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
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contained, totally integrated events
infrastructure. In addition to its
first-class facilities, Suntec
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region’s new centre for the</
