regional
Conference that will be held i
