From the Wonca President:
An Ancient Disease: A New Global Threat?
From the CEO’s Desk
:
Highlights from the Buenos Aires
2
3
5
Wonca Executive Meeting
From the Editor
:
Family Doctors Gather and Look Forward
to Singapore
FEATURE STORIES
6
•Wonca 7th Rural Health Conference a Success
•Register and Submit Abstracts Online for Wonca World 2007 in
Singapore
•Historic Wonca Working Party on Women and Family Medicine
Meeting Held in Hamilton
Wonca REGIONAL NEWS
9
•Three Year FaMEC Africa Project Initiated During Kampala Uganda
Meeting
HEALTH AND HEALTH SYSTEM NEWS
11
•Primary Care in the USA Contributes to Health and Health System
Improvement
•Women Family Doctors and the Doctor-Patient Relationship
MEMBER AND ORGANIZATIONAL NEWS
15
•Wonca Approves Six New Member Organization Applications
•The College of Family Physicians of Canada Holds Summit
RESOURCES FOR THE FAMILY DOCTOR
16
•Improving Health Systems: the Contribution of Family Medicine – The
Wonca-WHO Guidebook
•Faculty Development Program at the University of Toronto
WONCA CONFERENCES 2006-2011 AT A GLANCE
18
GLOBAL MEETINGS FOR THE FAMILY DOCTOR
19
VOLUME 32
NUMBER 5
OCTOBER 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, North America
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:
AN ANCIENT DISEASE: A
NEW GLOBAL THREAT?
“The drug resistance that we are
seeing now is without doubt the
most alarming TB situation on the
continent since World War II, and
our message to European Union
leaders is: Wake up. Do not delay.”
Markuu Niskala
Secretary-General
International Federation of Red
Cross and Red Crescent Societies
October 2006
The infective agent appears to
have been around since before man
evolved on earth. Its clinical
expression became a scourge in
Europe as the disease reached
epidemic proportions when the
crowded cities of the Middle Ages
and later the industrial revolution
provided the environment for its
spread. It was spread to ‘the
colonies’ by European empire
building and colonisation. It was
late in coming to the Pacific Islands
and Africa. In 1882, Robert Koch
identified the organism as the
bacillus responsible for tuberculosis.
Now it is the killer of millions
annually in the African continent,
made worse by its deadly close
cohabitation in individuals infected
by the HIV virus. But now, like a
pendulum that has just paused at
the end of its periodic swing, it
appears about to swing back with a
vengeance in the developed
industrial countries where is began.
It is a new phase in the evolution of
bacillus that could change the
nature and burden of disease in
family doctors’ practices globally.
This was highlighted for me in a
few weeks ago when I attended an
urgent meeting in Johannesburg on
WONCA
News
FROM THE WONCA PRESIDENT
2
XDR-TB, the abbreviation for
extensively (or extremely) drug-
resistant tuberculosis. A few days
before that, there had been an
emergency summit in Johannesburg
attended by WHO, CDC, other global
health agencies and health
ministries in the African sub-
continent to discuss an emerging
threat to the region. Data presented
at the XVI International AIDS
Conference in Toronto had indicated
the high mortality associated with
XDR-TB - of 536 patients with TB in
a rural district in KwaZulu Natal,
South Africa, 221 had Multi-drug-
resistant TB (MDR-TB), and 53 of
these were defined as XDR-TB, 43 of
whom were co-infected with HIV.
The tragedy was that 52 of these 53
patients had died. Since then XDR-
TB has been isolated in 28 hospitals
in South Africa.
MDR-TB, defined as resistance to
at least isoniazid and rifampicin,
requires the use of second-line
drugs that are less effective, more
expensive, and more toxic than first-
line regimens based on isoniazid
and rifampicin. Recognised earlier
this year, XDR-TB is MDR-TB that is
also resistant to three or more of
the six classes of second-line drugs.
Of 17,690 TB isolates taken
internationally between 2000 and
2004, 20% were MDR and 2% were
XDR. XDR-TB has now been
identified in all regions of the world
but is most prevalent in Asia and in
Eastern Europe. Since WHO
guidelines recommend the use of at
least four drugs for those with MDR-
TB, XDR-TB is untreatable to
international standards.
How much of a threat is it to
Europe and other developed
countries? MDR-TB in itself is a
major problem. “Drug-resistant
strains of the disease are lurking
just beyond the European Union’s
borders, in countries where AIDS
blossomed following the collapse of
the Soviet Union”, say U.N. and Red
Cross health officials. Of the 20
countries in the world with the
highest rates of multi-drug resistant
tuberculosis, 14 are in “the
European region,” according to a
recent global survey by the WHO
and the U.S. Centers for Disease
Control and Prevention. In Europe,
50 people get sick with TB and
eight people die of the disease
every hour, reports Pierpaolo de
Colombani, a WHO tuberculosis
expert.
Recent reports from the CDC and
WHO on data from 2000-2004
indicate that of MDR-TB cases 19%
in Latvia, 15% in South Korea and
4% in USA, met the criteria for XDR-
TB. In industrial countries, including
USA, the rate of XDR-TB has risen
form 3% to 11% of MDR-TB in the 5
year period. It is suggested that
failure to act now to contain the
threat posed by XDR-TB will have
devastating consequences for
patients with TB, particularly those
co-infected with HIV/AIDS.
The are many contributing
factors to the development of MDR-
TB and XDR-TB, including delayed
diagnosis; inadequate investigation
and poor management; shortage of
drugs; poor compliance by patients;
poor understanding of the gravity of
the condition by patients, families
and communities; failure of the
elements of the DOTS (Directly
Observed Treatment Short Course)
programmes; and poor monitoring,
follow-up and surveillance.
Primary care doctors globally,
especially those working in
community clinics and hospital-
based ambulatory services are to be
encouraged to exercise extra
diligence and care in TB
management. International travel
has made the problem a reality for
all primary care practitioners, who
should maintain a watchful vigilance
for possible TB patients.
WONCA
News
FROM THE WONCA PRESIDENT / FROM THE CEO’S DESK
3
FROM THE CEO’S DESK:
HIGHLIGHTS FROM THE
BUENOS AIRES WONCA
EXECUTIVE MEETING
The Wonca Executive met for
two-and-half days in Buenos Aires
from Sunday, 8
th
Oct to Tuesday,
10
th
Oct 2006 in conjunction with
the of the Iberoamericana-CIMF
Regional Conference.
This First-ever Wonca
Iberoamericana-CIMF Regional
Conference was successfully held at
the Sheraton Hotel and Convention
Centre in the district of San Martin,
Buenos Aires, Argentina. The
Conference was hosted by the
Argentine Federation of Family and
General Medicine from 11
th
– 14
th
November 2006. There were over
2000 registrants for the Conference
with a vast majority of delegates
from the Region itself. Over 1000
paper submissions were received by
the Host Organizing Committee for
There is also a major role for
University departments of family
medicine, Colleges and Academies
to offer training and refresher
courses, and assistance with audit
and quality assurance programmes.
There should be special emphasis
on prevention, early detection,
diagnosis and appropriate
treatment, monitoring, contact
tracing and follow-up. Those who do
not respond to treatment must be
adequately investigated for
resistance and managed
appropriately. Support for patients
and family members is of
paramount importance especially
when patients with XDR-TB are
‘incarcerated’ in isolation facilities
for long periods of time. Of concern
to me is that such long term
admissions could have inhibitory
effects on self-reporting by patients
with undiagnosed TB. Illegal
immigrants face a particular problem
when presenting for care, since once
they enter the health care system
their anonymity is not guaranteed,
and expulsion of them and their
families is more likely.
I encourage all member
organisations and individual
members of Wonca to heed the call
to be vigilant and assist in the
global programmes being developed
and disseminated over the next few
months. This is a serious threat.
MDR-TB has become a daily
consideration for us working in
Africa. In the early 90’s we were
faced with the beginnings of MDR-
TB which has now reached
pandemic proportions. When will
XDR-TB reach a similar global
coverage?
A useful website for frequently
asked questions about XDR-TB is:
http://www.who.int/tb/xdr/faqs/en/
index.html To read the entireReport
from the Expert Consultation on
Drug-Resistant Tuberculosis, go to:
http://www.who.int/tb/xdr/
johannesburg_report/en/index.html
Paul Sommerfeld of TB Alert, has
said: “XDR-TB is very serious - we
are potentially getting close to a
bacteria that we have no tools, no
weapons against. What this means
for the people in southern Africa,
who are now becoming susceptible
to this where it is appearing, is a
likely death sentence. For the world
as a whole it is potentially
extremely worrying that this kind of
resistance is appearing.”
Professor Bruce Sparks
President
World Organization of Family
Doctors
presentation. The Argentine Minister
of Health graced the opening of the
Conference followed by a special
Plenary Lecture by Dr Barbara
Starfield.
The attendances at the plenary
and workshop sessions were very
good and demonstrated the degree
on interest and commitment to
health system improvement, quality
practice, research and continuing
education by the family doctors of
the Region.
The agenda for this Executive
Meeting was, as was in the case
with past Executive Meetings, very
full. But the new approach in the
organizing of the Agenda Items and
Papers allowed Executive to
navigate through the agenda with
sufficient time to deliberate
adequately on the key issues. I will
highlight some of the interesting
and key issues below
Wonca Africa Region
Wonca Executive welcomed Prof
Khaya Mfenyana, the newly elected
Regional President for Wonca Africa,
to his first Executive Meeting. Prof
Mfenyana assumed office in May
2006 after the resignation of Dr
Abra Fransch. In his report, Prof
Mfenyana highlighted the many
existing challenges facing his Region
in terms of the distances between
members and member organizations
and the existing communication
difficulties and scarcity of resources.
Despite these difficulties, he was
pleased to report on the FaMEC
(Family Medicine Educational
Consortium ) Meeting that had
recently taken place on 15
th
– 16
th
June 2006 in Kampala, Uganda
which resulted in the inauguration
of the FaMEC Africa Project would
last for three years to April 2009.
The aim of the project is to
contribute to the health of
WONCA
News
FROM THE CEO’S DESK
4
communities through assessable,
responsive and quality health care
systems in Eastern and Southern
Africa with the education and
training of family doctors. The
overall academic objective would
be the planning, development
and strengthening of academic
departments or units of family
medicine that offer structured
training at undergraduate,
postgraduate and continuing
professional development levels.
Wonca North America Region
Wonca Executive approved the
new name of the Wonca North
America Region to replace the
Wonca Americas Region to better
reflect the region that now has
member organizations from the
United States, Canada and the non-
Spanish speaking Caribbean Islands.
The newly named Wonca North
America Region will also help
distinguish this region from the
recently established sixth Wonca
region, Iberoamericana-CIMF, which
includes member organizations from
Central and South America.
Wonca Middle East and South
Asia (MESA) Regions
There has been a rapid increase
in the interest to join Wonca by
family medicine organizations in the
countries of the Middle East these
past months. This has led to the
possibility that a new Wonca Middle
East Arab Region may be formed
out of the MESA Region. Current
Wonca members are from Bahrain,
Iraq, Jordan, Lebanon, Saudi Arabia
and the United Arab Emirates.
Executive discussed this exciting
development and felt that the new
region could be formed if there are
eight or more member organi-
zations to make up the new region.
There is currently an expression
of interest by a family medicine
organization in Egypt and if this is
approved, there will be only one
more member organization needed
to initiate the formation of the new
and Seventh Wonca Region.
Five New Wonca Member
Organizations Admitted
At this Executive Meeting, the
following were admitted as
members of Wonca subject to
some having to fulfill certain
required admission criteria:
1.Section of Teachers and Section
of Researchers, College of
Family Physicians, Canada –
admitted to Associate
Membership
2.Nicaraguan Association of Family
Medicine – admitted to Full
Membership.
3.Cuban Society of Family
Medicine – admitted to Full
Membership.
4.Romanian National Center for
Studies in Family Medicine –
admitted to Associate
Membership.
5.Serbia Medical Association,
Section of General Practice –
admitted to Full Membership.
The admission of the above
organizations would bring the total
Wonca Membership to 112
organizations (including 10
Organizations in Collaborative
Relations) in 93 countries globally.
Wonca Website
(www.Globalfamilydoctor.com)
This item was discussed at
great length by Executive. The
consensus was that the website
would play a key role in the
broader strategic plan of Wonca in
the future.
Executive also felt the need to
make Wonca more relevant to its
member organizations by putting
website information on the local
markets through encouraging
translations to the languages
dominant in each Wonca Region
(eg, Spanish for the Iberoamericana-
CIMF Region).
Executive also accepted the
plans for the hand-over of office of
GFD Chief Medical Editor from Prof
Wes Fabb to Dr Jim Vause. This will
be formally done at the Wonca
World Council in Singapore in July
2007
Timing of World and Regional
Conference in the Same Year
The issue of how best to time
the interval between a Wonca World
Conference and a Regional
Conference in the same year has
been discussed in several past
Wonca Executive Meetings. Prof
Igor Svab, the Regional President for
Wonca Europe was tasked at the
Kyoto Executive Meeting in 2005 to
study this issue in consultation with
the other Regional Presidents and
the CEO.
At this Executive Meeting, Prof
Svab’s recommendation that there
be an interval period of at least four
months between a World Conference
and a Regional Conference was
accepted. It was also agreed by
Executive that the World Conference
will have priority in setting its date
which will be informed to the CEO
who will in turn ensure that the
Regional Conference be held at least
four months earlier or later.
Gender Equity
Wonca Executive studied and
had extensive discussions on the
submissions of the Wonca Working
WONCA
News
FROM THE CEO’S DESK / FROM THE EDITOR
5
FROM THE EDITOR:
FAMILY DOCTORS GATHER AND LOOK FORWARD TO
SINGAPORE
This issue of Wonca News reports on important gatherings of Wonca’s
Regions, Working Parties and Member Organizations in the year leading up
to the 18
th
Wonca World Conference in Singapore from July 24-27, 2007.
In June, family doctors from the College of Family Physicians of Canada
gathered at Niagara Falls, Ontario to better understand the evolution of our
discipline and make their organization more relevant and meaningful. In
August, the Wonca Working Party on Women and Family Medicine hosted
family doctors from 16 countries at McMaster University in Hamilton,
Ontario, Canada to further their discussions and activities on gender issues
affecting physicians and patients.
In September, the Wonca Working Party on Rural Health hosted family
doctors from 20 countries at the 7
th
Wonca World Rural Health Conference in
Seattle, Washington and a post-conference in Alaska. In October, the Wonca
World Executive met in Buenos Aires, Argentina, site of the first Wonca
Iberoamericana-CIMF Regional Conference in the days that followed. In this
issue, Wonca CEO Dr Alfred Loh reports on the highlights of the Wonca
World Executive meeting in Buenos Aires.
Subsequent issues of Wonca News will report on recent and upcoming
important family doctor gatherings at Wonca Regional Conferences for
Wonca Europe held in Florence, Italy; for Wonca Asia-Pacific held in
Bangkok, Thailand; and for Wonca Iberoamericana-CIMF held in Buenos
Aires, Argentina.
These and many other family doctor gatherings crescendo towards the
triennial meeting of all meetings – the 18
th
Wonca World Conference in
Singapore. This issue reports that online registration is open at
www.Wonca2007.com and the deadline for submitting abstracts is
December 31, 2006. Look forward to seeing you in Singapore!
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)
Party on Women and Family
Medicine (WWPWFM) and The
Hamilton Equity Recommendations
(HER) Statement that was issued
following the WWPWFM meeting in
Hamilton, Ontario. Executive was
very appreciative of the efforts of
the WWPWFM to foster gender
equity in Wonca and supported the
principles enunciated in the (HER)
Statement. Wonca Executive will
work with WWPWFM to promote
gender equity through all Wonca
activities including Bylaws changes
where appropriate.
Special Interest Group to
Working Party
The submission by the Wonca
Special Interest Group on Psychiatry
and Neurology to have its status
changed to that of a working party
was accepted by Wonca Executive at
this meeting. Executive was
impressed with the amount of work
done by the SIG in the short span of
three years and with its
collaboration with the Mental Health
Division of WHO.
In the conversion to a Wonca
Working Party, Executive felt it best
to have the new entity called The
Wonca Working Party on Mental
Health. We congratulate all
participants of the SIG who now go
on to be members of the new
Wonca Working Party.
Dr Alfred Loh
Chief Executive Officer
World Organization of Family
Doctors
WONCA
News
FEATURE STORIES
6
FEATURE STORIES
WONCA 7TH RURAL
HEALTH CONFERENCE
A SUCCESS
The 7
th
Wonca World Rural Health
Conference was held in Seattle,
Washington, USA from September
8-13, 2006, and a post-conference
was held in Anchorage and
Talkeetna, Alaska, USA from
September 14-16. The Seattle
portion of the conference was
divided into a section on education,
policy and research for rural practice
and a second section of continuing
medical education for clinical
aspects of rural practice.
Since Seattle and the University
of Washington School of Medicine
are the home of the WWAMI medical
education program (WWAMI stands
for Washington, Wyoming, Alaska,
Montana, Idaho), we established the
conference theme of “Transforming
Rural Practice Through Education”.
Over 200 family physicians from
more than 20 countries attended
the Seattle meetings, and 40 of the
physicians went on to the Alaska
sessions.
Sessions were held on the campus of the
University of Washington attended by over
200 rural family physicians from over 20
countries
The Seattle meetings were held
on the campus of the University of
Washington School of medicine. In
keeping with the cultural themes of
prior Rural Wonca meetings, the
opening ceremonies included
traditional dances by Native
Americans and a ceremonial
blessing by a Native elder.
Yakima Native American Dance Club members
performing traditional dances during the
opening session
Three sets of plenary sessions
were presented, with each session
focusing on a specific theme. The
opening plenary was oriented
toward overarching issues that
impact rural family medicine.
Speakers and topics included the
following:
•“Building Rural Systems of Care”
by Mary Selecky – Secretary of
Health, Washington State
Department of Health
•“Impact of Violence and Social
Turmoil on Rural Health” by
Steve Gloyd, MD, Director of
International Health Program,
University of Washington
•“The Global Initiatives in Rural
Health – What is the Role of
Family Physicians?” by James
Litch, MD, DTMH, Maternal,
Newborn and Child Health
Specialist, PATH
•“Impact of Social and Economic
Disparities on the Health of Rural
Populations” by Victor Inem,
MBBS, MPh, College of Medicine,
University of Lagos, Nigeria
Plenary sessions for the next two
days focused on addressing
worldwide shortages of rural family
physicians and creating new, rurally
leaning medical schools:
•“Attracting Future Rural
Practitioners to Health Care: The
Experience on Two Continents”
by Roger Strasser, MD, Northern
Ontario Medical School
•“The Disturbing Evidence From
the U.S.” by Robert Bowman,
MD, University of Nebraska
•“An African Perspective” by Ian
Couper, MD, University of
Witwatersrand, South Africa
•“The European Story – Networks”
by Christos Lionis, MD,
Department of Social Medicine,
University of Crete
•“The Asian Experience” by
Fortunato Cristobal, MD,
Zamboanga Medical School,
Phillipines
•“The Australian Experience” by
Paul Worley, MBBS, Flinders
University Rural Clinical School,
Adelaide, Australia
•“The Canadian Experience” by
James Rourke, MD, Dean of
Medicine Memorial University of
Newfoundland, Canada
Slides from the plenary sessions
will be posted on the conference
website within the next month for
those who are interested in these
topics.
A highlight of the meeting was
the conference banquet that was
held on an island in Puget Sound.
Guests traveled by boat to the
dinner for a traditional northwest
native meal of salmon and fresh
vegetables. The view of the Seattle
skyline from the boat was
impressive.
Seattle skyline as seen by the rural Wonca
banquet guests
Following the policy, education,
and research portion of the
WONCA
News
FEATURE STORIES
7
conference, the guests attended two
days of clinical continuing medical
education as part of the 36
th
annual
Family Practice Update at the
University of Washington. At the
conclusion of the CME program,
forty physicians and guests traveled
to Alaska for an outstanding “post-
conference” that included tours of
the Alaska Native Medical Center,
the Sunshine Clinic (a rural
community health center), and a
stay at the Talkeetna Lodge, near
Denali National Park. Activities
included enjoying the scenery and
jetboat tours on the Susitna River.
Denali National Park
Overall, the meetings were
successful and were enjoyed by the
rural family doctors who attended.
Tom E. Norris, MD
Chair, Host Organizing Committee
Wonca 7
th
Rural Health Conference
tnorris@u.washington.edu
Register and Submit Abstracts
Online for Wonca World 2007
in Singapore
Singapore beckons! As we gear
up in our preparations for the 18
th
Wonca World Conference from 24-27
July, 2007, Singapore promises a
host of exciting attractions and
activities. Besides getting updates
on the latest advances that
genomics and biomedical sciences
have to offer, the scientific program
also promises a whole new
paradigm in delivery of lectures and
plenary sessions.
The deadline for submitting
abstracts is December 31, 2006.
Please submit your abstracts online
at www.Wonca2007.com Also,
please register for the online at
www.Wonca2007.com.
Officially opened on 30 August
1995, Suntec Singapore is a world-
renowned, international venue that
has the perfect location for
meetings, conventions and
exhibitions. Suntec Singapore is
situated in the Central Business
District, only 20 minutes’ drive from
Changi International Airport. Suntec
Singapore is in the heart of a self-
contained, totally integrated events
infrastructure. In addition to its
first-class facilities, Suntec
Singapore offers direct access to
5,200 hotel rooms, 1,000 retail
stores, 300 restaurants and the
region’s new centre for the
performing arts, Esplanade –
Theatres on the Bay.
The medical technology
exhibition will also provide a unique
business matching opportunity for
all family physicians and medical
groups wanting to scale up their
practice profiles and offer an
improved and vastly increased range
of point of care testing services for
their patients.
In addition to work and
academic schedules, the organizing
committee also promises to host a
dazzling array of social programs for
your partners and family members.
Thinking of bringing along your
loved ones? Fret not, as arrange-
ments have been made for the more
than 100 nurseries and child care
centers to take care of your kids
daily so that you can attend all of
our programs and social activities
with complete freedom from worries
of caring for the needs of your
young ones.
Shop till you drop, feast on
some of the greatest culinary
delights as well as attend world
class performances at our latest
state of the art architectural marvel,
the Esplanade. You will never have a
dull moment in Singapore, the city
that never sleeps!
So, stay tuned and make a date
with Singapore for the Wonca 2007
World Conference, 24 to 27 July
2007!
Dr Tan See Leng
Chairman
Host Organizing Committee
Wonca World Conference 2007
Email: contact@cfps.org.sg
Website: www.wonca2007.com
Historic Wonca Working Party
on Women and Family Medicine
Meeting Held in Hamilton
Members of the Wonca Working
Party on Women and Family
Medicine (WWPWFM) met in August
2006 at McMaster University in
Hamilton, Ontario, Canada to further
their discussions and activities on
gender issues affecting both
physicians and patients. The 25
participants came from 16 different
countries (Antigua and Barbuda,
Australia, Austria, Canada, Colombia,
Ecuador, Nepal, Nigeria, Netherlands
Antilles, Pakistan, Philippines, Sri
Lanka, Thailand, Uganda, United
States of America, and Venezuela),
representing all six Wonca regions.
The group included two university
vice-chancellors, a dean of a Faculty
of Health Science, current and
former associate deans, chairs of
departments of family medicine,
presidents of local organizations
and associations, as well as authors
of several books on aspects of
family medicine, all of whom
WONCA
News
FEATURE STORIES
8
brought a wealth of clinical, academic, research and
organizational experience.
The meeting was supported by generous grants
from Wonca, McMaster University, the American
Academy of Family Physicians, the College of Family
Physicians of Canada, the Royal College of General
Practitioners (UK) and a number of academic
departments of family medicine in the United States
and Canada. During this remarkable four-day
gathering, the participants thrived in the camaraderie
and collegiality, as well as the wonderful hospitality
of the group’s chair, Dr. Cheryl Levitt.
The 25 women family doctors at McMaster University in Hamilton
Ontario:
Fourth Row: Susana Alvear, Ecuador; Anne D Atai-Omoruto, Republic
of Uganda; Flor Ledesma, Venezuela; Zorayda Leopando,
Philippines;
Third Row: Jan Coles, Australia; Dorothy Pietersz-Janga, Neth.
Antilles; Liliana Arias-Castillo, Colombia; Ilse Hellemann, Austria;
Sue Smith, Nepal; Marlene Joseph, Antigua and Barbuda; Kymm
Feldman, Canada;
Second Row: Cheryl Levitt, Canada; Lucy Candib, USA; May Cohen,
Canada; Michelle Howard, Canada; Barbara Lent, Canada; Sheila
Dunn, Canada; Kate Anteyi, Nigeria;
First Row: Sarah Strasser, Canada; Betsy Garrett, USA; Ruth Stewart,
Australia; Linda French, USA; Marie Andrades, Pakistan; Somjit
Prueksaritanond, Thailand; Nandani de Silva, Sri Lanka
The participants reviewed Wonca’s previous
endorsements of both the Beijing Platform for Action
and the Millennium Development Goals in 2001.
These documents recognize that the elimination of
gender inequality (as well as other violations of
universal human rights) is an important prerequisite
for human development, including the improvement
and achievement of optimal health. The support for
these documents as well as the formal recognition of
the group as an official Wonca Working Party provide
evidence that Wonca is ready to move forward toward
gender equity in policy and program. The group’s work
in Hamilton furthered these goals.
The group accomplished several tasks fundamental
to its strategic plan developed at the last Wonca
Triennial meeting in Orlando in 2004.
First, the group finalized the Working Party’s
recommendations for gender equity amendments to
Wonca’s bylaws and regulations, following several
months of intense deliberation and legal consultation.
The WWPWFM will be proposing these amendments to
the core Executive Council in Buenos Aires in October
2006.
Second, the group developed a proposal for a
“Women’s Track” for the Wonca Singapore 2007
meeting. Such an important international meeting
provides concrete opportunities for the development of
leaders and the advancement of women general
practitioners/family physicians in Wonca. We plan to
offer a smorgasbord of activities including a WWPWFM
pre-conference, symposia and leadership workshops.
Third, the group made significant progress in
developing a statement urging Wonca to promote
awareness of the vital effects of gender as a
determinant of health.
Finally, the group put together a policy statement on
gender equity for Wonca’s endorsement: The Hamilton
Equity Recommendations (The HER Statement). We have
forwarded a signed copy of that statement to the Wonca
Executive for their consideration.
The members of WWPWFM look forward to working
with family physician colleagues in the ongoing efforts
to integrate gender equity into clinical practice, medical
education, research development, and organizational
activities. The WWPWFM will have an active presence at
the upcoming Wonca meetings (Buenos Aires in October
2006, Singapore in 2007, and Cancun in 2010).
Further information can be found at the group’s
website at www.womenandfamilymedicine.com, where
the group’s numerous documents are posted. We
encourage those interested in subscribing to the group’s
listserve to send a message to its co-ordinator, Dr. Lucy
Candib (at lcandib@massmed.org).
Cheryl Levitt MBBCh, Chair of the WWPWFM
Lucy Candib MD
Barbara Lent MD
WONCA
News
REGIONAL NEWS
9
WONCA REGIONAL NEWS
THREE YEAR FAMEC AFRICA PROJECT
INITIATED DURING KAMPALA UGANDA
MEETING
The leadership of the Family Medicine Education
Consortium (FaMEC) project in Kampala, Uganda from
15
th
-16
th
June 2006 to inaugurate the FaMEC Africa
project and introduce it to the participating countries
and institutions.The main purpose of the FaMEC Project
is to develop and strengthen training in Family
Medicine/Primary Health Care in Southern and Eastern
Africa, in order to contribute to the realisation of quality
and equitable health care in the region. The countries
involved in the project are: South Africa, Tanzania,
Kenya, Uganda, Democratic Republic of Congo, and
Rwanda.
The project duration is three years: from 01 April
2006 to 31 March 2009. Four major results are expected
in a period of 3 years:
1.A definition of the concept of Family Medicine within
an African context including the vision and strategy
for implementation;
2.The development of strategies that are necessary to
obtain more horizontal integration of vertical
programmes involving the community;
3.The formation of a strong, high quality Family
Medicine training programme through sharing of
experiences and resources with the participating
institutions;
4.The creation of a Family Medicine education
consortium for Africa, with clearly identified
membership and links to organisations with
complementary missions.
The aim of the FaMEC Project is to contribute to the
health of communities provided by accessible
responsive and quality health care systems in Eastern
and Southern Africa through the education and training
of family physicians who contribute to interdisciplinary
primary health care services, oriented towards the needs
of individuals, their families and the communities in
which they live. Research, capacity building and
extension are needed to realise this objective. Research
will try to define a comprehensive framework and
definition for family medicine/primary health care in an
African context. This will involve all stakeholders
utilising a DELPHI-procedure. Moreover, documentation
about field experiences will underpin specific strategies
of community oriented primary care, community based
education and service, and service-learning. Capacity
building is a main objective, focusing on the
establishment of training complexes, and making
available through South-South cooperation expertise in
the format of E-learning, training programmes,
workshops on “training the trainers”. Finally in order to
make the intervention sustainable networking will be
essential, exploring the possibilities for further funding
in a wider framework (EU-EDULINK-programme).
The overall developmental objective of the project is
to contribute to the health of communities through
accessible, responsive and quality health care systems
in Eastern and Southern Africa through the education
and training of family physicians who contribute to
interdisciplinary, primary health care systems, oriented
towards the needs of individuals, their families and the
communities in which they live.
The academic overall objective is the planning,
development and strengthening of academic
departments or units of family medicine that offer family
medicine training at the undergraduate, postgraduate
and continuing professional development levels.
The meeting was attended by representatives from 7
Departments of Family Medicine in South Africa (Walter
Sisulu University, Stellenbosch University, University of
Pretoria, University of Limpopo, University of Free State,
University of Cape Town, University of Witwatersrand),
Makerere and Mbarara Universities in Uganda, Univesity
of Goma in DRC, Moi University in Kenya, Ghent
University in Belgium, Ghets, Inter-University Council for
East Africa, FaMEC Regional Coordinators for Southern
and Eastern Africa, and President of Wonca Africa. The
partner institutions in full are:
•Department of Family Medicine, Walter Sisulu
University, Mthatha, South Africa
•Department of Family Medicine, University of
Pretoria, South Africa
•Department of Family Medicine, Aga Khan University,
Tanzania
•Department of Family Medicine, University of Free
State, Bloemfontein, South-Africa
•Department of Family Medicine, Mbarara University,
Uganda
•Department of Family Medicine and Primary Health
Care, University of Limpopo, South Africa
•Département de Médecine Générale, Centre
Universitaire de Goma, DRC
•Department of Family Medicine, Stellenbosch
University, South-Africa
WONCA
News
REGIONAL NEWS / HEALTH AND HEALTH SYSTEM NEWS
10
HEALTH AND HEALTH
SYSTEM NEWS
PRIMARY CARE IN THE
USA CONTRIBUTES TO
HEALTH SYSTEM AND
HEALTH IMPROVEMENT
(Editor’s Note: Dr Barbara
Starfield, a world renowned health
services researcher, has published
and spoken extensively on the
contribution of primary care to
health system and health
improvement. Dr Starfield and
Dr Shi published a landmark article
in this field entitled “Primary Care
Contributions to Health Systems
and Health” in the Milbank
Quarterly (Volume 83, Number 3,
2005), a highly respected
multidisciplinary journal of
population health and health
policy). The first excerpt of this
article, published with the
permission of Dr Starfield and the
Milbank Quarterly, focuses on her
research in the United States, where
Dr Starfield lives. The second
excerpt, to be published in a future
issue of Wonca News, will focus on
international comparisons. The
entire Milbank Quarterly article and
references, as well as additional
related resources, may be
downloaded from the Wonca Global
Resource Directory at
www.GlobalFamilyDoctor.com).
Evidence on the health-
promoting influence of primary care
has been accumulating ever since
research has distinguished primary
care as a special part of health
services. This evidence shows a
positive impact of primary care on
prevention of illness and death.
Evidence demonstrates that primary
care (in contrast to specialty care) is
associated with a more equitable
distribution of health in
•Department of Family Medicine, University of Kwa Zulu Natal, Durban,
South Africa
•Department of Family Medicine, University of Witwatersrand,
Johannesburg, South-Africa
•Department of Family Medicine, University of Cape Town, South Africa
•Department of Family Health, Division of Medicine, Moi University, Kenya
•Global Health Through Education Training and Service
•Department of Family Medicine and Primary Health Care, Ghent
University, Belgium
Envisaged links are with the Wonca Africa Region, the Inter University
Council for East Africa (IUCEA), Towards Unity for Health (TUFH), and World
Health Organisation (WHO).
Academically, the project aims to establish a specific institutional
network between departments and units of family medicine and primary
health care to:
•Define the discipline and specialty of Family Medicine academically
within the African context
•Enhance the quality of programme content, training and educational
methods, including community based education programs and service-
learning within training complexes
•Encourage research collaboration
•Foster high quality and locally relevant continuing professional
development
•Introduce a unified system of quality assurance of training.
The idea of a Wonca Africa Working Group on Education and Research
has been triggered by the FaMEC Africa project. The project activities and
meetings as outlined above place this group in an ideal situation to be a
working group that will generate educational issues and research projects
for the whole of Africa. The African countries that are not members of this
group will be invited to attend meetings and make contributions. This idea
was put forward to this group and has been accepted with enthusiasm.
All the efforts of the FaMEC Africa project, both educational and research
work can be shared openly in a conference and also published in peer
reviewed journals. Educational issues can be shared at workshops and
research work can be shared in posters and papers. The FaMEC Africa
project participants believe that a Wonca Africa conference will be the best
way to share what has been achieved. There is no better way to end the
funded life span of the project than showing the results concretely in this
way.
I look forward to receiving any communication from those Wonca
member organizations and individual family doctors with an interest or
experience working with family medicine development in Africa. Updates
from the FaMEC Africa projects will be periodically shared through Wonca
News.
Professor Khaya Mfenyana
President, Wonca Africa Region
mfenyana@getafix.utr.ac.za
11
WONCA
News
HEALTH AND HEALTH SYSTEM NEWS
populations, a finding that is
robust in cross-national studies
and within countries. The
mechanisms by which primary care
improves health have been
elucidated, thus suggesting ways
to improve overall levels of health
and reduce systematic differences
in health across major population
subgroups.
The term “primary care” is
thought to date back to about
1920, when the Dawson Report
was released in the United
Kingdom. That official report
mentioned “primary health care
centres” which were intended as
the hub of regionalized services in
that country. Although primary
care came to be the cornerstone of
the health services system in the
UK as well as in many other
countries, no comparable focus
developed in the United States.
The formation of one after another
specialty board in the early
decades of the 20
th
century
signaled the increasing
specialization of the US physician
workforce. The GI Bill of Rights,
which supported further training of
those returning from services in
World War II, fueled a further
increase in specialization of
physicians, many of whom had
been general practitioners
(generalists) before the war. At that
time, physicians who were general
practitioners lacked additional
training after graduation from
medical school apart from a short
clinical internship.
Professor Barbara Starfield
Concern that the survival of
generalist physicians would be
threatened by the disproportionate
increase in the supply of specialists
in the United States, family
physicians in the 1950s and 1960s,
working with international
colleagues, developed standards for
credentialing the new “specialty” of
family practice. In the 1970s, longer
postgraduate training became part
of preparation for the practice of
generalist physicians. Recognition of
a “specialty” of primary care in the
United States resulted in two
reports from the US Institute of
Medicine. These reports defined
primary care as “the provision of
integrated, accessible health care
services by clinicians who are
accountable for addressing a large
majority of personal health care
needs, developing a sustained
partnership with patients, and
practicing in the context of family
and community”. This definition is
consistent with international reports
from Wonca and the World Health
Organization and has been used to
develop instruments to measure
four main features of primary care
services: first contact access for
each new need; long-term person
(not disease) focused care;
comprehensiveness in dealing with
most needs for health services; and
coordination of care when it must
be sought elsewhere. Primary care is
assessed as “good” based on the
degree of attainment of these four
main features. For some purposes,
an orientation towards family and
community are also included.
Research on the beneficial effects
of primary care on health can be
demonstrated from three types of
studies: studies of the supply of
primary care physicians, studies of
people who identify a primary care
physician as their regular source of
care, and studies linking the receipt
of high quality primary care services
with health status. These three lines
of evidence represent a pro-
gressively stronger demonstration
that primary care improves health;
first by showing that health is better
in areas with more primary care
physicians, second by showing that
people who receive care from
primary care physicians have better
health, and third by showing that
the characteristics that constitute
primary care are associated with
better health.
More Primary Care Physicians
are Associated with Better
Health
These studies, as a group, cover
a variety of health outcomes: total
and cause-specific mortality, low
birth weight, and self reported
health. They examined the
relationship between primary care
physician supply and health at
different levels of geographic
aggregation (state, county,
metropolitan and non-metropolitan
regions); after controlling for a
variety of population characteristics
(such as income, education, and
racial distribution); and used a
variety of analytic approaches
(standard regressions, path
analyses) in both individual years
(cross-sectional) as well as over
time (longitudinal).
The number of primary care
physicians per 10,000 population is
the measure of “supply”. In the
United States, Primary care
physicians in the US include family
and general practitioners, general
internists, and general pediatricians.
These three types of physicians
constitute the primary care
physician workforce and have been
shown to provide the highest levels
of primary care characteristics in
their practices.
Studies in the early 1990s
showed that US states with higher
primary care physician to population
ratios had better health outcomes,
WONCA
News
HEALTH AND HEALTH SYSTEM NEWS
12
including lower rates of all-cause
mortality; mortality from heart
disease, cancer, or stroke, infant
mortality, low birth weight, and poor
self-reported health, even after
controlling for sociodemographic
measures (% elderly, % urban, %
minority, education, income,
unemployment, pollution) and
lifestyle factors (seatbelt use,
obesity, and smoking). Vogel and
Ackerman subsequently showed that
the supply of primary care
physicians is associated with an
increase in life span and with
reduced low birth weight rates.
Additional studies examined the
influence of primary care physician
supply at the state level while also
taking into account specialist
physician supply. These analyses
found that primary care physician
supply was significantly associated
with lower all-cause mortality
whereas greater specialty physician
supply was associated with higher
mortality. When primary care
physician supply was disaggregated
into its components (family
physicians, general internists, and
pediatricians), only family physician
supply showed significant
relationships with lower mortality.
Studies of health according to
people’s relationship with
primary care facilities and
providers
Because an increased number of
primary care physicians does not
necessarily mean that all people in
the area have greater access to or
receipt of primary care services,
analyses that consider people’s
relationships or experiences with a
primary care practitioner are helpful
in examining the primary care-health
outcome association. Thus the
second line of evidence for a
positive impact of primary care on
health comes from comparisons of
the health of people who do or do
not have a primary care physician as
their regular source of primary care.
A nationally representative survey
showed that adult US respondents
who reported a primary care
physician rather than a specialist as
their regular source of care had
lower subsequent 5-year mortality,
after controlling for initial differences
in health status, demographic
characteristics, health insurance
status, health perceptions, reported
diagnoses, and smoking status. That
is, people who go to a primary care
physician as their regular source of
care have subsequent better health
regardless of their initial health or
various demographic characteristics.
Studies of health according to
the primary care characteristics
As noted in the introduction,
until recently primary care could be
assessed only by determining the
type of physician who provided it:
family physicians, general internists,
and general pediatricians in the US,
and family physicians or general
practitioners in most other
industrialized countries. The
intensive examination of criteria for
the designation of “primary care” in
the most recent half century
encouraged the development of
tools to assess the adequacy of
those health delivery characteristics
which, in combination, define the
practice of primary care. This
development made it possible to
examine the extent to which receipt
of better primary care is associated
with better health.
Using these new methods,
several studies have demonstrated a
positive association between the
adequacy of the features of primary
care and provision of preventive
services. In a cross-sectional study
of patients in the state of Ohio, the
four primary care attributes were
evaluated for their relationship with
delivery of preventive services. After
controlling for patient age, race,
health, and insurance in the
hierarchical linear regression model,
each of the measured primary care
attributes was significantly
associated with patients being up to
date on screening, immunization,
and health habit counseling services.
In another study, adolescents with
the same regular source of care for
preventive and illness care (one
indication that the source is focused
on providing primary care) are much
more likely to receive indicated
preventive care and less likely to
seek care in emergency rooms.
The positive impact of primary
care also was shown by comparing
the self-assessed health of those
who actually experienced better
primary care (as assessed by the
health delivery characteristics of
primary care) with those who
reported less adequate primary care.
Among those who reported better
primary care, greater than 5% fewer
people reported poor health and 6%
fewer reported depression than was
the case for people experiencing less
adequate primary care. Just
considering those who reported the
best primary care experiences, 8%
fewer reported poor health and more
than 10% fewer reported feeling
depressed as compared with those
with less adequate primary care.
In summary, these studies in the
US are consistent in showing a
relationship between more or better
primary care and most health
outcomes studied. Primary care is
associated with improved health
outcomes as measured by all cause
mortality, heart disease mortality,
stroke mortality, infant mortality, low
birth weight, life expectancy, and self
rated health. The effect is also found
for cancer mortality in all but a few
studies. In addition, studies of the
13
WONCA
News
HEALTH AND HEALTH SYSTEM NEWS
impact of actually receiving care
from a primary care source are
consistent in showing benefits on a
variety of health and health-related
outcomes. The results of these
studies suggest that as many as
127,617 deaths per year in the US
could potentially be averted through
such an increase in the number of
primary care physicians,
Barbara Starfield, MD, MPH
The Johns Hopkins Bloomberg
School of Public Health
bstarfie@jhsph.edu
Leiyu Shi DrPH, MBA
The Johns Hopkins Bloomberg
School of Public Health
James Macinko, PhD
Department of Nutrition, Food
Studies and Public Health
WOMEN FAMILY DOCTORS
AND THE DOCTOR-PATIENT
RELATIONSHIP
(Editor’s Note: This article is
one of a series done by the authors
on behalf of the Wonca Working
Party on Women and Family
Medicine (WWPWFM) published in
Wonca News over the past few
months. Please see
www.womenandfamilymedicine.com
for the full monograph, literature
review, summary and annotated
bibliography on women family
physicians and the doctor-patient
relationship.)
Given the increasing numbers of
women in the medical profession
and the important role that building
and nurturing relationships play in
the socialization of women, one
might expect the gender of the
physician to be influential in the
doctor-patient relationship.
Enhanced communication skills
should also be beneficial in
providing more personal and
humanized medicine. Sensitive and
empathetic doctor-patient
relationships might help overcome
imbalances associated with expert
power and gender power.
Nevertheless, critics have expressed
concern about how the changing
gender distribution of the medical
profession will have a negative
impact on health care and on the
status of the profession. To shed
further light on these issues, we
have prepared a short article, based
on our review of the literature
(limited by it being mostly from
North America and Europe) on how
the gender of the physician
influences practice patterns and
communication styles.
Research demonstrates that
women family physicians are more
likely to provide more health
education and/or counseling to their
patients than men physicians.
Women physicians are also more
likely to offer more preventive
services, particularly, but not
exclusively, for gender-specific
procedures. Such studies raise the
question as to whether women
physicians are more prevention-
oriented; whether prevention-
oriented patients seek out women
physicians more; whether women
physicians are more comfortable
providing female specific
preventative services than men;
whether women are more risk
averse and therefore counsel more
for prevention; or whether women
see prevention as part of care-giving
role out of experience of mothering.
In North America, women
patients often seek out women
family doctors more than men family
doctors, preferring women for
obstetrical-gynecological and for
behavioral and emotional health
concerns; this gender preference
does not extend to other non-
female-specific health concerns.
However, it is unclear whether these
preferences reflect real differences
in physicians’ attitudes and
communication styles, or patients’
stereotyping of physicians, or
patients’ past experiences with men
and women physicians. Cultural
and/or religious factors are also
important influences on patients’
choices with respect to physician
gender.
Studies on the practice patterns
and activity levels of women family
physicians have raised questions
regarding the relative productivity of
women versus men physicians. One
Canadian study showed that women
family physicians billed more per
patient seen and provided fewer
services than men. These findings
might partly be explained by the
increased likelihood of more
counseling and length of encounter
offered by women physicians, as
data are based on payment per
encounter rather than quality and
extent of the encounter.
Comparisons of the productivity and
behavior of men and women
physicians can be further
complicated because women
physicians in these studies were on
average younger than men
physicians. Younger family
physicians differ from older
physicians in scope of practice and
in the number and proportion of
women patients seen per week.
In the area of doctor-patient
communication, research has shown
that women family doctors are more
likely to engage in more patient-
centered communication (e.g.
positive talk, partnership building,
psychosocial counseling and
question asking, and emotionally
focused talk) than men doctors. In
addition, women are more likely to
conduct longer visits, offer more
support to their patients and
possess a higher awareness of the
impact of psychosocial factors in
patient care. Interestingly, physician
WONCA
News
HEALTH AND HEALTH SYSTEM NEWS / MEMBER AND ORGANIZATIONAL NEWS
14
MEMBER AND
ORGANIZATIONAL NEWS
WONCA APPROVES SIX
NEW MEMBER
ORGANIZATION
APPLICATIONS
We continue to receive many
enquiries about membership in
Wonca as well as completed
applications. After the Core
Executive in Singapore, Wonca
represented 107 member
organizations from 90 countries.
This includes nine Associate
Members and ten members in
Collaborative Relationships.
During the Wonca Executive in
Buenos Aires, the following
membership applications were
reviewed and approved:
•The Sections of Teachers and
Researchers of the College of
Family Physicians of Canada was
approved for Associate
Membership.
•The Nicaraguan Association of
Family Medicine was approved
for full membership. This is
contingent upon receipt of their
financial records and the dues
payment.
•The Cuban Society of Family
Medicine was approved for full
membership. This is contingent
upon receiving their dues
payment.
•The Romanian National Centre
for Studies in Family Medicine
(NCSFM) is approved for
Associate Membership, subject to
payment of dues.
•The Serbia Medical Association,
Section of General Practice is
approved for full membership.
This was approved contingent
upon receipt of their financial
gender may also affect patient
behavior in the encounter, with the
patients of women doctors speaking
more, disclosing more biomedical
and psychosocial information, and
making more positive statements to
their physicians than patients of
men doctors. The impact of these
communication differences on
patient outcomes is as yet
unknown.
Women’s communication styles
may partly explain the high patient
satisfaction, compliance and some
patient health outcomes observed in
some studies. In one study, patients
were significantly more satisfied
with women physicians than men
physicians. In another, higher levels
of satisfaction were found among
women patients of women
physicians than women patients of
men physicians. However, in
contrast, another study reported
men doctors being preferred to
women doctors. Both men and
women patients examined by
younger physicians, especially
younger women physicians, tend to
be less satisfied, especially when
younger women physicians examine
men patients. This finding suggests
attitudes, values and expectations
may influence patients’ reactions to
physicians’ gender.
The doctor-patient relationship is
fraught with power imbalances.
Some researchers have suggested
that a feminist analysis of these
imbalances might help all doctors,
regardless of gender, to remedy the
impact of these imbalances in
clinical encounters. The high degree
of expert, esoteric knowledge
possessed by the physician allows
the physician to dominate the
medical encounter through either
validating or disregarding the
patient’s own understanding of his
or her health problem. This is
particularly problematic for women
patients who are exposed not only
to expert power but gender power
as well. Enhancing the patient’s
ability to care for him/herself
requires a range of skills:
recognition of the oppression felt by
the patient, empathy, respect for the
person as a person, responding to
the patient’s changing abilities,
exploring and understanding the
patient’s own understanding of her
illness, respecting and maintaining
the patient’s sense of control over
her life, and providing the patient
with the tools and information
required to maintain optimal health.
Physician and patient gender are
also influential in the establishment
and maintenance of appropriate
boundaries in clinical care. Sexual
abuse of patients is the most
serious boundary violation, and
typically occurs when men
physicians engage in sexual abuse
of women patients. Conversely,
women physicians may be at greater
risk of sexual harassment in clinical
encounters with men patients. On
the other hand, women physicians
can potentially blur the boundaries
between personal and professional
relationships by disclosing more
personal information as a way of
enhancing their relationships with
patients.
Patients choose physicians for a
myriad of non-clinical reasons, such
as life experience, comfort, stereo-
typing, culture and religion.
Understanding the differences
between women and men
physicians will allow us to
comprehend patients’ expectations
more fully. From the vantage point
of each gender, we can reflect
carefully on our own clinical
encounters, as we strive to provide
our patients with exemplary clinical
care in the context of their families
and communities.
Barbara Lent MD
Lucy Candib MD
Michelle Howard MSc
Cheryl Levitt MBBCh
15
WONCA
News
MEMBER AND ORGANIZATIONAL NEWS / RESOURCES FOR THE FAMILY DOCTOR
records, payment of the dues
and submission of its
membership list.
Subsequent to these actions by
the Wonca Executive in Buenos
Aires, Wonca now represents 112
member organization from 93
different countries comprising 85%
of the world’s population.
Professor Warren Heffron
Chair, Membership Committee
THE COLLEGE OF FAMILY
PHYSICIANS OF CANADA
HOLDS SUMMIT
Niagara Falls, Ontario was the
backdrop for the CFPC Summit in
June 2006. Focused on making our
organization relevant and meaning-
ful for all family physicians in
Canada, approximately 100 members
participated in activities to help us
better understand the evolution of
our discipline. Over a three-day
period, we explored the needs of
specific member groups such as
francophones, international medical
graduates and women. We
examined how well the College
addresses member needs through
education, training, continuing
professional development and
advocacy. We considered issues
surrounding focused practices. We
discussed a possible time-limited
alternative route to certification
(without examination) for our non-
certificant members. As a result of
our summit, on Sunday, June 4th, a
motion to acknowledge that Family
Medicine is a specialty with its own
body of knowledge, attitude and
skills was approved in principle by
the CFPC Board of Directors.
Our President, Dr. Louise
Nasmith, goes into more detail in
her report on the summit in the
August issue of CFPC News. Her full
message can be read at www.cfpc.ca
under the eNews heading.
Lynda Redwood-Campbell, Sarah Beer
Delaney, Katherine Rouleau, Kevin Pottie and
Veronic Ouellette pictured above at the
Family Medicine Forum 2006 in Vancouver,
British Columbia
RESOURCES FOR THE FAMILY DOCTOR
IMPROVING HEALTH SYSTEMS: THE
CONTRIBUTION OF FAMILY MEDICINE –
THE WONCA-WHO GUIDEBOOK
Why is family medicine emerging in almost every
health system of the world? How can Wonca member
organizations and their family doctors become involved
in improving health systems with family medicine?
Health systems everywhere achieve better outcomes
at lower costs when based on a strong foundation of
primary health care (PHC). Community based PHC teams
In February 2006, The College of
Family Physicians of Canada held
the first meeting of its International
Health Committee. Its mandate is to
promote the global development of
family practice and to support CFPC
members meeting health needs
worldwide. Our initial focus has
been the very significant overlap
between international health and
global health, specifically its impact
on our ability to care properly for
some populations at risk within
Canada. Our chair is Lynda
Redwood-Campbell of McMaster
University. The committee is
comprised of Veronic Ouellette,
Kevin Pottie, and Katherine Rouleau.
Dr. Francine Lemire, Associate
Executive Director of Professional
Affairs and Sarah Beer Delaney,
Manager of Member and Chapter
Relations, are the CFPC liaisons to
this committee.
are able to deliver PHC most effectively; team members
can share responsibilities to provide continuous access,
comprehensive coverage, and coordinate referrals with
others in the health system as needed. When family
doctors are appropriately prepared and available to
provide comprehensive care based on local needs and
resources, they can enhance both the scope and quality
of PHC teams.
Recognizing the fundamental importance of PHC in
all health systems and the critical role of family doctors
in PHC teams, the World Health Organization (WHO) and
the World Organization of Family Doctors (Wonca)
produced a guidebook, Improving Health Systems: the
Contribution of Family Medicine, that was published in
2002. The guidebook is intended to help countries
establish or strengthen family medicine.
WONCA
News
RESOURCES FOR THE FAMILY DOCTOR
16
The guidebook is the result of many years of
collaboration between the WHO and Wonca. As early as
1963 an expert committee of the WHO emphasized the
need for family doctors in every country. In 1978 the
Alma Ata conference on Primary Health Care urged all
governments to establish PHC as a vehicle to provide
health for all. Family medicine/general practice post-
graduate training programs began in Europe and North
America in the late 60s. Wonca was established in 1972
and now includes members from more than 60
countries. In 1993 representatives of WHO and Wonca
began meeting to identify common goals and strategies
for strengthening medical education, family medicine
and PHC delivery; the guidebook emerged from this
process.
The guidebook was prepared by co-authors Charles
Boelen, Cynthia Haq, Vincent Hunt, Marc Rivo and
Edward Shahady, with guidance from a steering
committee sponsored by the WHO and Wonca. More
than seventy individuals from six continents contributed
to to describe the similarities and differences in family
medicine in different regions of the world.
The book is divided into five chapters. Chapter 1
describes the features of responsive and sustainable
health care systems and the critical importance of
balancing conflicting priorities among those who
contribute to health care. Chapter 2 describes the
enormous challenges facing health systems and the
importance of PHC. Chapter 3 explains how family
doctors can make significant contributions to PHC. It
describes the attributes of family doctors, their roles
and responsibilities, and the quality and cost-
effectiveness of their work. Chapter 4 outlines the
continuum of training for family doctors that begins in
medical school, extends through specialty training, and
is sustained through a process of continuing medical
education. Chapter 5 calls for unified efforts among
policy-makers, health managers, health professionals,
academic institutions, and community representatives to
create a supportive environment for family practice. This
environment is sustained through dedicated leadership,
institutional commitment, strategic policy development,
and appropriate resources. A Resource Directory lists key
organizations and contacts to assist those interested in
considering development of family medicine programs.
The Wonca-WHO Guidebook has been widely
distributed, discussed and debated. It has been
discussed at Wonca executive and regional meetings
throughout the world. More than 2000 copies of the
Wonca-WHO Guidebook have been distributed to Wonca
member organizations and to WHO regional offices.
A Thai translation of the Wonca-WHO Guidebook has
been completed under a Wonca Agreement with Asst.
Prof. Dr. Nitaya Wongsangiem Tanuwong with of Faculty
of Medicine, Thammasat University
(nitaya@alpha.tu.ac.th).
A planned Greek translation of the Wonca-WHO
Guidebook was initiated through an agreement between
Wonca and Dr Christos Lionis
(lionis@galinos.med.uoc.gr), Associate Professor Clinic of
Social and Family Medicine, University of Crete and the
Greek Academy of Family Physicians, an affiliate of the
Greek Association of General Practitioners.
A planned Turkish translation of the Wonca-WHO
Guidebook was initiated through an agreement between
Wonca and Prof Dr Nazan BILGEL (communication via Dr
Hakan OZDEMIR hozdemir@uludag.edu.tr), Director of
Uludag University School of Medicine Department of
Family Medicine in Bursa, Turkey.
A planned Lao translation of the Wonca-WHO
Guidebook was initiated through an agreement between
Wonca and Dr Sing Menorath (menorath_s@yahoo.com),
Vice Dean of the Faculty of Medical Sciences, at the
National University of Laos.
A planned Korean translation of the Wonca-WHO
Guidebook was initiated through an agreement between
Wonca and Professor Hyun Rim Choi
(fmdr@dreamwiz.com), Senior Director at
The Wonca-WHO guidebook may be ordered from
Ms. Yvonne Chung, Administrative Manager, World
Organization of Family Doctors (Wonca), by emailing
admin@wonca.com.sg. It costs US$15 for Wonca
members, US$20 for non-members by airmail. In the
future the guidebook will be available on the Wonca
website at http://www.GlobalFamilyDoctor.com. Those
interested in translating the Wonca-WHO Guidebook into
their country’s language may also contact Yvonne Chung
for additional information and directions to complete an
agreement with Wonca.
FACULTY DEVELOPMENT PROGRAM AT THE
UNIVERSITY OF TORONTO
The program,
“Teaching & Learning in the Health
Professions”, will be offered May 7-11, 2007 at the
University of Toronto. It is based on the well regarded
Clinical Teacher Certificate courses established in the
Department of Family and Community Medicine over the
past ten years by Dr Helen Batty, last year’s national
Canadian ACFM award winning faculty developer.
The registration and brochure is at
http://www.cme.utoronto.ca/phs0602.html
Interested persons may also wish to register for
the full Clinical Teacher Certificate program which
has an additional field practicum that can be
completed in the home location, and a selective
course such as our online Teaching Evidence Based
Medicine which can also be completed in the future
without traveling to Toronto. The full Clinical
Teacher Certificate program can be seen at: http://
dfcm.utoronto.ca/GradStudies/ProgramInformation/
ClinicalTeacherCertificate.asp
Toronto is a welcoming multicultural city with
many interesting attractions. May is the beginning
of our lovely cool Spring season. There are good
reasonable accommodations in the area close to
the program location and the city streets are safe to
walk. Restaurants of many different special ethnic
and cultural varieties are nearby.
We hope local, national and international
colleagues from many health professions will
seriously consider joining us on campus in Toronto
for this innovative program.
Graduate degree credits
may also be available for participants already
enrolled in a Master’s or PhD degree.
Helen P. Batty MD, CCFP, M.Ed, FCFP
Professor
Director, Graduate Studies & Faculty Development
Programs
Department of Family and Community Medicine
Faculty of Medicine, University of Toronto
263 McCaul Street
Toronto, Ontario Canada M5T 1W7
Telephone: 416-978-1914
Fax: 416-978-3912
Email: familymed.grad@utoronto.ca
WONCA
News
RESOURCES FOR THE FAMILY DOCTOR
17
WONCA
News
CONFERENCES 2006 – 2011
17
WONCA CONFERENCES 2006 – 2011 AT A GLANCE
**Wonca Direct Members enjoy lower conference registration fees
See Wonca Website www.GlobalFamilyDoctor.com for upates & membership information
2006
Region
Venue
Theme
11 – 14 Oct
Iberoamericana -
Buenos Aires
Building a Primary Care-Based Health
CIMF Regional
ARGENTINA
THAILAND
System: the Role of the Family Doctor
Conference
5 – 9 Nov
Asia Pacific
Bangkok
Happy and Healthy Family
Regional Conference
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
Semptember
Europe
Istanbul
Theme to be confirmed
Regional
TURKEY
Conference
1 – 5 Oct
Asia Pacific
Melbourne
A Celebration of Diversity
Regional
AUSTRALIA
Conference
2009
5 – 8 June
Asia Pacific
Hong Kong
Building Bridges
Regional
Conference
Date to be
Europe
Basel
Theme to be confirmed
confirmed
Regional
SWITZERLAND
Conference
2010
19 – 23 May
19
th
WONCA
Cancun
Millennium Development Goals:
World Conference
MEXICO
the Contribution of Family Medicine
Date to
Europe
SPAIN
Theme to be confirmed
confirmed
Regional
Conference
2011
February 2011
Asia Pacific
Cebu
Paradigms of Family Medicine:
Regional
PHILIPPINES
Bridging Old Traditions with
Conference
New Concepts
Information correct as of October 2006.
May be subject to change.
19
WONCA
News
GLOBAL MEETINGS FOR THE FAMILY DOCTOR
GLOBAL MEETINGS FOR THE
FAMILY DOCTOR
WONCA WORLD AND
REGIONAL CONFERENCE
CALENDAR
18th Wonca World Conference,
Singapore 2007
Host:College of Family
Physicians, Singapore
Theme:Genomics and Family
Medicine
Date:24-28 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:cfps@pacific.net.sg
Web:www.wonca2007.com
Wonca Europe Regional Conference,
Paris, 2007
Host:French National College of
Teachers in General
Practice
Theme:Rethinking Primary Care in
the European Context
Date:17-20 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
8
th
Wonca Rural Health Conference,
Nigeria 2008
Host :National Post-Graduate
Medical College of Nigeria
Theme:Frontline Medicine – From
Natural Disasters to Daily
Care
Date:20
th
– 23
rd
February 2008
Venue:Calabar , Cross River State,
Nigeria
Contact:Dr Ndifreke Udonwa
Chair Local Organizing
Committee
C/O Office of C.M.A.C
University of Calabar
Teaching Hospital,
GPO Box 147, Calabar
54001,
Cross River State,
Nigeria.
Tel :234 (0) 803 341 6810
Fax:234 (0) 87 232 053
Email:nudonwa@yahoo.com
19th Wonca World Conference,
Cancun 2010
Host:Mexican College of Family
Medicine
Theme:Millennium Develop Goals:
The Contribution of Family
Medicine
Date:19-23 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
College of Family Physicians of
Canada (CFPC)
Family Medicine Forum, Manitoba
2006
Date:November 2 - 4, 2006
Venue:Quebec City Convention
Centre
Quebec City, Quebec
Contact:Joanne Langevin;
Meetings Manager
Cheryl Selig,
Registration Coordinator
2630 Skymark Avenue
Mississauga, Ontario,
Canada L4W 5A4
Tel:(905) 629-0900 /
1-800-387-6197
Fax:(905) 629-0893
Email: info@cfpc.ca
Web:www.cfpc.ca
Invitación VII Congreso Venezolano
de Medicina Familiar,
Lecherias Venezuela 2006
Date:7 -11 Nov, 2006
Venue:Maremare Hotel Marina
& Spa
Lecherias, Anzoategui.
Venezuela
Host:Sociedad Venezolana de
Medicina Familiar
(SOVEMEFA)
Contact Congrex of
Venezuela
SOVEMEFA
Phone:58212 - 2639733
Fax:58212 - 9762681
Email:info@congrex.com.ve
Web:www.sovemefa.net
Visit Global Family Doctor – Wonca Online
http://www.globalfamilydoctor.com
Check the regular features:
Journal Watch – synopses of research from the medical literature relevant to family doctors
Clinical Reviews – outstanding review articles for family doctors on a variety of topics
Journal Alerts – an emailed service about the latest in Journal Watch and Clinical Reviews
Journal Alerts en Espa–ol – a new batch is posted at the beginning of each month
Disease Alerts – the latest disease outbreaks from WHO and CDC
Travel Alerts – advice for you to give to your traveling patients
Online CME – interactive programs, some with CME credits
Clinical Nutrition Updates – a new topic is presented every three weeks
POEMs – Patient-Oriented Evidence that Matters – a new POEM is posted twice a week
POEMs em Portugu s – a new one is posted twice a week
eMedicine – a weekly clinical case for you to solve, with a visual cue: photo, ECG, radiograph
EBMsources – an appraisal of two evidence based medicine websites is posted every month
Cutting Edge – an interesting series about the latest medical hypotheses, posted weekly
Educational Resource Centre – a repository of educational materials for family doctors
Research – the latest on Wonca’s research activities, and opportunities for research
Conference updates – details of Wonca and other conferences
Publications – details of Wonca publications and Wonca News
Wonca Websites – addresses of Member Organization and other Wonca websites
Global Resource Directory – where you can record you international projects, and view others
Medical Mirth – humor with a medical angle to lighten your day
Quotable Quotes – quotes you can use, many with a medical slant
Latest News – of coming meetings, conferences and events
Patient education – resources you can use to inform your patients
About Wonca – details of the Wonca organization, office bearers and Direct Members
Wonca Groups – details of Wonca’s committees and working groups
Information – Notice Board, Letters to the Editor, Doctor of the Month, list servers, mailing lists
Search facilities – you can search the 5,000 items in Journal Watch and Clinical Reviews, as well as web pages and
documents on the Global Family Doctor website
Homepage promotions – conferences, symposia, website features, special offers
You can enjoy a FREE personalized updating service:
Journal Alerts – an email service to your own address that notifies you three days a week of the latest Journal Watch
items and Clinical Reviews – to join this free service, click ‘Enrol for Journal Alerts’ at the top right corner of the
Global Family Doctor homepage
We take days scanning the journals, so you need take only minutes.
We take days scanning the journals, so you need take only minutes.
We take days scanning the journals, so you need take only minutes.
We take days scanning the journals, so you need take only minutes.
We take days scanning the journals, so you need take only minutes.
Visit Global Family Doctor daily – and keep up to date
Global Family Doctor – Wonca Online is supported by Wonca’s Global Sponsors:
ALTANA • AstraZeneca • Boehringer Ingelheim • MSD • Pfizer • Abbott Nutrition
