Americas Heartbeat (AHB) 4 by International Federation of Medical Students' Associations

Human Resources

FOR HEALTH

IFMSA

Imprint Editor in Chief Maria Jose Jaramillo C - RD Americas Content Editor Juliana Lira - IFMSA Brazil Cianna Lunan - JAMSA Jamaica Suzzette Navarro - AMMEF Mexico Content designer Paula Amado - ASCEMCOL Colombia Americas Team officials RD Americas - María José Jaramillo C. IDA -Pablo Santamaría Finances Assistant - Eva Pizzolato CB RA - Juan Carlos Chávez EA RA - Rodrigo Sánchez SCOME RA - Bianca Quintella

The International Federation of Medical Students’ Associations (IFMSA) is a non-profit, non-governmental organization representing associations of medical students worldwide. IFMSA was founded in 1951 and currently maintains more than 140 National Member Organizations from more than 129 countries across six continents, representing a network of 1.3 million medical students. IFMSA envisions a world in which medical students unite for global health and are equipped with the knowledge, skills and values to take on health leadership roles locally and globally, so to shape a sustainable and healthy future.

SCORE RA - Verónica Moreno

IFMSA is recognized as a nongovernmental organization within the United Nations’ system and the World Health Organization; and works in collaboration with the World Medical Association.

2020

This is an IFMSA Publication

Notice

Publisher IFMSA

All reasonable precautions have been taken by the IFMSA to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material herein lies with the reader. Some of the photos and graphics used in this publication are the property of their respective authors. We have taken every consideration not to violate their rights.

SCORA RA - Fátima Rodríguez SCOPH RA - Catalina González SCORP RA - Ana Paula Estrella SCOPE RA - Gabriel Ortez

Norre Allé 14, 2200 Kobenhavn N., Denmark

Email: gs@ifmsa.org Homepage: www.ifmsa.org

Disclaimer This publication contains the collective views of different contributors, the opinions expressed in this publication are those of the authors and do not necessarily reflect the position of IFMSA. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the IFMSA in preference to others of a similar nature that are not mentioned.

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CONTENTS

Theme Articles: Human Resources For Health Standing Committee Articles: SCOME Standing Committee Articles: SCORP Standing Committee Articles: SCOPH

www.ifmsa.org

Standing Committee Articles: SCORA Standing Committee Articles: SCOPE/SCORE Regional Articles: We are the Americas Photographic category: Story Behind Uniforms

Dear Americas, It is an utmost pleasure to present to you our fourth edition of the Americas Heartbeat Magazine (AHB), the Americas Region Publication. This edition is special in the sense that we went back to the origins of the publication in 2002, and understood the reasoning behind its creation, its progress and then further reinvention in 2009. We realized the importance of having voices of our members of the region being raised in topics that concern them, their NMOs and the Americas as a whole. And not only this, but also to have a standardized and objective process of selection as to improve the quality of our magazine while portraying all voices from our different subregions and NMOs. For the first time, we implemented an Editorial Board with content editors and content designers with whom we created a blinded selection process with criteria for both articles and photographic submissions, along with a “peer” review with our Regional Team members. This, supported by the creation of entirely new Publishing Guidelines for our authors, as well as incorporation of new categories such as “We Are the Americas” - articles to portray our uniqueness as a region- and “Story Behind Uniforms”first ever photographic category - was also an elevation for the magazine. With over a hundred submissions from all our sub-regions we are thrilled to present the results, while we envision this as a baseline for the possibility of a high quality magazine with academic articles from all of our members. We deeply believe that our members have a lot of academic production that needs to be portrayed, and that this is merely the beginning. On behalf of the Editorial Board, and the Regional Team I hope you truly enjoy all of the amazing contents in this magazine and you get to know our Region in the best way possible. Abrazos, abraços, hugs, étreintes!

Cianna Lunan

Suzzette Navarro

María José

Paula Amado

Juliana Lira

Regional Team for the Americas 2019 - 2020

María José Jaramillo Cartwright Regional Director for the Americas

Eva Pizzolato

Pablo Santamaría

Juan Carlos Chávez

Finances Assistant

Internal Development Assistant

Capacity Building Regional Assistant

Bianca Quintella

Rodrigo Sanchez

SCOME RA

External Affairs Regional Assistant

Fátima Rodríguez

Catalina González

SCORA RA

Ana Paula Estrella

SCOPH RA

SCORP RA

Gabriel Ortez

Verónica Moreno

SCOPE RA

SCORE RA

The Americas Heartbeat is our annual regional magazine, which seeks to give our members the opportunity to express their ideas on different topics relevant to the region. Every edition stands by a theme selected by the Regional Team, in the seek to accomplish internal and external work of our priorities as Americas.

2002

The magazine and regional publication was born as a newsletter for the Americas' members. Two editions of this newsletter were published

2010

It was reborn as "PAMSA Heartbeat", with the next Regional Teams replicating it:

AHB History

(09/10, 10/11, 11/12, 12/13, 13/14).

2014

A renewal process of the magazine was made, under the new name of "The Americas Heartbeat"

(15/16, 16/17 and 17/18)

AHB 4

Americas Heartbeat Magazine 4th Edition

During this year, for the ďŹ rst time we implemented an Editorial Board with members from our NMOs that worked along our Regional Team as peer reviewers to ensure an objective selection process, Along with the new publishing guidelines, also 2 new sections (We are the Americas and a photographic category: The Story Behind Uniforms) to showcase and honor features from our regionâ&#x20AC;&#x2122;s countries and our healthcare workers. We included also articles from our Regional Stakeholders and Partners such as IPSF, and from our representatives in delegations to external meetings such as the delegation to 58th Directive Council of the Pan American Health Organization; to give our magazine high quality standards and varied representation.

2020

Human Resources for Health

From the Editorial Board

world without the health workforce would be a world in chaos. We have experienced a fraction of what that world would be like during the onslaught of COVID-19. If there is one thing this pandemic has taught us, it is that we need our healthcare workers. According to the WHO World Health Report the health workforce is â&#x20AC;&#x153;all people engaged in actions whose primary intent is to enhance health.â&#x20AC;?(2006) This includes clinical personnel as well as administration and auxiliary workers who work hard to keep our health care systems running. The best healthcare systems have adequate Human Resources that are evenly distributed in satisfactory work environments with the skills, knowledge and motivation to fulfill their roles. According to WHO there will be an estimated shortage of 18 million healthcare workers by the year 2030.There are simply not enough health workers to meet the demand. This insufficiency has a direct effect on the standard of healthcare services. To have healthcare that is available, accessible, acceptable and of good quality there needs to be investment in the development of a healthcare model that addresses problems being faced by health workers. An important part of achieving Universal health Coverage is sustaining the health workforce. There are a myriad of reasons as to why there is a lack of skilled healthcare staff. To find solutions all stakeholders in healthcare, including health professions students, should play an active role in institutionalizing poli-

cies and frameworks that enable healthcare workers to work efficiently and comfortably. Medical education is the foundation of the healthcare system, this is where basic values, skills and competencies are developed. Training enough competent professionals who are socially accountable is a key part of the process to achieving UHC. World leaders and governments must see the crucial part HRH plays in their national strategies to improve healthcare. There must be emphasis on the importance of the retention of skilled professionals and ways to minimize brain drain. Investment in the health workforce, is an investment in the well-being of whole countries. Healthcare workers are the backbone of healthcare systems. Without health, there would be no workforce to drive the economies, shorter lifespans, increased disease burden and explicit inequalities. Human Resources for health is a fundamental part of health systems. On our journey to achieving SDG 3, let us acknowledge the shoulders of those our health systems stand on and why we need them. The sacrifices being made by our healthcare workers across the world shows how essential they are to the development and sustainability of our society. Everyday they choose to serve others, putting their lives on the line to care for and treat their patients. To the heroes of the pandemic, we salute you. Reference: World Health Organization (2006). The World Health Report 2006 - Working Together for Health. WHO Press, World Health Organization. https://www.who.int/ whr/2006/whr06_en.pdf?ua=1

Story Behind Uniforms

A clinical chemist during COVID-19 pandemic Saliha Karina Hernรกndez Chรกvez Universidad Pontifica AMMEF Mexico

This is a clinical chemist that works at a hospital in Mexico. Months ago, she worked only in taking samples such as blood, urine, stool and some others to run the tests that where requested by doctors. This is important to help determinne diagnosis, perform general exams and even to ensure patient status before surgery. In order to do this job, previously the uniform was a laboratory coat and closed toe shoes; something relatively normal considering she works in a laboratory. But in this picture we see something different.

Why is she dressed like that? We are currently living through a pandemic due to SARSCOV2 and samples need to be taken. Clinical chemists are the people who take samples from hospitalized or clinical patients. Given that they work close with the virus, they must wear personal protective equipment. I am incredibly thankful to all the healthcare workers who are giving their all to help during the pandemic. Specially to my mother, who is the one portrayed in the picture.

Story Behind Uniforms

The woman warriors of COVID-19, infectologists Emanuelle Nóbrega Rebouças Figueiredo UNIFACISA IFMSA Brazil

In this photo we can see four infectologists, who were running the COVID-19 ward of Campina Grande, Paraíba - Brazil. In the first day of september the ward was sussesfuly closed. Those woman faced countless adversities. And they are an exemple of not only doctors, but humans, they faced with love and determination. Giving every attention for each patient singularities. They are our truly local heroes.

THEME ARTICLES

Human Resources

FOR HEALTH

It is a fact that uniforms have always been a personal protection tool that as health professionals we must use daily in the clinical setting or anywhere else where the service is to be provided. In the current pandemic caused by SARS-CoV-2, using the elements of personal protection has become even more indispensable than before, as they help us decreasing contagion’s risk. This applies especially for doctors, nurses, auxiliaries and other staff in the healthcare setting who are exposing their lives in a daily basis, as well as their families when they get back home. It is important to note that carrying this uniform has become a double-edged sword, since many people are not aware of the current situation. This leads to beliefs that just because we carry a uniform, this accredits health professionals as carriers of the virus and that being in contact with us implies they will get infected. This has led to both, non justified, physical and verbal aggressions towards health professionals and it should stop.

That’s why we want to thank to all our health workers for the strength, and courage they’ve been working in this pandemic.

Protection elements during the pandemic, a double-edged weapon Story Behind Uniforms

Rossy A. Santacruz Reales Darcy Julieth Moreno Sánchez Corporación Universitaria Rafael Núñez ASCEMCOL Colombia

Current situation of health personnel in the Americas and the presence of young people on it: Mr. Jean-Pierre Regalado Escobedo1 Ms. Sofiya Terekhovska2 1 Chairperson of the IPSF Pan American Regional Office 2019-20 2 Chairperson of the IPSF Pan American Regional Office 2020-21

By 2018 there was a shortfall of about 800,000 healthcare professionals in the Pan American region (Pan American Health Organization, 2018). This number is very important to reduce in order to guarantee universal access to health care for all people in our region, or in other words to ensure Universal Health Coverage. This problem has been addressed by the World Health Organisation (WHO) for some time and there are plans such as the Global strategy on human resources for hea th: Workforce 2030 , Five-year action plan for health employment and inclusive economic growth (2017 -2021) ,among others, which aim to reduce the deficit of healthcare workers around the world. And this situation is especially alarming in low- and lower-middle income countries, in the case of our region. During the 70th Session of the Regional Committee of WHO for The Americas, the new Plan of Action on Human Resources for Universal Access to Health and Universal Health Coverage 2018-2023 was created. This guide aims to reduce the deficit of healthcare workers in our region and achieve Universal Health Coverage by 2030. The way in which

the guide outlines facing this challenge is by providing tools to the countries to be able to implement policies and work plans that allow increasing the quantity of healthcare workers without reducing their quality.Thus, it establishes the need for greater public investment in the health area, as well as improvements in the supply of employment and working conditions. This guide explains that most of the time and in most of the countries of our region there is no adequate profile, competence or training to be able to generate health professionals in the required quality. According to the Pan American Health Organization (2018), this is due to the fact that there are no Click here to read the guide.

accreditation systems for careers that take into account scientific-technical competences, but also social ones. For this reason, an interprofessional approach and interaction between healthcare professionals, such as doctors, nurses, midwives, pharmacists, dentists, among others, is very important. And the earlier in their careers as students, recent graduates or professionals these exchanges of views can take place, the greater the benefit. This is because from their training they will take into account that in order to achieve the objective of improving health of the patient and the community, as well as achieving universal access to health, it is essential to be able to relate adequately to the different professions that have a place within these issues. Now, more than ever, adequate training of healthcare professionals and interprofessional collaboration is essential in ensuring the health of the public. We have all seen how COVID-19 has brought forth a need for an increased amount of human resources in healthcare - such as physicians and pharmacists. Putting aside all the risks associated with a pandemic, health-

care students and recent graduates rushed to the frontlines in order to do what they have been taught to - ensure the health of their communities. Through various projects and portfolios, IPSF has provided multiple opportunities for education and professional development of pharmacy students and recent graduates to ensure they can perform their role to their full scope in practice.The Federation aims to highlight the unique needs of healthcare in each region of the world, bring awareness to it and provide pharmacy students and recent graduates with adequate tools to support the health of their communities. Now, more than ever, it is crucial for student advocacy organizations to support their members, equip them with appropriate knowledge and skills to optimize therapies, ensure their effectiveness and safety, as well as strive towards improving healthcare worldwide.

References: Pan American Health Organization - PAHO (September 27th, 2018). New PAHO plan aims to reduce a shortage of nearly 800,000 health workers in the Region of the Americas. [Press Release]. https://www.paho. org/hq/index.php?option=com_content&view=article&id=14693:new-paho-plan-aims-to-reduce-a-shortage-of-nearly-800-000-health-workers-in-the-region-of-the-americas&Itemid=1926&lang=en

Perspectives on the Role of PAHO in promoting Human Resources for Health management during the pandemic IFMSA Delegation to the 58th Directive Council, 72nd Session of WHO Regional Committee for Americas

Healthcare providers are currently facing one of the most difficult times for humanity that has deeply impacted our region and Pan American Health Organization (PAHO) Member States in several aspects. The ongoing global health crisis has inflicted significant strain on our health systems and entailed unprecedented health measures. As the future health workforce, we support and highlight all of the PAHO efforts and leadership through the COVID 19 response. However, we do perceive opportunities for improvement and further advancement both at the regional and national level. As youth, we are strong advocates in the global movement for Human Resources for Health and we firmly believe that the quality and quantity of the health workforce play a significant role in our ability to cope with situations such as the current pandemic. We strongly believe that the four pillars and reinforcing lines proposed by PAHO are crucial in the improvement and progress of the current response. The pillars are: 1) Strengthening leadership, stewardship and governance; 2) Strengthening epidemic intelligence; 3) Strengthening health systems and service delivery networks; and 4) Strengthening emergency operations response and supply chain (Pan American Health Organization, 2020). As a Region we recognize that a strong health workforce as one of the building blocks of a strengthened health system (World Health Assembly, 2016), we therefore believe an important focus should be put on a human resources for health strategy and plan of action as mentioned in the third pillar. Adequate human resource management and empowerment must be implemented at local, national and international levels. Not only should their preparedness be ensured with

certified and accredited capacity building models, but also with resources, remuneration and implementation of health workforce plans supported by appropriate governmental investments. Member States should implement surveillance systems to ensure that healthcare workers and medical students during outbreaks, have access to appropriate biosecurity measures while performing their daily tasks. The COVID 19 pandemic has enlightened the need for health systems strengthening, especially in developing countries and countries with economies in transition that are experiencing critical health workforce shortages. This, added to high mobility and migration of the health workforce and poor employment conditions, are critical gaps that not only affect our response to the current health emergency, but also the resolution capacity of the health workforce itself. We believe Member States ought to reinforce investment in their health workforce as a key element of strengthening national health systems, and to provide adequate working conditions. As first line responders, the health workforce is crucial in adaptive response capacity and must be considered a priority. References: Pan American Health Organization (2020). COVID19 Pandemic in the Region of the Americas. 58th Directive Council, 72nd Session of WHO Regional Committee for Americas. https://www.paho.org/en/documents/cd586-e-covid-19 World Health Assembly. (2016). Global Strategy on Human Resources for Health: Workforce 2030. 69th World Health Assembly. http://apps.who.int/gb/ebwha/ pdf_files/WHA69/A69_R19-en.pdf

IFMSA Delegation to the 58th Directive Council, 72nd Session of WHO Regional Committee for Americas

María José Jaramillo Cartwright Regional Director for Americas

Javier Shafick Asfura RD Americas Elect

Yousra-Imane Benaskeur IFMSA Québec

Alvaro Josué Mazariegos IFMSA Guatemala

Mariana Martins

Christopher Nahuel Spina Mena

Kelan Wu

IFMSA Brazil

IFMSA Argentina

CFMS Canada

Read our delegation statements here 1

Human resources in health: The reasons for the crisis Natรกlia Federle and Marina Helena Godoy Univeristy Center of Maringa IFMSA Brazil

Human resources for health, according to the Pan American Health Organization (PAHO), are all people, from different professions and occupations, who work to improve the health of the population. This includes those who work as employees or as volunteers in the public and private sectors.

they need to travel kilometers away to reach their place of work, which can be exhausting. These areas tend to not be so attractive to the worker and their family. Countries in the African and Southeast Asian regions have 10 to 15 times less healthcare workers than the European regions and the Americas.

According to data analysis (WHO, 2016), the regions that present low average density of health workers per population are Africa, Southeast Asia and the eastern Mediterranean. Current data estimates that there will be a global shortage of 12.9 million health workers by 2030. A global health workforce crisis has been alarmed in these locations. Due to the large gap between healthcare workers and the population there is a deficit in health care, making these regions more vulnerable. The main reasons for fewer healthcare workers in these regions are rural locations without resources, population ageing, and the lack of investment in producing new professionals, especially in countries experiencing economic crises, wars and natural disasters.

According to the UN the global number of elderly (60 years or older) is projected to increase from 962 million in 2017 to 1.4 billion in 2030. This age group has the highest growth rate in the world. With the increase of age, more age associated problems will become more prevalent, such as urinary incontinence, falls and fractures, depression, insomnia, dementia and immobility syndrome. In these circumstances, patients need to receive daily care in prevention and promotion of health by different specialists, such as physicians, nurses, psychologists, physiotherapists, among others. Many of these elderly people live in less developed regions (about 64% of the total elderly), which hinders accessibility to human resources in health. With the ageing population, there will be a significant increase in the demand of these health care professionals. To meet the needs of the people new differentiated treatments and patterns of care are required as well as changes in competencies of health professionals.

In most remote places, there is a shortage of human resources in health because there are poor healthcare systems and structures which are necessary for the best quality healthcare. Important hospital equipment is scarce such as imaging exams x-rays, ultrasound and computed tomography, and laboratory tests. In addition, some places are so poor in resources that they do not even have a bed or a basic suture material. Another issue is the poor standard of living in the disadvantaged regions. The healthcare workers do not want to be subjected to living in an area without basic sanitation and hygiene, treated water, and good infrastructure. Oftentimes,

In addition to the aforementioned causes, there is also the question of countries that live in crises, civil conflicts, and natural disasters. These

undergo several socio economic difficulties, this is reflected in the lack of investments in the areas of safety, health and education. Education is essential for the development of a country. However, in contexts of war and disaster, about a third of young people are out of school (UNICEF â&#x20AC;&#x201C; United Nation Childrenâ&#x20AC;&#x2122;s Fund, 2018). Countries in these situations end up having no resources to invest in basic elementary or secondary education, much less higher education. This interferes directly with the development of professions from all areas, including health. There is a crisis of the health workforce, and these countries will need voluntary help from other governments and institutions to adequately care for the population. There are international humanitarian organizations that offer health support to regions facing epidemic situations, wars, economic crises and natural disasters. Among them are The Red Cross, the Red Crescent and Doctors without Borders. These entities provide outpatient consultations, vaccines against the most prevalent diseases, physical rehabilitation and nutrition programs, food products, treated water and basic sanitation, hygiene articles, basic medical materials, among others. This is only possible because of donations from ordinary citizens, corporate partnerships with private and governmental sectors, philanthropic events, and contributions from the volunteer health workers. There is also direct assistance from countries, which are linked to the UN, who participate in missions such as the United Nations Stabilization Mission of Haiti after the Earthquake (2010) and Hurricane disaster (2016) . Military troops from Brazil and 15 other countries were sent to reestablish the security and institutional normalcy of Haiti. However, it is possible to observe that despite su-

pport of these institutions and countries, there is still a global deficit in human resources in health. Great interventions are needed to solve the global crisis. This can be done by:

promoting equality in the distribution of professionals through governmental financial incentives or spreading awareness about the profession in healthcare in academic institutions. Another intervention is to introduce improvement programs in caring for the elderly in medical homes and universities. A way to solve armed conflicts, mitigate epidemic situations, catastrophes and economic crises would be for external countries assist with both financial resources and human resources. Human resources in health are essential to the continuous development of communities and whole regions.

References: Chaimowicz, F. (2013) SaĂşde o idoso. (Second Edition). Belo Horizonte: Universidade Federale de Minas Gerais. https://sbgg.org.br//wp-content/uploads/2014/10/saude-do-idoso-2edicao-revisada.pdf CICV (2020). O Movimiento. CICV. Retrieved on September 9th, 2020 from https://www.icrc.org/pt/o-cicv/o-movimento.

More references:

Humanity: a scarce finding Doctors have many faces, uniforms, stigmas; and yet, they are known as humans who lack a critical trait. From the stone ages, until our current decade, doctors have been portrayed in innumerous ways from the ones who wore beak-like masks during the Black Plague to doctors working in clinics nowadays. They are the ones responsible for saving a life or the ones to blame for not trying hard enough to keep their patients alive. Nonetheless, after countless medical school years that are required to make an excellent, competent and responsible doctor, they are still criticized for failing to deliver the most important medical characteristic: humanity. The sole purpose of medicine is the active practice of one individual helping another, therefore, why is it that we need to humanize their attitudes when compassion is supposed to be a natural human trait (Cristina et al., 2007)? Well, the answer is precisely, that medicine has lost its a r tis-

Milena Fernandez Mezei Universidade Anhembi Morumbi IFMSA Brazil

tic side. Due to the overwhelming amount of high standard technology, compassion and altruism have taken the back seat (Cristina et al., 2007). These essential aspects have been replaced with millions of possible diagnoses that require thousands of exams/screening tests and a few hundred consults all to just look a patient in the eyes and give them the time of day. Even though medicine has evolved and guaranteed more results due to the advance in technology and equipment available to physicians, the doctor-patient relationship has taken a toll and began to crumble into pieces that lack selflessness and consideration. This situation has needed such drastic adjustments that universities are now proposing to change their curriculu ms in order to train future

physicians the ability to develop bonds with their patients, and, therefore, practice an integral medicine (Costa & Azevedo, 2010). Only then, the patients will not be seen as illustrative figures but someone who is in actual need of help and needs to be understood as such. Consequently, albeit the innumerous advances in technology, a treatment’s success depends, essentially, in the relationship between these two parties, where trust, reciprocity, compassion, and authority (never corroborating to submission), are fundamental factors in establishing these connections (Barsanti, 2007).

Blasco argues that the medical negligence, often described by patients when unsatisfied with the care provided, has a direct implication on the dissatisfaction between the physician’s self and technology, knowledge and the patient (Blasco, 2011). Nevertheless, the issue deliberated consists of a human obstacle, not a technological one (Blasco, 2011). Bernard Lown claims that medicine has never had the capacity to influence humankind as much as it does nowadays, yet, patients have never been so disillusioned with their doctors (Cristina et al., 2007). According to a study, done in 2018, by the Mayo Clinic “found that when patients are first describing their main medical concern, physicians interrupt patients within 11 seconds on average” (Seppälä, 2019). Meaning doctors are less interested in what patients have to say than they are in actually just speaking their mind, however, medicine is the work of helping others which includes the work of listening to your patient.

Although there has been commotion into bringing the human aspect back to doctor-patient relationships, the crucial matter that must be taken under consideration is how to reassemble the concept of humanity. Humanizing medicine goes beyond the lines of proximity, longer appointments, eye contact, active listening and collaboration. It actually goes a lot further than the time of appointment made by the doctor in his/her office or any other actions being Patients tend to walk into an emergency room taken nowadays. or doctor extremely anxious or scared of the results of their exams and if doctors do not have The concept of humanity is inserted into the the courtesy of being gentle to their patients’ universe of medicine as a global, effective ser- feelings, then that hurts the patients more than vice, complying with the patient’s condition. it helps. When you throw a bunch of medical Along with a sharp and complete examination, jargon at a person that knows nothing about followed by exams, diagnosis, treatments and medicine then it’s as if the patient is listening post-treatment care (Mitri, 2016). It revolves to another language. The patient needs to feel around the act of healing and constantly moni- understood as well as understand. Therefotoring the patient as a whole, providing aiding re, it doesn’t matter how many facts a doctor and guidance throughout the process with knows, if they can’t express to a layman what the support of a multidisciplinary team (Mitri, is happening in a way they will understand, it 2016). It’s imperative to highlight that this pro- really doesn’t matter how much information a cess incorporates the health of every individual doctor knows. that requires any medical attention, including health care workers, which are often perceived To get a better understanding of the public as an unaffected public group. service offered by doctors, Conselho Federal De Medicina did research As considered by Pablo Blasco, that discovered that 92% The primary step in having a of Brazilians would rate more humanitarian system is public and private medical services in Brazil acknowledging that doctors as either horrible, bad are the first that need to be or fine (corresponding humanized (Blasco, 2011). to grades 0 to 7 out of 10) (Conselho

Federal de Medicina, 2014). Consequently, this exemplifies how we have lost the vision of the sick man. Sickness isn’t just about the individual and the coldest from doctors’ attitudes shows ignorance in relation to the insecurity, panic, suffering that the patient is going through (Decourt). Thus, in recent years the doctor-patient relationship has been a key focus

for improving the quality of health services. Returning to the title as “doctor” there is a need to place the patient in a position as active as the doctor, therefore, the patient’s complaints should always guide the patient’s care. Consequently, rethinking the patient’s place in this relationship would help target the humanization project of medicine (Caprara & Franco, 1999).

Humanity is more than a basic characteristic in the medical field; humanity is the base of health-care studies; it is just as important as the abilities and medical practices that are required in a graduate’s program. A self-reflective posture, as well as embracing the veritable philosophic exercise of the profession is the baseline in applying humanitarian actions, regardless of the particular area of specialization that is being focused on (Blasco, 2011). It’s about looking at the ill and not the illness. Therefore, the ultimate human resource for health, at this point, is simply bringing humanity back into doctor-patient relationships. References: Barsanti, C. (2007, August 29). A importância da relação médico-paciente. Retrieved August 30, 2020, from https://www.spsp.org.br/2007/08/29/a-importancia-da-relacao-medicopaciente/ Blasco, P. G. (2011, April). O humanismo médico: Em busca de uma humanização sustentável da Medicina. Retrieved August 30, 2020, from https://sobramfa.com.br/wp-content/uploads/2014/10/2011_mai_o_humanismo_medico_humanizacao_sustentavel_da_medicina.pdf Caprara, Andrea, & Franco, Anamélia Lins e Silva. (1999). A Relação paciente-médico: para uma humanização da prática médica. Cadernos de Saúde Pública, 15(3), 647-654. https://doi.org/10.1590/S0102-311X1999000300023 Conselho Federal de Medicina. (2014, August 19). Pesquisa revela que 92% da população está insatisfeita com a saúde no Brasil. Retrieved August 30, 2020, from https://portal.cfm.org.br/index.php?option=com_content Costa, Fabrício Donizete da, & Azevedo, Renata Cruz Soares de. (2010). Empatia, relação médico-paciente e formação em medicina: um olhar qualitativo. Revista Brasileira de Educação Médica, 34(2), 261-269. https://dx.doi.org/10.1590/S0100-55022010000200010 More references:

Work as a determining factor in the health-sickness process in the daily life of the Brazilian Community Health Agents. José Vinícius Bezerra de Moura IFMSA Brazil Universidade de Pernambuco (UPE)

In Brazil, the Family Health Strategy (Estratégia de Saúde da Família - ESF), which replaces the Family Health Program (Programa de Saúde da Família - PSF), emerges as an attempt to establish changes in how health is seen within the Unified Health System (Sistema Único de Saúde - SUS): the ESF seeks to put into practice the concept of health of the World Health Organization (WHO), which defines it no longer as a simple lack of disease, but as “a state of complete physical,

mental and social well-being” (WHO, 1947). Within the Strategy, the figure of Community Health Agents (Agentes Comunitários de Saúde – ACS) is of fundamental importance. These professionals act as a link between the community and the ESF, combining both popular and scientific knowledge. Their actions, as described by Brazil’s Health Ministry (1997), involve frequent home visits, monitoring the health of the assisted families, development of actions that seek integration between the ESF team and the community, activities for health promotion and surveillance, disease prevention as well as guidance on the use of health services. As can be seen, these Agents have a very wide range of activities, all of which are extremely necessary to ensure community access to health care. However, due to their importance, a series of physical, mechanical, chemical, biological, cognitive, psychological, social and environmental workloads are placed upon them. A study made by Almeida, Baptista and Silva (2016) with 137 ACS that work in Caraguatatuba (in São Paulo) has identified 140 workloads present in the routine of these workers. Among those, there is a prevalence of mechanical loads over the others, representing 55% of complaints, followed by biological ones, corresponding to 16.43%, all of which can be extremely damaging to the ACS. In order to understand the situation to which these workers are subjected, it is necessary to make a historical tracing of the great majority of the Brazilian communities. Emerged without prior planning, these sites often have

a high population density, with more houses nized and valued by their own companions. than the territory could support. The territory, too, is another factor: the great majority is in This problem of lack of recognition and appreslums, with very steep slopes and sliding risks. ciation is not unique to the work environment. The government itself fails in this matter, which There is yet another aggravating factor for this can be perceived in the low salary attributed to situation: the lack of public policies aimed at these professionals and in the deficiency for perthese places. Most governments do not give sonal protective equipment, such as uniforms their attention to low-income communities, and sunscreen, not offered, as they should be. which ends up depriving them of basic needs, such as adequate basic sanitation – for exam- A social theme that exerts enormous negatiple, the issue of sewage and garbage, situations ve force on these professionals is the violence that are present in these communities’ daily life. present in the communities in which they work. And when we speak of “violence” we do not Through all these factors, it is possible to only talk about the shootings and armed people understand a part of the loads to which the found in these places, but also about violence ACS are submitted. In their work routine, they within people’s homes - cases of men who athave to walk great distances on foot carr- tack their wives and children, for example -, siying weight and having to climb hills or walk tuations of sexual violence, mainly suffered by through terrain of difficult locomotion, which the female Agents and also violent acts comgreatly hinders their work. In addition, we mitted by the local residents themselves when can mention environmental issues of Bra- their needs are not met as they were expecting zil itself: the sun and heat, quite common in and end up discounting their anger and frusmost part of the country, are also aggravating. tration in the ACS, both verbally and physically. Considering all of those, it is understandable Psychological loads are also present in the daihow damaging the work of a Community Heal- ly life of these health professionals. As much th Agent can be for their own health. Problems in joints, pains all over the body, spots on the skin resulting from excessive exposure to the sun without protection – which can lead to skin cancer –, risk of developing infectious diseases transmitted by the population are some of the various health problems that can affect ACS. Issues inherent in health posts to which these Agents are attached can also be listed as grievances in their well-being. Many health centers do not have the right physical structure to function - whether it is a lack of materials, a small space or a lack of rooms, to name a few problems - or the professionals who work there cannot live in harmony. In these disharmonious spaces, strong hierarchical relations predominate and it is the ACS (who occupy a position of base in these relations) those who suffer most from this, since it does not have their work recog-

of the work of the ACS involves home visits, very strong bonds are formed with the people visited, who end up using these professionals as a psychologist, someone with whom they can talk and tell all their problems. Here the question of empathy comes into focus, because the ACS put themselves in the place of the other and end up taking their pains for themselves. However, unlike the people served who use the Agents as an escape mechanism, the Agents themselves have nothing similar: there is no one to take care of those who dedicate their lives to taking care of others. Work-related stress emerges, then, as a problem and deserves special attention because it acts as a “trigger” that can set off a series of other complications. According to Rosario and Vasconcellos (2008), these can go from physical symptoms, such as hypertension, digestive problems, low immunity, to psychological symptoms such as anxiety, insomnia and depression. Stress can alter not only the work efficiency of these professionals, but especially their quality of life. Frames of continuous occupational stress also lead to the development of Burnout syndrome, characte-

rized by a physical and emotional exhaustion that leads to loss of identification of the worker with its work activity and with itself. To have an idea of how critical the situation is, in 2013, all the ACS of a city in the countryside of Minas Gerais were diagnosed with Burnout - half of them had already showed signs of loss of identity (Barroso & Guerra, 2013). Because of the facts mentioned, one can understand how influential the work of someone in your life is. When one analyzes all the demands required of a worker, together with the means offered for him to carry out his activity and temporal issues, it is possible to characterize work as a crucial determinant in the health-disease process, as shown by Cardoso (2015). If all these factors are in an imbalance, the negative consequences will overlap with the positive ones in order to bring losses. In the case of Community Health Agents, these losses go beyond the individual sphere and fall into the community, since, as mentioned previously, they are responsible for the direct link between population and community.

References: Almeida, Mirian Cristina dos Santos, Baptista, Patricia Campos Pavan, & Silva, Arlete. (2016). Workloads and strain process in Community Health Agents. Revista da Escola de Enfermagem da USP, 50(1), 93-100. https:// doi.org/10.1590/S0080-623420160000100013 Barroso, Sabrina Martins, & Guerra, Adriane da Rocha Pereira. (2013). Burnout e qualidade de vida de agentes comunitários de saúde de Caetanópolis (MG). Cadernos Saúde Coletiva, 21(3), 338-345. https://dx.doi. org/10.1590/S1414-462X2013000300016 Brasil. Ministério da Saúde. (1997). Saúde da Família: uma estratégia para a reorientação do modelo assistencial. Retrieved from http://bvsms.saude.gov.br/bvs/ publicacoes/cd09_16.pdf Cardoso, Ana Claudia Moreira. (2015). O trabalho como determinante do processo saúde-doença. Tempo Social, 27(1), 73-93. https://doi.org/10.1590/0103207020150110 More references:

A call for an intersectoral Caribbean coalition for Human Resources for Health (HRH) development Nikolai J. Nunes & Toni-Ann Mundle Faculty of Medical Sciences, Mona Campus, The University of the West Indies JAMSA-Jamaica

Human Resources for Health (HRH)

The University of the West Indies (The UWI)

Human Resources for Health is defined by the World Health Organization (WHO) as ‘all people engaged in actions whose primary intent is to enhance health. (WHO, 2006) The Health Workforce is one of six building blocks of Health Systems and is a critical bottleneck in improving systems and their outcomes. Today, we are entrenched in a global health workforce crisis in terms of numbers, training, and distribution. This is magnified by the projected growth of our current shortage of 7 million health workers to 18 million by 2030. Health workforce development is directly related to health system performance, consequently, restructuring and revitalizing the health workforce is key amongst WHO’s Global strategy on HRH: Workforce 2030 goals. At the national level, HRH issues encompass governance, financing, planning and projections, regulations, evolving HWF demography, migration, shortages, imbalanced geographic distribution, education and continuous professional development, and information systems.(WHO, 2016)

The regional university, The University of the West Indies (The UWI) consists of approximately 50,000 students across 4 physical campuses in Jamaica, Trinidad, Barbados, and Antigua, as well as a virtual campus (Open Campus). The UWI has and continues to provide most of CARICOM’s human resources for health. There are three health professions campuses in Jamaica, Trinidad, and Barbados, as well as a school of clinical medicine in the Bahamas which produces multidisciplinary health care professionals at both undergraduate and postgraduate levels. The 2006 WHO annual report, ‘Working Together for Health’ cited UWI as a successful example of regional training given that one institution serves several countries.

The Present: National and Regional HRH Challenges

The dawn of the 21st century saw The UWI dramatically increase its student intake, as much as three-fold. Today, approximately 500 physiThe Caribbean Community cians, are produced per annum across The UWI (CARICOM) leading to a surplus of junior doctors but paradoxically a shortage of specialist doctors as a The Caribbean Community, CARICOM, consis- result of not enough post-graduate training poting of twenty nations (15 members and 5 as- sitions. In addition to the shortage of specialist sociates), are majority English-speaking, stret- doctors both in terms of posts and inequitable ching from the islands of the Bahamas in the distribution there is also now a shortage of north to the South American nations of Guyana junior doctors. This is a result of outdated huand Suriname. CARICOM nations comprise of man resources assessment, planning, policy, over 16 million citizens, with 60% being youth. and structure that stretches as far back as the (CARICOM, 2019) 1970s ultimately leading to an inability in retai-

ning both junior and specialist doctors. However, HRH issues must be addressed holistically and multidisciplinary and thus that includes our interprofessional health workforce colleagues. This applies especially to our nurses who make up our largest health workforce cadre in terms of both production and migration. Nursing supply can barely keep up with demand, such that it seems that the Caribbean produces nurses for export. While most of the regional research into health workforce migration centers on the nursing workforce, the research outcomes can be extrapolated to physicians and other health workforce cadres. Research by PAHO on Caribbean health workforce perceptions and migration identified better working/employment conditions (45%) as the number one reason for migration followed by better financial/economic opportunities (25%), Better educational/training opportunities (15%) and too much bureaucracy (7%) as the other major reasons. (PAHO, 2019) The double burden of disease of the epidemiological transition from infectious diseases to NCDs coupled with high levels of violence and trauma in our LMIC region has almost overwhelmed all levels (primary, secondary, and tertiary) of the health system leading to overworked and underpaid health workers who are under-resourced. Concomitantly, the current COVID-19 pandemic has ruthlessly exploited these systematic structural weaknesses and inequities.

PAHO’s Plan of Action on Human Resources for Universal Access to Health and Universal Health Coverage 2018-2023 proposes three strategic lines of action: Strengthen and consolidate governance and leadership in HRH. Develop conditions and capacities in HRH to expand access to health and health coverage, with equity and quality. Partner with the education sector to respond to the needs of health systems in transforming towards universal access to health and universal health coverage.(Pan American Health Organization, 2018) IFMSA’s Policy Document for Global Health Workforce was adopted at March Meeting Egypt 2018 and Global Health Workforce is a Focus Area on IFMSA’s Global Priorities 2019/2020. Human Resources for Health was adopted as an Americas Regional Priorities in AmRM 2019 Ecuador with both internal and external goals, and the Regional Implementation Plan for HRH adopted at August Meeting Taiwan 2019

Internal goals 1.1

To promote interdisciplinary collabora-

Potential solutions for the future: Social tion and educate medical students about the

Accountability in Health Professions Educa- importance of collaboration between different healthcare professions to strengthen the healtion and Interprofessional Education th workforce. 1.2 To spread awareness about the topic of Human Resources for Health to the members of the Americas Region and provide them with the tools and resources to actively work on it. External goals 1.1 To collaborate with other student-led organizations in the Americas Region in addressing the issues that the health workforce are facing. 1.2 To actively advocate for better working conditions for interns and the young health workforce in external meetings. 1.3 To involve members from the Americas in

the process of developing updated and com- Caribbean coalition on HRH development prehensive regional policy documents on hu- and the role of Meaningful Youth Particiman resources for health. (IFMSA, 2019) pation in national and regional policy deSocial Accountability in Health Professions Education will be important in addressing the critical shortages and issues in retention of physicians in primary health care and in rural and underserved communities and socially accountable admissions policies will help address structural inequities in medical school admissions. Research shows that future physicians recruited from rural and underserved communities are more likely to return to their communities to practice. Socially Accountable curricula that include topics such as social determinants of health and health inequity are necessary to educate tomorrow’s physicians today. (IFMSA, 2018) Of note, is the Faculty of Medical Sciences (FMS), Mona Campus, UWI Jamaica which has now formally incorporated the principles of social accountability and interprofessional education into its mission, vision, and strategic plan. In 2019, the FMS Mona through Government of Jamaica sponsorship admitted 47 rural and underserved medical students who as part of their socially accountable admission would return to and serve their communities following their graduation from medical school.

The future: The need for an intersectoral

velopment and implementation

The strategic policy framework exists to tackle the Health Workforce crisis globally, regionally, and locally. However, the question is, has this ongoing crisis ever been tackled holistically from medical school admissions through to postgraduate specialization programs? To this end, the authors call for and propose to establish an intersectoral Caribbean coalition for physician Human Resources for Health development in the first instance that comprises all stakeholders: PAHO, CARPHA, Governments led by their respective Ministries of Health, academia through The UWI, and physician associations and unions such as the Jamaican Medical Doctors Association (JMDA) and the Trinidad and Tobago Medical Association (TTMA), to contribute to the development of a comprehensive regional physician HRH policy from admissions to specialization. However, we must not forget perhaps the most important stakeholders of all; our health professions students and youth! IFMSA’s Policy Document on Meaningful Youth Participation was adopted at March Meeting Tanzania 2017 and is a Focus Area in both IFMSA’s Global Priorities 2019/2020 and

IFMSA Americas Regional Priorities. This is a policy document requires that individuals (health professions students and youth) are entitled to participate in the decisions that directly affect them, including design, implementation, and monitoring of interventions.(IFMSA, 2017) Therefore, it would be most fitting if the driving force for this advocacy coalition would be a cross Caribbean collaboration of NMOs and medical students’ associations led by the Jamaica Medical Students’ Association (JAMSA) and the Trinidad and Tobago Medical Students’ Association (TTMSA). Students are viewed as future professionals and members of the workforce, but health professions students occupy a unique space. We are both student and professional, student and workforce. As apprentices we are members of the current health workforce; members of the multidisciplinary health care team. As members of the current health workforce it is essential that we not only have seat at the intersectoral health systems table, but also that our voices are heard as valued stakeholders in the whole of government, whole of society partnership. It is past time that students and youth claim our seat at the development table and have our voices heard and our input valued.

References: CARICOM. (2019). Who we are. CARICOM. Retrieved on September 9th, 2020 from https://caricom.org/ about-caricom/who-we-are PAHO (2019) Health Workforce Migration and the Caribbean Region. PAHO Department of Health Systems and Services. https://www.paho.org/en/file/70717/ download?token=kAcUe4Es PAHO (2019) Health Workers Perceptions and Migration Caribbean Region. PAHO Department of Health Systems and Services. https://www.paho.org/en/ file/70717/download?token=kAcUe4Es Pan American Health Organization (2018). Plan of Action on Human Resources for Universal Access to Health and Universal Health Coverage 2018-2030. 56th Directing Council, 70th Session of the Regional Committee of WHO for the Americas; 23-27 September 2018; Washington DC: PAHO 2018 (Document CD56/10 Rev.1). Available from: https://www. observatoriorh.org/sites/default/files/webfiles/fulltext/2018/CD56-10-e-PoA-HR.pdf IFMSA. (2017). IFMSA Policy Document: Meaningful Youth Participation. International Federation of Medical Students’ Associations, 66th General Assembly August Meeting, Tanzania. Retrieved from: https://ifmsa.org/wp-content/uploads/2017/08/ GS_2017AM_Meaningful-Youth-Participation.pdf IFMSA. (2018). IFMSA Policy Document: Social Accountability in Medical Schools. International Federation of Medical Students’ Associations, 67th General Assembly March Meeting, Egypt. Retrieved from: https://ifmsa.org/wp-content/uploads/2018/03/Social-Accountability-In-Medical-Schools.pdf IFMSA (2019). IFMSA Americas’ Regional Implementation Plan Human Resources for Health. International Federation of Medical Students’ Associations, Americas Regional Meeting 2019. Retrieved from: https://docs.google.com/document/d/1nOg1Tq43kQWdLGKOxN7k70DxvWJWl894zpjWz8NI0RA/edit WHO. (2006). The World Health Report: Working together for Health. WHO Press, World Health Organization. https://www.who.int/whr/2006/whr06_en.pdf?ua=1 WHO (2016). Global Strategy on Human Resources for Health: Workforce 3030. WHO Press, World Health Organization. https://apps.who.int/iris/bitstream/ handle/10665/250368/9789241511131-eng.pdf?sequence=1

Human Resources in Indigenous Health in Roraima, Brazil Narottam Sรณcrates Garcia Chumpitaz1 Vitor Ernesto Caliari Mota1 Mayara Floss2 1 Universidade Federal de Roraima 2 Wonca Working Party on Rural Practice / WONCA Environment IFMSA Brazil

The state of Roraima, located in Brazil, is nationally recognized for its triple border, cultural diversity, natural beauty, and also because a large part of its area consists of indigenous territory and environmental preservation, occupying about 46.37% of the total territory1. Historically, the contact between natives of this land, whether children, teenagers, adults and the elderly, with non-indigenous people who came to Roraima was due to conflicts of interest to a lesser or greater degree; on the other hand, it resulted in miscegenation forming a large part of the Roraima population. The purpose of this piece is to briefly discuss indigenous lands and peoples and the emergence of health in relation to mining in the region of Roraima.

among the Yanomami of Surucucus2,3. In 2020, the situation of indigenous peoples, in particular the Yanomami, is not different. According to the Brazilian Socio Environmental Institute (Instituto Sรณcio Ambiental - ISA) in partnership with the Federal University of Minas Gerais (Universidade Federal de Minas Gerais - UFMG), it is estimated that, currently, around 20 thousand gold miners are in the Yanomami Indigenous Land3. It is worth mentioning that with the COVID-19 pandemic, this situation is even more aggravated, since the constant contact with non-indigenous people increases the contamination within these communities close to the mining sites. According to data from the Coordination of Indigenous Organizations of the Brazilian Amazon (COIAB), until 06/09/2020, over 2,600 confirmed cases of Coronavirus were recorded in over 70 indigenous peoples affected by the pandemic 4.

A problem that has marked the history of Roraima, especially that of indigenous peoples, is illegal mining. In 1975, the discovery of cassiterite ore in Serra dos Surucucus led to a large number of prospectors to the heart of the Yanomami territory in Brazil. The Yanomamis are an indigenous ethnicity, whose land is the largest in Brazil, with over 9 thousand hectares For UFMG and ISA researchers, this contamidistributed between the states of Roraima and Amazonas, and is home to 26,780 indigenous people. The illegal and uncontrolled presence of miners in the region resulted in conflicts between indigenous and non indigenous, as it inserted pathologies like tuberculosis, STIs, flu outbreaks and deaths

nation by COVID-19 is considered as a new genocidal wave against the Yanomami who live in the lands that are being explored by mining, as the Yanomami are classified according to the analyzes of a study produced by UFMG and ISA as “the most vulnerable people to the pandemic in the entire Brazilian Amazon”. In addition to the pandemic spread of COVID-19, there is also environmental degradation resulting from the action of illegal mining: water contamination and groundwater, deforestation, silting of rivers, contamination of the land and water by mercury and fuels causing poisoning of animals and people3,5. In addition to their rights guaranteed by the federal constitution having been harmed for years by illegal mining, the federal government itself, in particular the statements by the President of the Republic Jair Bolsonaro, expresses support for mining in indigenous lands. Raoni Metuktire, indigenous leader of the Caiapó ethnic group, affirms that “Bolsonaro takes advantage of Coronavirus to eliminate indigenous people”. But he also mentions “the precariousness of health care” to its people, whose mortality is twice as high as among the rest of the population, affecting children, including babies, due to weaker immunity 7. Regarding gold mining activities in Roraima, the State Government has been taking positions that are not favorable for the rights of indigenous peoples and environmental law. In October 2019, there was an assembly to

implement the legalization of mining in Roraima. But also, the federal government directly encourages the work of illegal mining: in one of this speeches, the president of Brazil points out that “In Roraima, there are trillions of reais underground. And the Indigenous has the right to exploit this in a rational way, obviously. The indigenous cannot continue to be poor on rich land “, while presenting, through a live broadcast on his Facebook page, the possibility of communities to develop mining and agricultural activities in their territories in May 20198,9. In this context, a bill 191/20 was drafted by the federal government’s initiative and meets the statements of President, which defines specific conditions for the research and mining of mineral resources, such as gold and iron ore, and hydrocarbons, such as oil and natural gas; and for the water use of rivers to generate electricity in indigenous reserves10. Thus, even with a change in the project, its tends to significantly impact the health of this population. These works generate a migratory influx; create an environment that is favorable to the intensification of disputes over the possession and control of land and territories; accelerate the deforestation process for the implantation of monocultures; have a systemic impact on the food chain, especially that of fish; they introduce new pathogens and vectors (of great current importance due to COVID-19), or they interfere in the process of dissemination of malaria, leading to an increase in the incidence of this and other infectious diseases; and are associated with the exponential growth of STI cases (sexually transmitted infections). According to the National Health Foundation (Funasa), the morbidity and mortality rates of Indigenous are three to four times higher than the rates of the Brazilian population in

general. A large percentage of indigenous children still die from simpler problems such as intestinal parasitosis and malnutrition11. Furthermore, the contact with non-indigenous with indigenous could be a risk, mainly of isolated and remote communities and need to be regulated avoiding contacts with religious interests, like Ethnos360, an evangelical Christian

missionary group12. Thus, the contact of non-indigenous people with native peoples is a health emergency and receives attention from professionals in the area. In addition, there are few references on the topic and it is up to us, academics, to be defenders of these human rights through research and knowledge dissemination.

References:

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1. Portal do Governo do Estado de Roraima. (2020, Jun 20). RORAIMA. https://web.archive.org/ web/20070702215729/http:/www.rr.gov.br/roraima. php?area=dados

5. BBC News. (2020, Jun 20). Covid-19 pode infectar até 40% de indígenas yanomami em aldeias vizinhas a garimpo, diz estudo. https://g1.globo.com/bemestar/ coronavirus/noticia/2020/06/02/covid-19-pode-infectar-ate-40-de-indigenas-yanomami-em-aldeias-vizinhas-a-garimpo-diz-estudo.ghtml

2. Comissão Pró-Yanomami. (2020, Jun 20). Comissão Pró-Yanomami. http://www.proyanomami. org.br/v0904/index.asp?pag=htm&url=/apy/urihi/boletim_11.htm 3. G1 Globo. (2020, Jun 20). Garimpeiros podem levar coronavírus à Terra Yanomami e causar genocídio, diz procurador de RR. https://g1.globo.com/rr/roraima/ noticia/2020/06/04/garimpeiros-podem-levar-coronavirus-a-terra-yanomami-e-causar-genocidio-diz-procurador-de-rr.ghtml 4. COIAB. (2020, Jun 20). A COVID-19 adentra nas Terras Indígenas da Amazônia brasileira e o cerco se fecha para os povos indígenas isolados. https://coiab. org.br/conteudo/nota-p%C3%BAblica-159173458863

6. Conexão Planeta. (2020, Jun 23). Mapa inédito revela áreas de garimpo ilegal em terras indígenas e unidades de conservação na Amazônia. https://conexaoplaneta. com.br/blog/mapa-inedito-revela-areas-de-garimpo-ilegal-em-terras-indigenas-e-unidades-de-conservacao-na-amazonia/#fechar 7. UOL Rio de Janeiro. (2020, Jun 23). Bolsonaro ‘se aproveita’ do coronavírus para eliminar indígenas, diz Raoni. https://noticias.uol.com.br/ultimas-noticias/ afp/2020/06/05/bolsonaro-se-aproveita-do-coronavirus-para-eliminar-indigenas-diz-raoni-a-afp.htm

International Medical - Student Congress in Cardiology: a learning opportunity for human talent in health Laura S. Muñoz Pardo and Daniel F. Gutierrez V.l ASCEMCOL Colombia Universidad Pedagógica y Tecnológica de Colombia

A constantly evolving concept

Medical education is a concept that has been evolving over time; being one of the most important strategies when we refer to human talent in health, since it allows us to offer students, teachers, health professionals and all those people with a role in the area, an adequate professional growth that will impact their performance in their profession as well as in the care of other people. However, medical education has been threatened throughout history by different external and internal factors, which has led it to evolve and adapt to the challenges that the context entails. Currently, the SARS-CoV2 pandemic that causes COVID 19 has been one of these limitations for medical education and for the development of health personnel. Different educational institutions at all academic levels (preschool, primary, secondary and superior), closed in 188 countries around the world by May, interrupting more than 91% of the student population, because according to UNESCO (Ahmed, 2020) ; social distancing, the closure of campuses and the stop of practices in hospitals and other places, have led academics to adapt and seek new pedagogical strategies to work and study from home. (Sandhu, 2020) At the same time, undergraduate medicine students has been seriously affected, thanks to the fact that the academic content in the upper semesters is minimal, and practical activities cover the majority of the academic curriculum; In addition, government entities have made the decision to graduate students

early in some countries, like this reinforcing the public health emergency but leaving aside the well-being of health personnel. As a consequence, traditional education has been subjected to virtuality, which safely allows the entire academic population (students, teachers, essential staff) to advance theoretical content but not guaranteeing educational quality in all its forms. (Pather 2020)

C-MEIC strategy

International Medical - Student Congress in Cardiology C-MEIC (its acronym in Spanish for “Congreso Médico- Estudiantil Internacional en Cardiología”), is a future strategy born from the virtual conditions that world is currently facing; where student of health sciences, as well as the professional with a desire to know more about the subject under development, will have the opportunity to attend and interact in a series of sessions, where specialists in the topic will guide the main bases. Additionally, it focuses on a fundamental subject into public health problems of global importance, such as Cardiology, providing the opportunity to participants to boost their knowledge and obtain quality education during the pandemic. “Cardiology” is defined as the branch of medicine specialized in prevention, diagnosis, treatment and study of diseases belonging to the heart, blood vessels and circulatory system; which include acute myocardial infarction, heart rhythm problems and heart failure, among many others (WHO, 2020). Throughout the history of cardiovascular diseases (CVD), there has been an ever greater growth in its prevalence and an increase in its main con-

sequences, which the world population faces; which are directly related to an excessive increase in the population and its aging (Castellano, 2014). Global health is at high risk, given the frequency of CVD; the socio-economic contexts, the excess of bad nutritional habits, poverty, obesity and arterial hypertension that contribute to its increase (Callo, 2018). They occupy the first place in the burden of non-communicable diseases, with the highest global morbidity and mortality, especially in middle and low income countries, which corresponds to 30% of annual deaths, more than 43% of deaths cases of permanent disability and about 9% of temporary disabilities in many developing countries (WHO, 2020).

It is a duty of the State and a commitment of the entire population to work to strengthen each day the conformation of this group as well as its capacities to provide the service, not only guaranteeing the well-being of the population but also of all personnel.

According to the World Health Organization, CVDs produce the highest number of deaths each year compared to any other cause of death in the world (WHO, 2020). It is estimated that in 2012 17.7 million people died from CVD, of these deaths, about 7.4 million were due to coronary heart disease, and 6.7 million to cerebrovascular accidents, these being the most important cases in the development of the CVD; estimating that by 2030, almost 23.6 million people will die from one of these diseases (WHO, 2020). Human talent in health is defined by PAHO as â&#x20AC;&#x153;the basis of the health systemâ&#x20AC;? (OrtĂz Monsalve et al., 2013) thanks to its main characteristic of being the one that contributes directly to the development and equitable access to quality health services. It is a duty of the State and a commitment of the entire population to work to strengthen each day the conformation of this group as well as its capacities to provide the service, not only guaranteeing the well-being of the population but also of all personnel. Education for work and educational services represents a key tool to respond to the aims of academia, strengthening the principles, norms and providing skills to the staff to guarantee a comprehensive development, performance and exercise of human talent in health. The above mentioned constitutes a chain reaction, characterized by mutual help between health personnel and society in terms of the corresponding global well-being; Taking into account that training and guaranteeing quality education for students and peers leads to the improvement of the health systems of the countries, creating like this entities with greater capacity to face the obstacles that may arise, as is the case of the COVID-19 pandemic.

A melting point

Understanding these two components, medical education and human talent in health, the motivation is born to create a complementary strategy that will support the staff as it is focused on a global problem and that seeks to partially solve the crisis we are currently experiencing with medical education in times of

Reserve hospital Xla Boerhavegasse (Rudolfspital) Operation in the presence of interested doctors, around 1943 Photo taked of Unsplash Austrian National Library’s profile

pandemic. We firmly believe that C-MEICs will be a viable strategy to implement nationally and internationally; waiting, not only for its replication and support in our country, Colombia, but waiting for the C-MEIC to be able to adapt to many other specialties and context in the future, providing a solution through medical education to many other current health problems.This is how we faithfully believe that medical education represents a fundamental pillar of support for human talent in health; educating ourselves to educate and support those who in the future will be fundamental not only to face a health crisis like the one that the world is facing but also all areas of global well-being.

References Ahmed, H., Allaf, M., & Elghazaly, H. (2020). COVID-19 and medical education. Retrieved 30 August 2020. Callo, G., & Lessa Horta, B. (2018). Overweight trajectory and cardiometabolic risk factors in young adults. Revue D’épidémiologie Et De Santé Publique, 66, S314-S315. h t t p s : // d o i . o r g / 1 0 . 1 0 1 6 / j . r e s p e . 2 0 1 8 . 0 5 . 2 0 3

Castellano, J., Narula, J., Castillo, J., & Fuster, V. (2014). Promoción de la salud cardiovascular global: estrategias, retos y oportunidades. Revista Española De Cardiología, 67(9), 724-730. https://doi.org/10.1016/j.recesp.2014.01.024 World Health Organization. (2020). ¿Qué son las enfermedades cardiovasculares? Retrieved 30 August 2020, from https://www.who. int/cardiovascular_diseases/about_cvd/es. Pather, N., Blyth, P., Chapman, J., Dayal, M., Flack, N., & Fogg, Q. et al. (2020). Forced Disruption of Anatomy Education in Australia and New Zealand: An Acute Response to the Covid‐19 Pandemic. Anatomical Sciences Education, 13(3), 284-300. https://doi.org/10.1002/ase.1968 Sandhu, P., & de Wolf, M. (2020). The impact of COVID-19 on the undergraduate medical curriculum. Medical Education Online, 25(1), 1764740. https://doi.org/10.1080/10872981.2020.1764740 WHO (2020). Enfermedades no transmisibles. Retrieved 30 August 2020, from https://www.who.int/es/newsroom/fact-sheets/detail/noncommunicable-diseases. Ortíz Monsalve, L., Cubides Zambrano, J., & Restrepo Miranda, D. (2013). Caracterización del talento humano en salud: Hacia el sistema de información del registro único nacional del talento humano en salud. Superintendencia Nacional De Salud, 4, 63-68. Retrieved 31 August 2020, from https://www.minsalud. gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/ TH/Caracterizacion-talento-humano-en-salud.pdf.

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SCOME Medical Education

Story Behind Uniforms

The reflection of our soul, education and peace. Maria del Mar Saa Dorado Universidad Pontificia Javeriana de Cali ASCEMCOL Colombia

because we are believers, leaving the world a little better than we found it. We create, research, study and replicate ideas for our patients, we are prepare to do things for the love of art and our fervent dream Behind our uniforms, changing the that things can always be better with a world. We are dreamers that believe in smile. people, in genuine gestures, human rights, education, peace, gender equality, global health, love, ecology and great changes. The world needs us, This photo was taken in a rural indigenous school in Meta, Colombia, it reminds us how education should be our weapon, be the young leaders, not in the future, but now.

Taking action to achieve quality medical education in the new american context through pandemic Pedro J. Benavides R. and Ricardo J. Freile A. ASCEMCOL Colombia Universidad del Norte - Universidad de Antioquia

In the Americas and in the world, medical education during this pandemic has undergone important modifications for the new necessities of the population.

The pandemic has not only brought great problems, it has been able to force the change of the paradigm that was thought about education.

reness in this problematic through peer education. This aim to allow Colombian medical students understand their role and their mission in the construction of new educational models, always considering factors as:

The importance of social accountability in the medical education feedback process related to the limited access to new education systems. With the sanitary emergency, the educational differences have been increased in all levels, not only in university education. Understanding the economical, social and emotional factors of all the students is necessary This transformation can be attributed to the to generate proposals that are feasible for all great social impact caused by quarantine students, and not only for the privileged ones and sanitary preventions, that have exposed that count with all the facilities in their contexts. multiple problems in our american countries. Talking about the educational area in speci- The relevance of looking for quality fic, difficulties in the access to virtual content, education, counting if this implies the quality of this content and the impossibi- overhaul some process or preclulity of having clinical practices in hospitals des the process at all. The docare some issues in this context (Rabe et al., tor-patient relation is fundamental for 2020; Theoret & Ming, 2020). the medical practice (CeledĂłn L, 2016), consequently itâ&#x20AC;&#x2122;s important to consider the viaFrom the Standing Com- bility of eliminating this relation in our medical mittee of medical Edu- programs only for accomplishing a deadline. cation (SCOME) in the Colombian Associa- Check the different e-learning tion of Medical strategies and resources that Studentsâ&#x20AC;&#x2122; Scienti- can complement the educatiofic Societies (AS- nal strategies, always consideCEMCOL) some ring the capacity of access for the students, the orientation for strategies are maximizing their use for teachers and stumade looking dents, and the correct correlation between to create awathese resources and the medical practice.

Advocate for efficient evaluation methods, looking for measures of the quality of the educational strategies and the fulfilment of the objectives of the curriculum. This implies evaluation tests that guarantee enough time to resolve the test, but do not allow fraud. Maybe the world never comes back to normality, but these are the moments that take us out of our comfort zone, that help us to look for new forms to build medical knowledge. Just in this pandemic, we stand out our importance in the construction of new educational paradigms. Today, more than ever, we have a unique opportunity for all medical students to become aware of their learning process, to advocate and innovate with unorthodox methods necessary for the distance education has the best possible quality, in addition to seeking safe and efficient alternatives to return to face-to-face education.

“These are the moments that take us out of our comfort zone, that help us to look for new forms to build medical knowledge.”

References: 1. Rabe, A., Sy, M., Cheung, W. Y. W., & Lucero-Prisno, D. E. (2020). COVID-19 and Health Professions Education: A 360° View of the Impact of a Global Health Emergency. MedEdPublish, https://doi.org/10.15694/mep.2020.000148.1 2.Theoret, C., & Ming, X. (2020). Our education, our concerns: The impact on medical student edu-

cation of 591–592.

COVID-19. Medical Education, 54(7), https://doi.org/10.1111/medu.14181

3. Celedón L, C. (2016). Doctor-pacient relationship. Revista de Otorrinolaringología y Cirugía de Cabeza y Cuello, 76(1), 51–54. https:// doi.org/10.4067/S0718-48162016000100007

Theoretical and practical experience in Family Medicine: a student perspective Matheus Gaspar de Miranda UNIFACID/WYDEN IFMSA Brazil

semester, the approach of the family health strategy, addressing health care networks, valuing teamwork and multiprofessional. In the third, the perspective of health surveillance was performed, such as epidemiology, health, environmental and worker. In the fourth, health prevention with concepts and practices of cervical screening, breast cancer, chronic non-communicable diseases and sexually transmitted infections. In the fifth, attention to patients with expanded gaze, with care and clinical care centered on the The course has a differential in its curriculum, person of the important for the learning of physician m o s t education based on the person. The CFM skills integralize the areas of knowledge of PHC, in which it provides for the insertion to the public health service of this first semester. The principles of Family and Community Medicine (CFM) and the characteristics of Primary Health Care (PHC) are fundamental elements as skills to be learned for the training of the general practitioner. The medical course should be structured with a curriculum focused on this principled medical training, which permeates the initial eight semesters with theoretical-practical classes. The practical scenario is in PHC with medical teachers in the Health and Family Strategy, using active methodologies based on the competence of the students.

Formed by all areas of public health, it begins with the introduction of basic principles of primary care and notion of history of public health. In the second

common problems in PHC, including systemic integral approach in various dimensions arterial hypertension and diabetes of the person, in the various basic mellitus and communicable diseases. medical specialties; for good generalist medical training. Thus, the presence In the sixth, womenâ&#x20AC;&#x2122;s health was approached, of the discipline in the curriculum has such as attention to her diseases been of great value in the academic formation such as breast and ovarian cancer, gestational of its students. The perspective has process and comprehensive care for changed that the doctor is impartial, pregnant patients from diagnosis to post-par- addressing the human being, with tum. In the seventh, it was the management empathy and emotion of the student of children and adolescents in PHC since to integrate into clinical practice since. the puerperium, consultations of evaluation of neuropsychomotor development, growth and child nutrition. In the eighth, the focus is on the health of the elderly patient and the care of the aging process. In the internship, there is the internship of collective health, with the immersion of undergraduates in the development and improvement of all the concepts learned, promoting their insertion in clinical practice. The construction of students knowledge through immersion in public health provided them with a holistic and comprehensive approach with achievements of health protection and promotion actions, disease prevention, rehabilitation and healing of the individual within their context family and community. Besides motivating by the area because of the total care of the human being and not of the disease. It can be perceived that the practice was different by the

The construction of students knowledge through immersion in public health provided them with a holistic and comprehensive approach with achievements of health protection and promotion actions, disease prevention, rehabilitation and healing of the individual within their context family and community. Besides motivating by the area because of the total care of the human being and not of the disease.

The role of the teacher assistant in online classes Adapting to the new ways of medical education Monique Frank de Vasconcelos Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM) DENEM-Brazil

In Brazil, most college professors have help from maybe one or a few students for some classes. These students, called tutors, already passed their subject with great grades, and show interest in the professor’s department. Usually, these assistants help with practical classes, since it might be hard for just one teacher to check all the students by himself and also answer any eventual doubts. In my personal case, I am a pediatrician tutor and I help students practicing physical examination in children or newborns and its many details. I used to help as well at the hospitals and at the primary health care unit. However, due to COVID-19 pandemic, these activities were suspended for students, leaving tutors with with no practical activities to help.

contact us regarding any questions about the topic and/or the exercises. Our role is to help the students in any possible ways. Also, we discuss two articles per week with the students, in order to implement our knowledge and be always updated. Not only on the newest themes but also on topics we’re working at the time, which is extremely relevant to the practice.

We understand online classes are not easy, adapting to this new reality takes time. It is not ideal, but it’s what we have for now. The best thing we can do is making the most out of it and try to take this time to improve our knowledge as much as we can and explore new possibilities. Besides that, we can now watch online classes from the best professors in the field from all around the world without leaving As the world changes, we must go with the home. Let’s take this situation in our favor. flow and implement new ways to work. During this pandemic, we learned more about In conclusion, in one way or another, we are online classes, their ups, and downs. In order still helping students a lot. However, in my to still be able to help the students, we opinion as a tutor, we are learning way more now assist the professors in online classes. right now, because we must always be updaHence, our new job as a tutor is organizing ted to discuss the topics and to help virtually materials, preparing presentations and training with any doubts. It’s important to remember exercises, and discussing with the students we are not the professors, so it isn’t a proarticles about many present themes. blem if we do not know all the answers for the students’ questions and it’s fine to ask for Thus, once a month we, the tutors, prepare all help and to look for answers on the internet. the slides presentations the professors will So let’s use the lemons life has given use during their classes and also the practice us and make sweet lemonade out of them! exercises. We are available for the students to

Let´s learn together Angelo Estefano Moreno, Ayrton Alcívar Universidad San Francisco de Quito AEMPPI Ecuador

Albert Einstein said: “The important thing is not to stop questioning. Curiosity has its own reason for existing”. What will happen if there is no guide or chance to give answers to curiosity? The human being could have lost their unique opportunity in our universe. Therefore, education is our solution. It is the key to growing as individuals, and our path to reduce inequalities. In March, the Ecuadorian government decided to close all the schools in the country, in response to the detection of the first case of COVID19. According to UNICEF Ecuador, the disruption has left 4.6 million children in Ecuador without access to education. 3% of the student population are last year students, who must give an exam to get a public university quota. This exam may generate anxiety and fear in the youth population. Due to the closing of high schools, preparatory courses and the pandemic, national students may feel lost in the process. In response, our national committee developed a series of videos to help high school students with the subjects of anatomy and biology. The activity was named Let´s learn together. We wanted to show that they are not alone; that companion and

love could help to deal with this pandemic. The topics were selected according to the national curriculum. The series covered 26 lectures of anatomy and biology. They were created by 38 medical students from 12 medical schools, then reviewed by a biology professor and the NMO external team. Their mean duration is 15 minutes. They were published on YouTube according to the preparation dates for the national exam. One month later, the series got 2100 viewers. 47% of them have completed a video. The mean age of the viewers was 17 years old and they came from 21 different provinces of Ecuador. As medical students, we have given a little grain of sand to the solution.

We believe that education is our path for the future. It is the light of our human consciousness. We cannot lose the opportunity to ensure that everyone may have access to, because the knowledge learned today is the base of the development of the entire world. References UNICEF Ecuador. (2020, July). ¿Por qué los niños te necesitan? Retrieved from UNICEF.org: https://www. unicef.org/ecuador/s%C3%BAmate-la-respuesta-ante-el-coronavirus

Click here to see.

United Nations. (2020, August). Policy Brief: Education during COVID 19 and beyond. Retrieved from UN.org: https://www.un.org/development/desa/dspd/ wp-content/uploads/sites/22/2020/08/sg_policy_ brief_covid-19_and_education_august_2020.pdf

Teaching and experience of brazilian sign language as an instrument for medical education and improvement in addressing hearing disabled population - an experience report Luana Santos de Oliveira & Guilherme de Sousa Lima Federal University of Piauí IFMSA Brazil

A deaf population, which in Brazil totals almost 30 million people (Crevilari, 2017), needs a differentiated service and done by a qualified health professional. It is a demand that must be solved to comply with the principle of equity (Ministério da Saúde, 2017), established in the Brazilian health system. Therefore, it is of fundamental importance in the medical curriculum, national or worldwide, which requires adequate and continuous preparation on the mastery of the country’s sign language, since the official language does not meet all requests from a diverse society. Among the varieties of Brazilian communication, we have the Brazilian Sign Language (LIBRAS), created by the deaf community itself, and established by law as a legal means of communication and expression (Diário Oficial da União, 2002). In this context, its teaching to health workers is necessary to attend the deaf population, aiming at an effective health care.

Fig 1. Teachers and interpreters of the lenguage

deaf students who helped in the practices.

There was a wide demand (Fig. 2), to the point of enrolling students from other health courses, such as nursing and physiotherapy, and from other institutions, a fact that demonstrates both the need for this knowledge for With a view to better prepared students for all health professionals, and the lack of it in comprehensive care for deaf patients, the lo- the curricula, which it has already been evical IFMSA Brazil committee at the Federal denced in previous research (Dias, 2017). University of Piauí (UFPI) organized the first LIBRAS course aimed at health professionals, In the theoretical classes, relevant topics based on prior knowledge, that this is the sphe- were addressed, such as the types of deafre of greatest difficulty for this population. ness, the main difficulties faced, the importance of LIBRAS, and the grammatical rules The course took place between August and about the language. In the practical part, seDecember 2019, with a workload of 40 hours, veral essential signs were taught to enable distributed in 13 classes, with a theoreti- communication, as well as simulations of the cal and a practical part, in addition to a work main health situations, such as accidents, containing an intervention proposal aimed at childbirth, and emergency consultations. deaf patients. The classes took place at the LIBRAS Department at UFPI, taught by 2 tea- At the end of the course, in addition to knowing chers and interpreters of the language (Fig. more about both the deaf population and the 1), in addition to the participation of some Brazilian Sign Language, students were trai-

ned to establish effective communication with deaf patients, and have strategies, developed by the class itself, to better serve this audience. It is undeniable that LIBRAS has a unique importance for the health field, as communication is the basis of the doctor-patient relationship. This course proved to be a valuable strategy to reduce the barrier between the deaf population and the doctor. Although more actions are still needed to allow the inclusion of this population, the active performance of students, who makes difference, has a truly relevant impact.

REFERENCES 1. Crevilari, V. (2017, September 19). Quase trinta milhões de brasileiros sofrem de surdez. https://jornal. usp.br/atualidades/quase-30-milhoes-de-brasileiros-sofrem-de-surdez/ 2. Ministério da Saúde (2017, September 9). Princípios do SUS. https://www.saude.gov.br/sistema-unico-de-saude/principios-do-sus. 3. Diário Oficial da União (2002, April 24) Lei 10.436. “Dispõe sobre a Língua Brasileira de Sinais - Libras e dá outras providências.” http://www.planalto.gov. br/ccivil_03/leis/2002/l10436.htm 4. Dias, A., Coutinho, C., Gaspar, D., Moeller, L., & Mamede, M. (2017). Libras na formação médica: possibilidade de quebra da barreira comunicativa e melhora na relação médico-paciente surdo. Revista de Medicina, 96(4), 209-214. https://doi.org/10.11606/issn.16799836.v96i4p209-214

Fig 2. Students attending the course

“More actions are still needed to allow the inclusion of this population, the active performance of students, who makes difference, has a truly relevant impact.”

Taking action to achieve quality medical education in the new american context through pandemic Andrea Carolina López Cuello Universidad de Antioquia ASCEMCOL Colombia

With the aim of building knowledge around the members of the Standing committee on medical education, of growing as inclusive future health professionals and promoting activities in our educational training to generate national impact in vulnerable communities, highlighting the importance of high quality medical care in disabled people, and with the contribution of other committees to raise awareness about their rights and their inclusion in public health programs (where progress has been made but there is still a way to go); Colombian Association of Medical Students’ Scientific Societies (ASCEMCOL) set out to create active change not only as future doctors but as human beings.

petency role has been promoted, developing learning strategies about the need for social and communication skills with people in situations of disability, along with learning activities to eliminate the ignorance that has arisen during the years in medical practice; these correspond to training courses in sign language with an emphasis on medical terminology; searches for information for research purposes on the current global situation regarding coronavirus disease (COVID19) (replicating information pertinent to the disabled community, as well as providing new information) and on guidelines for the prevention of transmission by COVID19; an orientation and accompaniment project for the general About 15% of world population are people with and disabled population on COVID19; disabilities, therefore health personnel must and the production of academic bulletins. ensure compliance that people with disabilities have the right to enjoy the highest level of One of the projects with the greatest impact health without discrimination, abuse or was “EL MUNDO a través del tacto” which violence. We must fight for de-stigmatizing corresponds to a mini-booklet for caregivers the fact that having a disability is being sick, for of people with deafblindness; its objective their education and social protection, was to provide recommendations for turning them into agents who can assume civic responsibilities and health care with preparation (World Health Organization, 2018). Especially from medical education in ASCEMCOL, the improvement in the c o m -

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One of the projects with the greatest impact was “EL MUNDO a través del tacto” which corresponds to a minibooklet for caregivers of people with deafblindness; its objective was to provide recommendations for improving life quality of both.

improving life quality of both. The results were reflected in the appropriation of knowledge and competences of students to communicate with said population, this is part of the social responsibility of learning how to be a good doctor in actual society and the acquisition of skills for interaction in the clinical practice in the future and on a daily basis (Hernández Ríos, 2015). To summarize, the applicable and rewarding learning of a significant experience in medical training with the commitment and desire to keep growing as future professionals, in order t o

meet the expectations in a working life for the population with disabilities. Medical education in Colombia advances by strengthening itself with a greater interest, and contributing to the scientific culture with a social vocation, alliances to continue working on the fulfillment of the objectives every day by giving the best in our training. We should not forget that we can all be different, standing up for our human rights, which includes health; That is why today I invite you to leave excuses behind, suppress the barriers and create hope with love. Let us raise our voices and unite for a comprehensive medical education References World Health Organization. (2018). Disability and health.Retrieved 31 August 2020, from https://www.who. int/news-room/fact-sheets/detail/disability-and-health Hernández Ríos, M. (2015). El Concepto de Discapacidad: De la Enfermedad al Enfoque de Derechos*. Revista CES Derecho, 6(2). Retrieved from http://www.scielo.org. co/pdf/cesd/v6n2/v6n2a04.pdf

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This is us! Behind our uniforms, changing the world.

Maria del Mar Saa Dorado Universidad Pontificia Javeriana de Cali ASCEMCOL Colombia

Violence against women: how to help break the cycle? Rebecca C. Sanches R. & Marina Candido da Silva University Center Ingá - Uningá IFMSA Brazil

The increase in violence against women during the pandemic by Covid-19 was seen in Brazil due to social isolation. A survey conducted in 2019 by the Brazilian Public Security Forum in Brazil, showed that 16 million women over 16 years of age suffered some type of violence. In this context, it is extremely important to address the types of violence that women suffer, so that we can identify them, denounce them and guide the victim on possible ways to break this cycle.

Due to the relevance of this agenda in view of the current social context, we highlight the discrimination suffered by women shortened in social roles of a subdued minority, context of eroticization (direct incentive to rape) and domestic work, which was carried out an online activity through the YouTube platform. The class was lectured by a lawyer, which helped us achieve an interdisciplinary and comprehensive content on the subject exposed.

The increase in domestic violence during the new coronavirus pandemic has already been observed in some states of Brazil, due to the social isolation that provides risk situations, and the theme again has some notoriety in public discussions. However, gender-based violence did not come up with the pandemic.

An impact assessment was conducted through online questionnaires before and after the event, where students qualified themselves at levels 1 to 10 on their knowledge related to violence against women. Among the questions contained in the form were: 1. “Do you feel empowered to identify signs of violence against women?”; 2. “Do you know the types of domestic violence against women?”; 3. “Would you know which organs to call suspected violence against women? “.

A survey released in 2019 by the Brazilian Public Security Forum

pointed out that 16 million women over 16 years of age suffered some kind of violence in Brazil, and most of them in their family life.

In the pre-event questionnaire, the answers varied among all 10 levels, demonstrating a certain discrepancy among the students. In the post-event questionnaire, 100% of the answers were obtained, framing their knowledge between seven and ten, confirming the effectiveness of the class

on the points questioned, leading to the addition, there was an increase in theoretical achievement of the desired objectives. knowledge about victim support networks; and encourage the academic on The results of the activity were positive the biopsychosocial aspect of the given to the results through the action individual and a degree of training on basic there was an appreciation of knowledge aspects of complaints and legal to the participating students about the knowledge in the subject and health. multidisciplinarythat fits the exercise of medicine and clarity in the understanding about the different types of violence against women. In

“If we are to fight discrimination and injustice against women we must start from the home for if a woman cannot be safe in her own house then she cannot be expected to feel safe anywhere.” ― Aysha Taryam. References Beatriz curia et al, B. .S. (2020). INSULATION DURING THE COVID-19 AND VIOLENCE INSIDE HOME. Retrieved on September 9th, 2020 from: http://www.pucrs.br/wp-content/ uploads/2020/04/Cartilha-isolamento-e-violencia.pdf Castro, L. (2020). Underreporting and triggers: the drama of domestic violence in quarantine. Retrieved on September 9th, 2020 from: https://veja.abril.com.br/brasil/ subnotificacao-e-gatilhos-o-drama-da-violencia-domestica-na-quarentena/

Panorama of assistance in brazilian penitentiaries: health behind the grills Fernanda Clara da Silva, Danielle Correia Furtado, Sadi Bruno Freitas Santin, Tammy Rodrigues Rio Grande do Norte State University (UERN) IFMSA Brazil

The prison population in Brazil already exceeds 773 thousand prisoners, a number that has grown in the last decade, according to the National Penitentiary Department. With the enactment of the current Brazilian Federal Constitution of 1988, the access to universal and free health was instituted through the Unified Health System (SUS), which is a social right of each and every citizen. SUS propagates, in its principles, the pillars of universality at all levels of assistance, equality without privileges or prejudices and integrality. However, in the population deprived of liberty, the guidelines of these public policies are still compromised impaired, since the context of these individuals includes violence, precarious physical space and hygiene conditions, which predisposes to several health problems (Ribeiro and Silva, 2013). With this, the National Health Plan in the Prison System is instituted, which implements multidisciplinary actions and services to contribute to the control and reduction of the most frequent injuries of this population, in order to expand health care. Among the action lines of this program, there is the main control and treatment of tuberculosis and

Sexually Transmitted Infections (STIs), with a focus on the Human Immunodeficiency Syndrome (HIV). In particular, these diseases are the most prevalent and with the highest morbidity and mortality in the prison population compared to the general population (MinistĂŠrio da SaĂşde, 2005). In addition, womenâ&#x20AC;&#x2122;s health is an important pillar in these policies. As in prisons there is overcrowding and poor hygiene conditions, inmates need specialized attention. Thus, in pregnant women, prenatal and obstetric care should be offered, as well as the screening and treatment of infections by Human Papilloma Virus (HPV), and some diseases, as breast cancer and cervical uterine cancer by cytopathological examination, which are diseases of high mortality in women. Such measures are essential for early detection and the guarantee of diagnostic and therapeutic access (Delziovo, de Oli-

“In the Brazilian scenario, the challenges imposed on the health of the prison population and how this impacts a basic right that should be guaranteed by law are noted. Thus, it is essential that coping strategies are put in place to prevent prison from being an epicenter of the pandemic and preventable infections.” veira,

Jesús

and

Coelho,

2015). from being an epicenter of the pandemic and preventable infections. Although the efforts of these health policies are institutionalized, the greatest difficulty faced is to see this come off the paper. There is still a great difficulty for REFERENCES this assistance to be maintained amidst Delziovo, C.R., de Oliveira C.S., Jesus, L.O., Coelho, the current fragile social conditions E.B.S. (2015). Atenção à Saúde da Mulher Privada de mentioned that worsen the health of Liberdade. https://ares.unasus.gov.br/acervo/html/ detainees. In the context of the new ARES/7427/1/Saude_Mulher.pdf coronavirus pandemic, prison health is even Ministério da Saúde. (2005). Plano Nacional de Saúmore fragile. This is due to the overcrowding de no Sistema Penitenciário (2nd ed.). Ministério da conditions and the sharing of objects, which Saúde. http://bvsms.saude.gov.br/bvs/publicacoes/ favor COVID-19’s aerial and interpersonal plano_nacional_saude_sistema_penitenciario_2ed.pdf contact. In addition to this, as the confined population has a higher incidence of Ribeiro, M. and Silva, I. (2013). A saúde no sistema prisional. Pontifícia Universidade Católica de Goiás. comorbidities, such as heart disease, Retrieved on September 19th from: http://www.cpgls. AIDS and tuberculosis this group is vulnerable pucgoias.edu.br/8mostra/Artigos/SAUDE%20E%20BIOto the severe and fatal forms of the LOGICAS/A%20sa%C3%BAde%20no%20sistema%20 coronavirus (Sánchez, Sismas, prisional.pdf Diana and Larouze, 2020). In the Brazilian scenario, the challenges imposed on the health of the prison population and how this impacts a basic right that should be guaranteed by law are noted. Thus, it is essential that coping strategies are put in place to prevent prison

Sánchez, A.R.; Simas, L.; Diuana, V.; Larouze, B. (2020). COVID-19 nas prisões: um desafio impossível para a saúde pública?. Cadernos da Saúde Publica. 35(5). http://dx.doi.org/10.1590/0102-311X00083520.

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The face we don’t know Daniel Felipe Gutiérrez Villamil Universidad Pedagógica y Tecnológica de Colombia ASCEMCOL Colombia

This photograph was taken in the municipality of Cumaribo, Vichada, Colombia; A war zone where they long for a little hope; Every 6 months, in two military helicopters, a group of young students and professionals in the health area land, escorted by two squadrons of the Colombian air force and military army. These brave volunteers carry few medicines, a pair of hands and a big heart full of love to give.

“Medicine is not the same for everyone, it is not fair.”

This group gives itself 2 full days to work for the community; The people who live in this poor municipality walk for whole days, exposed to an infernal heat in the middle of the thick Colombian jungle, all this, for a simple medical evaluation; many of them barefoot, together with their sick relatives, the elderly and children; however, their only fear is that they will be able to get to the health brigade on time so they don’t have to wait another 6 months without medical care. It seems like a fictitious story, but in Colombia, fictitious stories are every day.

CPAIS-SCOPH a good option for medical students Darcy J. Moreno Sánchez Corporación Universitaria Rafael Núñez ASCEMCOL Colombia

We are part of ASCEMCOL, our local association is ACEM UNINUÑEZ and our committee is CPAIS-SCOPH, a public health-oriented committee that helps us to unite two worlds of medicine that are indispensable in our work as a physician the care to the community and the scientific part of the career, helps us to forge ourselves as integral doctors. During the nearly one year we have been on this committee the experiences have been endless, all rewarding and all with a great teaching different from each other; it’s really so exciting to be part of this committee, because one way or another you never know what the reaction of the community you’re going to reach with information is going to be, so all the activities come with surprises, with exciting moments, that fill us with a lot of joy and pride. It is that seeing the face of thanks from the people to which the activity is aimed is something that does not compare to anything, is to realize that what you are really doing will be of benefit to the community, is to know that little or much you are contributing a grain of sand that will help now or in the future to build a better society. An unmatched advantage of this committee is that we can reach all the age groups, children, adults, the elderly and each of them will welcome what was taken to them, we can go out on the streets too and talk to people, the public is very wide.

Without a doubt, being part of this committee has been one of the best experiences lived in the career, that it is a privilege to belong to such a beautiful committee, it has so many things to offer the public, that sometimes we fall short with what can be done, this given by the low availability that we sometimes have due to the high demand of some subjects of our career. But always, and without a doubt when it comes to some activity of our committee and provided that the situation does not allow them we will have to carry it out with the best of spirits, with the best of energies, because the gratification of the act performed is not compared to any other. Like everything in life, there are good and bad things, and this is no exception, sometimes tiredness can play against us and make our performance not 100%, but we always try to give the maximum. And it is that since, we how not do it?, and although we have already mentioned it above, carrying out the activities of this committee is so rewarding, that that tiredness is gone, that we forget for a moment the large number of jobs, partials and other academic activities of the career; only to have the pleasure of enjoying the community, of learning from it and of contributing our knowledge and actions to its construction.

Young doctors: newly trained in the emergency of covid-19 Bruna Calaça Araújo and Luana Araújo Moreira State University of Rio Grande do Norte IFMSA Brazil

In mid-2020, after a string of cases in China, it detected a new virus. The SARS-CoV-2 coronavirus causes COVID-19, presenting a clinical picture that varies from asymptomatic infections to severe respiratory conditions. In terms of history, SARS-CoV-2 was not the first coronavirus that infected humans, the first being identified in 1937. Coronavirus is a common type of infection in children, the most common being: alpha 229E and NL63, and beta OC43 and HKU1.1 However, SARSCoV- 2 appears aggressive and fatal.

are valued and, often, they are limited, causing the need for savings, that is, these professionals spend 6 to 8 hours in service with the same PPE. Limitations, psychological pressure and fear of contamination are factors that influence their mental health, exposing the importance of special care and support measures to avoid causing greater damage to the health of these young people. We know that a health professional has great social weight and the doctor carries a heroin mystification, increasing responsibility and stress. Added to this, the fact that they are on the front line and have a high degree of contamination increases the psychological challenges that these young people face, since in Brazil, more than 100 doctors died in the confrontation with COVID-19. In this sense, in a study carried out in the context of the pandemic, about 68% 4 of the professionals in the emergency rooms showed signs of aggravated depression, anxiety, insomnia and anguish.

With the emergence of COVID-19 and its spread around the world, it is necessary to expand and specialize health professionals, and health professionals have been included in a reality that has not been experienced in recent years. To assist and expand the confrontation with COVID-19, the Ministry of Education, approved a decree to anticipate the training of medical students who have already completed 75% of the workload. About 5,000 newly trained doctors 2 were placed in a pandemic scenario, without psychological preparation, with little experience and often with few PPE for effective protection. In this sense, the World Health Organization has developed 5 tips for these professionals, In view of the above and in reports 3 collected, in order to reduce stress and improve mental the recent graduates stated that the N95 health. Thus, it is suggested: taking breaks mask was not provided indicated for prevention, during the workday, avoiding the use of drinks they are only wearing the surgical mask, which and tobacco for stress relief, exercising, leaves them vulnerable, exchanging experiences and anxieties with as well as there is no access other professionals at the front, maintaining to protective clothing, social contacts with friends and family protective gloves or visor, and seeking support professional whenever seen scenario, main- necessary. ly in the public health References: network. In addition, 1. Ministério da Saúde. (2020). Sobre a doença. https:// the recent graduates sta- coronavirus.saude.gov.br/sobre-a-doenca. More references: ted that the use of PPE’s

Digital and Remote Actions Front of IFMSA Brazil: Youth emergency health leadership during the covid-19 pandemic. Valéria C. Armas, Andreson L. Melo , Bruno Pellozo; Fernanda Cristina de Oliveira; Gabriella Zaccarelli, Juliana Vieira; Lucas Loiola Ponte; Patrícia Cristiane Gibbert. Faculdades Pequeno Príncipe IFMSA Brazil

Since December 2019, the world has lived with COVID-19. What started as a cluster of pneumonia cases in China, was declared a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO) in January 2020 and characterized as a pandemic in March. In Brazil, the first case was confirmed in February, bringing instability in relations and uncertainties about the continuity of medical classes. Facing this scenario, IFMSA Brazil decided to create a Crisis Committee on March 24th. Initially with 6 of the 20 members of the National Executive Council, and then divided into 4 action fronts, including the digital and remote actions that will be presented in this article.

needs, such as a virtual literary soiree, a book club, tracking the production of Personal Protective Equipment (PPE) initiatives, PPE production instructions and actions to improve student’s mental health. We also did research on the mentoring program in Brazil and how to implement it in all medical schools from those that already have it.

REFLECTIONS (DISCUSSION) From when we started up to now it is possible to perceive the huge impact of Meaningful Youth Participation in COVID-19 pandemics adaptation. There was a remarkable need to structure the Crisis Committee to constitute a more organized plan for the federation in the face of the EXPERIENCE REPORT pandemic scenario. Previously to their The idea of the Management and Digital formation many committees were inacand Remote Actions front is to plan and tive during a certain period, so a national execute national actions related to the Covid-19 pandemic period and its consequent initiative was helpful to inspire those local quarantine. In this sense, we organi- committees on how to do online activities zed national meetings to value neglected in this period. Since February the Brazilian gopopulations and online producti- vernment has legally recommended the use ve activities in pandemic context. of PPE and many volunteer groups across In addition to the country have started operating at a nato produce and donate tional level, we inPPE. Therefore, to entended to embracourage the active ce each one of the participation of local local committees committees, a guide (LC). For this, we was elaborated containing data organized camon these groups paigns that corresand informaponded to those

“Currently, local committees are developing online courses and events at a national level, which, at the beginning of the pandemic, only a few managed to do. Very varied thematic activities are also being done, making matters important to the medical curriculum.” tion compiled on how to make PPE, collected through a form on IFMSA Brazil Instagram. The writing of the Personal Protective Equipment Manual had the objective to give more visibility to PPE production initiatives and to encourage local committees to, in addition to supporting and publicizing these works, generating activities on this topic. CONCLUSION At the beginning of the pandemic, most of the local committees were struggling to continue as IFMSA Brazil activities, as it is a unique moment in the world and no one was prepared. Currently, local committees are developing online courses and events at a national level, which, at the beginning of the pandemic, only a few managed to do. Very varied thematic activities are also

being done, making matters important to the medical curriculum.

REFERENCES World Health Organization. (2020). WHO Timeline on COVID19. WHO. Retrieved on September 19th, 2020 from https://www.who.int/news-room/detail/27-042020-who-timeline---covid-19 Ministério da Saúde Brasil. (2020, a). Resposta nacional e internacional de enfrentamento ao novo coronavírus. Ministério da Saúde. Retrieved on September 19th, 2020 from https://coronavirus.saude.gov.br/ linha-do-tempo/ Ministério da Saúde Brasil. (2020, b). Nota Informativa No 3/2020-Cggap/Desf/Saps/Ms. Ministério da Saúde. Retrieved on September 19th, 2020 from https://www.saude.gov.br/images/pdf/2020/April/04/1586014047102-Nota-Informativa.pdf

SUS: national heritage of Brazil Marina Candido da Silva, Eloyne Sartor Holanda, Júlia M. Orsini Zava, Rebecca C. Sanches R, Taís Lorrane Mendes S. University Center Ingá- Uningá IFMSA Brazil

Change is the result of immense effort. After decades of struggling with the Health Reform Movement, the SUS (Sistema Único de Saúde - Unified Health System) was finally instituted in the Brazilian state. The public health system in Brazil, which is seen as an example for several countries, was instituted by the Federal Constitution of 1988 and regulated by organic law 8,080 and 8,142. The system was established on the principles of inclusivity and equity, offering health services to all. Thus, the services offered by SUS are comprehensive including procedures ranging from pressure assessments to complex surgeries. Furthermore, it is responsible for financing 95% of organ transplants in Brazil. The SUS utilizes other practices such as yoga, reiki, music therapy and medicinal plants to give an holistic approach to healthcare. They offer condoms, copper IUD contraceptives and administer HPV vaccine and provide Prep (pre-exposure prophylaxis) used by people with greater chance of coming into contact with HIV.

problems that prohibit its full effectiveness. The lack of refresher courses means that professionals end up following outdated protocols that often do not match the reality of certain regions of the country. In addition, there is an inequality in the doctor-patient ratio in the Brazilian regions, while in the Southeast there are 2.81, the northern region has 1.16 doctors per 1,000 inhabitants, which shows the lack of assistance in some regions. Another point of paramount importance is the lack of qualified management to manage the financial part of the SUS, which still has misappropriated funds. Despite its problems, SUS is the promotion and reduction of health risks. The Credit Protection Service (SPC Brazil) and the National Confederation of Shopkeepers (CNDL) showed that in 2018, 70% of Brazilians did not have health insurance, with classes C, D and E being the most affected.

This research shows the importance of the public health system for the most Among lesser known services, there are hu- disadvantaged population (most of Brazil), sinman milk banks, sex-change surgeries, and ce medicines, consultations and laboratory and reparative surgeries for female victims of image exams have a high cost when compared violence. It also offers the largest vaccine co- to what most workers in these social classes verage in the world, which have been respon- receive in wages . Thus, having a public and unisible for the elimination and control of immu- versal health system guarantees full and free ne preventable diseases, such as smallpox, health care and care for the entire population. eradicated from the country in the 1970s. SUS relies on the National Immunization Program, established in 1973, which has shown positive results due References to the work that involves the three spheres of management. This enables coverage rates to 1- Carvalho, G. (2013). A saúde pública no Brasil. Estureach adequate numbers and the maintenance dos Avançados , 27(78),7-26. https://doi.org/10.1590/ of the condition of eradication of immunopre- S0103-40142013000200002 ventable diseases. However, SUS has countless More references:

Brazilian scenario on bone marrow donation, an experience report Celina Maria de Carvalho Guimarães and Igor Montenegro Galvão University of Pernambuco IFMSA Brazil

Perceived as a last treatment approach, the bone marrow transplant can be an option of recovery to many patients who suffer from hematologic and immune diseases, as well as certain types of cancer. In Brazil, there has been an increase in the number of bone marrow transplants in 2018, since between 2006 and 2017 happened a variation of 198 to about 393 yearly donations (Hemocentro Ribeirão Preto, 2018). This increase was considerable, however still not enough to attend the demand, since about 850 people are waiting for a compatible donor. (REDOME, 2020) Furthermore, the bone marrow transplant follows a lot of protocols and precautions, which collaborate for a better procedure quality and safety for both the donor and the receptor. Therefore, it is necessary to instruct the population about the topic, in order to clarify the maximum of doubts that could appear. Taking this into account it will be possible to increase the registration on REDOME, the Bone Marrow Donors National Register, to improve the possibilities of people in the transplant row. This becomes even more relevant because naturally the biocompatibility of bone marrow is considerably rare, being one for each a hundred thousand, and it is important to emphasize that even between two consanguineous brothers the odd is about of 25%. (Ministério da Saúde, 2014) Besides that, Watanabe et. al (2010) demonstrated a resistance from the population of the study to join the donors list, either by unfamiliarity with the theme or by fear. One of the possible reasons behind such unfriendly perspective are the taboos which

were spread, as the risk of lesioning the spinal cord, which is not possible. Therefore, it strengthened the importance of promoting stimulative and educational actions about this subject, aiming to reach the population. In this context, in 2019, the IFMSA Brazil’s Local Committee UPE promoted a campaign named “Meu amigo Sangue bom”, which means “My good blood friend”; to encourage the donation of blood and bone marrow tissue, through the sensibilization and explanation about the registration process, bone marrow transplant and the requirements to become a donor. During the campaign, which was promoted in a public square, people were questioned about the topic, and the students awaited to demystify inaccurate information over the bone marrow transplant. However, differently from the expectations, the majority of people manifested unfamiliarity with bone marrow’s function, so they were not acquainted with REDOME and the relevance of being registered. From this experience, it is evident the need for a greater project of continued education involving the population, in whole levels, about bone marrow and the process to become a donor. For that, an integration of public health politics is required, operating together with an interprofessional effort, since it is a problem prevailing not only in Brazil but on a global level. Therefore, it will be possible to encourage and transmit more information to the population, so that people can become potential donors and collaborate with those who are waiting for their transplant in hope to have a healthier and better life.

See references:

“Dia do Carinho”: a day in the palliative hospital Carolina Martins Coelho, Bianca Pereira B, Isabela Alves da Silva, João V. Rocha Alves, Jonathan J. Diniz IFMSA Brazil UNICEPLAC

The concept of palliative care officially appeared in 1990, when the World Health Organization (WHO) defined comprehensive care and end-of-life care for patients with terminal cancer. In 2002, the concept was expanded to include assistance for diseases such as AIDS, heart, kidney, degenerative and neurological diseases.

diatric diagnoses are generally rare and occur only from childhood, however, some children can survive to adulthood (Iglesias, Zollner and Constantino, 2016).

Pediatric palliative care differs from adults and is characterized by having some peculiarities, such as: the number of pediatric deaths is lower than in relation to adult patients, p e -

“Dia do Carinho” aimed to put medical students in contact, in theory and in practice, with patients under palliative care, so that they could understand the importance of this aspect together with curative medicine. In addition, getting to know the concept, as well as its importance in the life of a patient and his family, in addition to having contact with children with rare syndromes and terminal stages of cancer, gaining experience in how to approach them and offer dignified treatment.

The intervention period for palliative care is different from that for adults, which may include days, months or years, the diseases are often familiar and there is more than one In 2004, a new document published by WHO, child affected, requiring genetic counseling. reiterates the need to include palliative care The diseases occur in phase of life in which as part of comprehensive health care, there is great physical, emotional and cognitive in the treatment of all chronic disea- development, it is essential to guarantee ses, including programs for the care of the continuity of the educational process. It the elderly (Gomes and Othero, 2016). is also important to be aware of how much Currently, this concept is adapted to the disease can reflect on the child’s ability to local realities and known as an approach to understand his or her pathological situation. improve the quality of life of patients and fa- Despite the recognition of the importance mily members who face a life threatening of palliative medicine, our universities still disease, through the prevention and relief of prioritize curative medicine. Instituting this suffering, through the early identification and theme in the doctor’s training process is a evaluation and treatment of pain and other real and absolute necessity, aiming to provide problems, physical, psy- dignified life and death to our patients chosocial and spiritual. (Javorski, Bushatsky and Viaro, 2014).

The action was of great importance for the students, who were able to have contact with

Encouraging sign made for children with cancer at the National Institutes of Health Clinical Center in Bethesda, Maryland. Pediatric, childhood, AYA. Photo taked of Unsplash - National Cancer Institute profile

“A new document published by WHO, reiterates the need to include palliative care as part of comprehensive health care, in the treatment of all chronic diseases” different syndromes and their therapeutic approach. The visit allowed students to get in touch with patients, analyze their clinical condition and have a conversation with their respective caregivers in order to better understand the individuality of each child. Afterwards, students could

spend time talking and entertaining each child through stories, music and games. In addition, the visit was of great value to the employees of the home, who work with overload due to the high demand from patients, and were able to show all the work done by them on a daily basis.

References Gomes, A. and Othero, M.B. (2016). Cuidados Paliativos. Estudios Avanzados. 30:88. Pg. 155-166. Retrieved from: https://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-40142016000300155&lng=en&nrm=iso

Javorski, A., Bushatsky, M. and Viaro, V. (2014). Cuidados Paliativos em Crianças com Câncer: Revisâo Integrativa. Revista de Enfermagem UFPE online. 9(2), pg. 718-730. https://periodicos.ufpe.br/revistas/revistaenfermagem/article/viewFile/10392/11150

Iglesias, S., Zollner, A. and Constantino, C.F. (2016). Cuidados paliativos pediatricos. Residencia Pediatrica. 6(1). https://doi.org/10.25060/residpediatr

Valadares, M., Mota, J. and Oliveira, B. (2013). Cuidados paliativos em pediatria: uma revisão. Revista da Bioetica. 21(3), pg. 486-493. Retrieved from: http:// www.scielo.br/scielo.php?script=sci_arttext&pid=S1983-80422013000300013&lng=en&nrm=iso

Standing Committee Related Articles

SCORA

Sexual & Reproductive Health and Rights

Story Behind Uniforms

Pilates with teenage expectant women Shabnam Debbie Santos María Estela Zurita Universidad San Francisco de Quito AEMPPI Ecuador

Pilates activity with teenage expecting women. Ecuador is one of the countries with a higher prevalence of teenage pregnancy. I was able to experience this component of our country firsthand during my 3rd year of medical school. I rotated in gyneco-obstetrics in primary health care. In a rural zone in Ecuador named “El Quinche”. My rotation was part of a program about medical students interacting with the community. Therefore, we did a great number of activities such as education about nutrition during pregnancy, quizzes about the topics taught, games and various

activities such as pilates and yoga. All of these activities where done during a period of 6 months, after which we rotated to another health center. Because of the high prevalence, we studied the psychological aspects that predispose teenagers to become mothers at a young age. Many of the reasons found where cultural and life-goal oriented. The picture describes the joy of medical students making a small change and being able to understand the community we live in to be able to make a bigger change, one step at a time.

The best way to break a taboo is breaking the silence Fernanda Maria Viana do Amaral Rio Grande do Norte State University IFMSA Brasil

Adolescence is a phase of biological and social transformations, a time when sexual discoveries begin. The TV show Sex Education addresses the taboo of human sexuality by showing the impact that knowledge about oneâ&#x20AC;&#x2122;s own body, basic rights and sexual diversity can have on the young personâ&#x20AC;&#x2122;s life. Set in a high school, students as well teachers demonstrate that they do not have sexual health skills.

se are the contributing factors to the prevalence of STIs among this age group. The issue is normal among young people, as those who become infected are more susceptible to getting other STIs. This correlates with the increase in maternal and child mortality, sterility, inflammation, emotional damage and premature births (Brazilian Society of Pediatrics, 2018). It is found that there is an underestimated perception that many of them have This goes to show that if they do not understand of their risks of contracting these what human sexuality means at an early age diseases however studies prove otherwise. they will reach adulthood ignorant of sexual health. This creates an environment where Thus, several studies suggest that an uninformed individuals are the main cause effective way to avoid the high rates of STIs of the spreading of Sexually Transmitted among adolescents is to approach the subject Infections (STIs). in a natural manner The World Health Organization that is free of prejuestimates that there are more than dice. It should prefe1 million new cases of STIs daily rably be in social insSexuality, especially with adolescents and young adults titutions and forums during adolescenwidely attended by (13 to 24 years of age) more likely ce, tends to manithis population, such fest itself through to become infected (WHO, 2016). as school (Costa et unprotected practial, 2019). Therefore, ces that are a direct stimulating debaresult of the lack of information, tes on the topic since youth could communication between family change the social awkwardness members and secular myths and of avoiding issues that refer to taboos that permeate society. sexuality by providing young people with the necessary In addition, many adolescents information to act with are afraid to assume their own maturity and responsibility. sexuality and desires, further distancing themselves from safe informaSince this debate still does tion and discussions about sexuality. not occur in the desired Thus, the lack of guidance added way in Brazil, activities to the typical curiosity of this phathat are aimed at highlighting sexual health education are

“Stimulating debates on the topic since youth could change the social awkwardness of avoiding issues that refer to sexuality by providing young people with the necessary information to act with maturity and responsibility.”

important. By ensuring an environment where young people can know each other, express themselves, and consequently take better care of themselves, the various barriers that hinder their access to knowledge can be broken down. Finally, ignoring and denying the sexuality of young people is an irresponsible attitude, as it deprives them of the right to information.

References: 1. World Health Organization. (2016). Global health sector strategy on sexually transmitted infections 2016-2021: toward ending STIs. https://www.who.int/ reproductivehealth/publications/rtis/ghss-stis/en/ 2. Brazilian Society of Pediatrics. (2018). Practical Update Guide: Sexually Transmitted Infections in adolescents. h t t p s : // w w w. s b p . c o m . b r / f i l e a d m i n / u s e r _ u p l o a d / 2 1 1 8 8 b - G PA _ - _ I n fec_Sexual_Transmiss_Adolesc.pdf

It is through the adoption of a culture of dialogue that one understands the needs of a group and is better able to bring about necessary change. 3. Costa, Maria Isabelly Fernandes da, Viana, Tami-

res Rebeca Forte, Pinheiro, Patrícia Neyva da Costa, Cardoso, Maria Vera Lúcia Moreira Leitão, Barbosa, Lorena Pinheiro, & Luna, Izaildo Tavares. (2019). Social determinants of health and vulnerabilities to sexually transmitted infections in adolescents. Revista Brasileira de Enfermagem, 72(6), 1595-1601. https://dx.doi.org/10.1590/0034-7167-2018-0726

Perception of Sexually Transmitted Infections among high school students at a public school in Pelotas/ RS - Brazil Nicole Borba Rios Barrosa Federal University of Pelotas IFMSA Brazil

According to the World Health Organization, adolescence is the period between 10 and 19 years of age, with great physical, psychic and social changes (World Health Organization, 2020). Sexuality is present throughout life and finds in adolescence a moment of great vulnerability due to hormonal changes, the need to go through new experiences, the great influence of the environment, among other reasons (Genz, Meincke, Carret, et al., 2017). As a consequence, literature confirms the high rate of teenage pregnancy, adoption of risky sexual behaviors, and drug abuse, increasing even further the risks of this phase, leading to high prevalence of Sexually Transmitted Infections (STIs) in this age group. In this way, it is extremely necessary to plan actions aiming to develop together with students a reflection about their attitudes, conceptions and values to approach sexuality. Therefore, students improve knowledge and, as a result transmit safe awareness about sexuality education (Alves and Lopes, 2008). Using the “Te Liga!” campaign, conducted by members of SCORA at the Federal University of Pelotas, medical students hold lectures and conversation circles with adolescents in schools in order to clarify doubts about sex education.

lity education for these young people. Methodology: a descriptive cross-sectional study was carried out using a self-applied questionnaire created by the coordination of the campaign and answered by students from the first and second grade of a public school in the interior of Rio Grande do Sul – Brazil. Eligible students were those whose parents or guardians signed the consent term for the study. The variables were inserted and analyzed using Word Excel. Results: The sample consisted of 31 school children aged between 14 and 19 years. As for sexual behavior, those who answered the questions regarding age of first sexual intercourse (N=29), 31.0% (N=9) had never had sexual intercourse and 69.0% (N=20) had already had sexual intercourse. The average age of the first sexual intercourse was 14.9 years and 85% started being sexually active at 15 or younger. Among those who had had sex (N=20), 55% (N=11) reported always using a condom during sex, 30% used a condom sometimes, and 15% did not. Regarding the descriptive question about ways to get contaminated with STIs, the great majority answered by the sexual act, however, only 9 described the sexual act without using a condom; another 5 mentioned kissing. The main response regarding how to avoid STIs was using condoms, in addition to “not having sex”, “taking medication” and “having good hygiene”

Objective: to assess knowledge and behaviors related to sexuality, and then analyze data to better target the issues discussed with students aiming at improving sexua-

Conclusion: Based on analyzed data, it is necessary to clarify to adolescents the real ways to acquire a STIs, as well as to inform how to avoid these infections, reinforcing the idea that the sexual act can be safely performed, also avoiding an unplanned pregnancy in adolescence. See references:

“AUGUST LILÁS”: a reflection of the need to fight against violence against women and the importance of directing a more sensitive look at this problem Luana Araújo Moreira Bruna Calaça Araújo State University of Rio Grande do Norte IFMSA Brazil

Any aggression, be it physical, moral, sexual, patrimonial and/or psychological. (Silva and Oliveira, 2015) In this way, it is known that crimes against women happen daily and their marks go beyond the physical: they hurt the victim’s dignity. In this sense, law 11.340 / 2006 entitled Maria da Penha, was created on the basis of protecting Brazilian women against domestic violence, punishing their aggressors. However, even with this measure, the violence rates increased significantly and it is estimated that 30 women suffer some type of violence per minute. (Instituto Maria da Penha, 2017)

of notification to provide visibility to the problem and to take actions to address it, as this is necessary to combat the underestimation of the magnitude of this social problem and public health. In this perspective, it is noteworthy that the law implemented faster emergency protection measures, and it is possible for the police to ask the judge to remove the aggressor, which previously could only be done through a lawyer, (Machado,Almeida, Dias, et al., 2020) making an improvement in protective measures and providing greater support for women. In light of these considerations, in the same year and month in which the Maria da Penha Law celebrates its 14th The purpose of this text is build a narrative birthday, the Agosto Lilás Campaign deserves review about the problem arising from violence greater representation in the spheres of socieagainst women, assess the importance of ty, since it represents the fight against violence protective measures and dates that resemble against women and feminicide. (Santos, 2018). such a theme. For this narrative review, articles were searched in the electronic databases Pub- Based on the above, it is reiterated that violence Med, SciELO and DataSUS, using the following against women is a social and public descriptors: security measures, public health, health problem that needs to be unveiled violence against women, underreporting, do- and widely addressed. mestic violence. Articles from the last 5 years Thus, it is necessary to implement eduand free access were selected, reaching 4 final cational practices in institutions and in works that were selected and read in full. society in general, as well as traiBrazilian data showed that, from 2017 to 2018, there was a 19.1% increase in cases of domestic violence. (DATASUS, 2020) However, it is confirmed that there are underreporting, which points to the importance of sensitizing professionals regarding the relevance

ning for health professionals in order to guarantee visibility for the fight of this cause and for lilac August. REFERENCES Instituto Maria da Penha. (2017). Relógios da Violência. https:// www.relogiosdaviolencia.com. br/ More references:

An Alternative Approach In Sexuality For Medical Students Miline Weis Becker Júlia Carolina Esteves de França Universidade da Região de Joinville (UNIVILLE) IFMSA Brazil

The World Health Organization defined sexuality as “a central aspect of being human throughout life encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction” (World Health Organization, 2020). In addition, it is known that sexuality is still a stigma in most conversations and consultations, for most of the population and also physicians, becoming a public health issue. Healthcare has evolved extensively over the last years, now focusing on a broader approach, considering all aspects of a patient’s life in order to understand the ideal treatment and how to proceed. However, one key aspect is regularly ignored, both by professionals and patients, that is sexuality In

Studies have shown that the majority of healthcare courses don’t include sexuality in their curriculum, leading to underprepared professionals, who feel intimidated, scared or ashamed to bring the subject up during health appointments (Braun, Ramirez, Zahner, Gillis-Buck, et al., 2017).

that way, a recent study with transgender population showed that 50% of the group reported having to teach their medical providers about transgender healthcare, showing the deficiency in sexuality education. Moreover, the same research pointed out that 28% of the participants had their healthcare postponed when reported being sick or injured (Grant, Mottet, Tanis, Harrison, et al., 2011) . Considering the lack of discussion regarding this subject, crucial to an integrated health care, it is essential the use of new approaches about sexuality to medical students and p r o f e s s i o n a l s . Regarding this fact and taking into consideration the power of connection through art, it was established the exhibition of the film “I Don’t Want to Go Back Alone”- a short production that encompasses the theme of understanding s e x u a l i t y in a young age. After the display of the movie, a space was opened for discussion, and a number of themes were brought up. They ranged from the known deficiency of the education sys-

shouldn’t be omitted and ignotem in covering sexuality in health it red. There is an abysm between care, to the reasons why the students felt daunted to talk to patients about their sexuality. the ideal and the reality of healthcare Many participants stated that their preferred technique is to indirectly introduce the subject during anamnesis, referencing the patient’s responses to do it. While the majority said they considered sexuality to be important or very important in healthcare, a third declared that addressing sexuality depends on the case and if it’s related to the medical condition presented. When correlating the information given by students and the ones found in research, it’s noticeable the importance of discussion pertaining to sexuality in health care. Students and professionals can no longer go uneducated and underprepared, there needs to be a change in mindset in order to truly provide a holistic medical care. For sexuality is a part of the being and a part of life,

“There needs to be a change in mindset in order to truly provide a holistic medical care. For sexuality is a part of the being and a part of life, it shouldn’t be omitted and ignored. There is an abysm between the ideal and the reality of healthcare”

References Braun, H. M., Ramirez, D., Zahner, G. J., Gillis-Buck, E. M., Sheriff, H., & Ferrone, M. (2017). The LGBTQI health forum: an innovative interprofessional initiative to support curriculum reform. Medical education online, 22(1), 1306419. Grant, M., Mottet, L., Tanis, J., Harrison, J., Jody L. Herman, and Keisling, M. (2011). Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force, 1-228. Van der Geest, V. M. (2016). Avaliação de necessidades de treinamento de profissionais de enfermagem na área da sexualidade [Doctoral dissertation, Universidade de São Paulo]. https://teses.usp. br/teses/disponiveis/59/59137/tde-17012017-203441/pt-br.php. World Health Organization. (2020, June 12). Gender and human rights. https://www.who.int/reproductivehealth/topics/gender_rights/sexual_health/en/

¿Where is LGBT+ health in the medical curriculum? Fernanda M. Viana do Amaral, Danielle Correia Furtado, Sadi B. Freitas, Ellany Gurgel Cosme do Nascimento IFMSA Brasil Rio Grande do Norte State University

In most societies, there is a great inequality in gender relations, seen in laws, policies and social practices. These imbalances bring to the fore marginalized populations, such as Lesbians, Gays, Bisexuals, Transvestites and Transsexuals (LGBT +), who face barriers and discrimination in health services. This interferes both in the health-disease process and in the specific demands of this public, such as the prevention of sexually transmitted infections, hormone therapy and sex reassignment surgery for transsexuals. In the Brazilian scenario, the National Policy for Comprehensive Health Care for Lesbians, Gays, Bisexuals, Transvestites and Transsexuals was created, in order to highlight these demands and promote greater equality and medical assistance, however, the challenges are still present and experienced by LGBT+¹.

biological bias, without integration with the themes of gender and sexuality in curricular projects². As a result, health sciences marginalize broad and inclusive education. The direct consequence of this is that, with the lack of academic training in addition to hetero-normative, future doctors are not prepared to care for LGBT+ people and do not know their specificities in health, while the LGBT+ group itself tends not to seek comprehensive care services in health, or avoid them, already knowing the limitations or prejudices they may suffer, transforming health, which should be a basic and egalitarian right from any citizen, into a chain of LGBTphobia¹. Against this background,

The reformulation of medical curricula with the inclusion of LGBT+ diversity and broader approaches is necessary to eliminate the current discrimination.

In this context, it is important to see that these LGBT + exclusion parameters are also present in health professionals, who reproduce discourses of hate and insecurity, the result of a socio-cultural process that preaches heteronormativity within academic training. Thus, even though the curriculum guidelines enabling improved access for undergraduate medical school courses to health and define that health care should not be discri- giving visibility to minated against by gender or sexual these people. orientation, which is seen in classroom theory a n d clinical practice, it is well different and excluding for non-cisgender people. In Brazilian medical schools, it is noted that the approach to content and classes by teachers still prevails an organic and

In addition promoting education, research and extension in this segment of gender and sexuality is an essential tool to ensure that students understand LGBT+ demands and that, in the future, we have doctors who have a human and clinical eye for all colors of the LGBT+ rainbow.

References 1. Raimondi, G.A. et al. (2020). Gênero e Sexualidade nas Escolas Médicas Federais do Brasil: uma Análise de Projetos Pedagógicos Curriculares, 44(2). https://doi.org/10.1590/1981-5271v44.2-20190050 2. Moretti-Pires, R.O. et al. (2020). Preconceito contra Diversidade Sexual e de Gênero entre Estudantes de Medicina de 1º ao 8º Semestre de um Curso da Região Sul do Brasil, 43(1). https://doi.org/10.1590/1981-5271v43suplemento1-20190076

Standing Committee Related Articles

SCOPE/SCORE

Professional Exchanges / Research Exchanges

Practicing medicine in a developing country can be a great challenge but there is nothing more rewarding than being able to help the community with our own hands and provide a breath of fresh air. Story Behind Uniforms

A breath of fresh air Mateo Villafuerte Castillo Universidad San Francisco de Quito AEMPPI Ecuador

Using Research to Promote Equity, Diversity and Inclusion in Health Care Vernon Antonio Davis Jr. University of the West Indies TTMSA Trinidad and Tobago

If this year has taught us anything, it has certainly taught us that the world is no longer impassive to inequity. During the confines of the lockdown period, much has been revealed. We have seen throughout the media, issues regarding the treatment of others trending over news stations, social media and communication platforms. Activism has been reignited among people, ranging from all ages as a part of a global statement. Countries around the world have made a stance on very controversial issues ranging from racial discrimination, colonial figures, police brutality and racially motivated violence. Research has thus surfaced to capture this period of time. It is through research that SCORE TTMSA was able to use our platform to bring awareness to issues with diversity, inequity and inclusion in healthcare.

Research can give insight into current problems. This information is not limited to purely scientific subject matters but can extend to social and economic topics. For instance, Covid- 19 revealed a great disparity in access to healthcare and subsequent resources. Racial and ethnic disparities were evident in research worldwide, especially in the Americas. Social determinants of health were proven to play a major role in the health of medical treatment of individuals (Shah et. al, 2020). Many individuals experiencing medical care for Covid-19

were seen to be predisposed due to genetic and social factors such as diet, economic status and education (Peery, 2020). With information at our fingertips, it became imperative for SCORE to use research to promote proper access to healthcare to all persons. Various topics of research became readily available during the worldwide pandemic. As the world shifted to a nearly exclusive virtual focus, access to information became even simpler. SCORE TTMSA was able to launch Speak Up Sundays which gave research to support advocacy claims. This evolved to a greater platform for research distribution. Articles were circulated on topics ranging from stigma against migrants, healthcare workers and Covid-19 patients. A special segment was circulated entitled “Black Lives Matter in Healthcare Too.” Further topics explored included (but were not limited to) “Micro Inequities and Classism in Medical School, Underrepresentation in Medicine, Wet

Nursing and Black Trauma, Leadership and Gender Gaps, Creating an LGBTQ+ Friendly Healthcare, Caribbean Health Worker Migration and Artificial Intelligence and Healthcare. Ultimately, the use of research is endless. It can be used to approve or disprove current viewpoints, inform an audience of industry standards, persuade an audience and in this instance, give factual support to advocacy efforts.

All standing committees should be encouraged to work along with SCORE to add statistical and factual information to support their initiatives.

SCORE is the ideal partner to help catapult any initiative. References: Peery, M. (2020). COVID-19 Underscores Wealth and Health Disparities in the African American Community. Retrieved April 20, 2020, from https://www.nmanet.org/news/500673/COVID-19-Underscores-Wealth-and-Health-Disparities-in-the-African-American-Community.htm Shah, M., Sachdeva, M., &amp; Dodiuk-Gad, R. P. (2020). COVID-19 and racial disparities.Â Journal of the American Academy of Dermatology,Â 83(1), e35.

DICCIO-MED: A New Way to Learn a Language for Future Professional Exchanges Marcela Peñaloza Rallón, María Fernanda Quintero and Michelle Lorena Pérez López Universidad Pedagógica y Tecnológica de Colombia ASCEMCOL Colombia

As local exchange officers, we have had to find new ways to motivate our students and teach them about our exchange program by virtual means due to the pandemic. After conducting an analysis in our local association, we realized that many students feared the language barrier. It prevents them from picking certain exchange contracts. In addition, we wanted to find different ways to keep our community connected during the pandemic. For this reason, we designed a project titled “DICCIO-MED.” The main aim of the project is to help our members learn about medical terminology in different languages for their future professional exchanges (Fig.1 and Fig.2). This project

consists of presenting a word related to the medical field with its definition and translation in 5 different languages. We made note of the countries that our members would like to travel to but were hesitant to because of the language barrier. We began by introducing the terminology in Spanish, the language spoken by most of the Colombian population. Then, we presented the translations in English, German, French, Italian, and Portuguese. The 4 main categories for the terminology were signs and symptoms, anatomy, basic procedures, and surgical procedures. To start, we first introduced signs and symptoms that are most frequently encountered during a medical consultation. In order for the information to get to as many medical students as possible, we shared the terms through our Instagram account (@acemed_uptc) and national WhatsApp groups. Throughout this process, we have noticed that medical students all over the country, even those who are not part of the association, have shared and liked DICCIO-MED.

Figure 1. Example of a DICCIO-MED cover.

One of the barriers with learning a new language is the overwhelming feeling that there is too much to learn. However, by having access to a few contextualized words at a time, the students

Figure 2. Example of a DICCIO-MED publicity with the multiple translations of aphasia.

have expressed that they feel less pressure and more motivation to learn. They also feel that it is incredibly relevant to their career and also essential for their future clinical rotations during their professional exchanges. Due to the project’s success, we hope to continue with the other subjects. We have proposed to add more terms for the future. Once finalized, we will compile all the content so that anyone who is interested can have access to them. Finally, from the Standing Committee on Professional Exchanges in ASCEMCOL we would like to cordially invite all of you to participate in our posts and take advantage of the didactic and synthesized medical terminology provided with DICCIO-MED.

“By having access to a few contextualized words at a time, the students have manifested that they feel less pressure and more motivation to learn.”

REGION ARTICLES

We are the

AMERICAS

Click here to see more The of Americaâ&#x20AC;&#x2122;s Region Americas region is one of the most diverse regions, comprising over a billion habitants in 35 countries, ecosystems from the arctic tundra to amazonic rainforests and one of the widest ranges of nationalities, ethnicities and cultures with more than 700 indigenous peoples. With four subregions: North America, Central America, the Caribbean and Southern America, the Americas region faces different challenges and needs daily, but also shares a mixture of different cultural expressions in our NMOs are able to portray different characteristics and traditions from the countries they represent, as to showcase this rich variety and diversity in the Region.

Please, enjoy and get to know us, as: We are the Americas! To know more visit our Facebook group, click here

An Slavic part of Brazil Izabele Maria Geri Mackenzie Evangelical College of Paraná IFMSA Brazil

Prudentópolis is a beautiful and inconspicuous small countryside town in Paraná, a state of the south of Brazil.

The culture here is one of the most vibrant in the region because of the influence of Ukrainian immigrants that colonized the town many years ago.

like it because of its acidity. However it is worth trying because there is a lot of culture and love wrapped up in each dish. Interestingly enough we do not have many restaurants in our little town. The best place to try the food would be at a local resident’s house. Every year we have a special event called ‘’Ukrainian night’’, where you can eat and drink typical ukranian foods. It is a night when we experience the true essence of the culture with music and dance.

The immigrants brought with them a great deal of their customs including their lanamazing town is full guage, clothes, mannerisms, commerce This and food. Even today, their traditions conti- of surprises, culture and lovely local nue to play part in the way of life of the resi- residents, and we are the Americas! dents. Although Prudentópolis has a lot of character, it is not a popular tourist destination. Many people have no idea that they can have a truly slavic experience here in Brazil. The first thing you must know about Ukrainian gastronomy is that they enjoy sour foods and many kinds of pasta. You cannot leave Prudentópolis without trying: Borsch - typical soup that is basically made with beet, vinegar and some meat; Varenyky - our favorite kind of pasta which can be filled up with potatoes, beans or cottage cheese; and Kutiá - our basic dessert that is made with wheat, cinnamon, honey and hot water. Of course, the food is of an acquired taste so people may not

How is to live in a planned city during the Sars-cov-2 pandemic Marcelle Rodrigues Carneiro de Souza Reis Felipe Romerio Marques Durães Barbosa Fernanda Pacheco Mendes Coelho Centro Universitário do Planalto Central Apparecido dos Santos IFMSA Brazil

According to John Hopkins University & Medicine, Brazil is known to be one of the most affected countries by the pandemic of the new coronavirus, surpassing more than 3,5 million cases. Its capital, Brasília, is a planned city, and it’s possible to see how this may have helped prevent the fast spread of Covid-19. Since many of its inhabitants have a high purchasing power, and the roads were made for the population expected, most of the population have their own vehicles. Unlike other capitals, as São Paulo and Rio de Janeiro, where people need public transportation, and this can lead to a higher exposure time, in Brasília we can see fewer people using it, and prefering the safeness of their car. Next to Brasília, there is Ceilândia, an adminis-

trative region located in the Federal District, where people have a lower social level and depend more on public transportation, making it difficult to follow strictly the social distacing rules. And the numbers proved this point, with Ceilândia having higher rates of cases than Brasília. Brasília also stands out as a city designed for having the best network of health infrastructure and hospital complexes in DF, where large hospitals are located and, as well, the first Campaign hospital exclusively for coronavirus patients in the region was built. This fact contributed substantially to the decrease in mortality and recovery of cases. The site has all the personal protective equipment (PPE) necessary for professionals at the forefront of care for patients with Covid-19. The structure was equipped with almost 200 beds for low and medium complexity care. Another highlight for the city is our Unified Health System (SUS), one of the largest and most complex public health systems in the world, ranging from simple care for blood pressure assessment, through Primary Care, to organ transplantation, ensuring comprehensive, universal access and free for the entire population of the country. Therefore, SUS became the primary method to oppose coronavirus.

Yes, I swear! Santiago Bravo Loaiza Universidad Nacional de Loja AEMPPI Ecuador

The Great Colombiam Federate Republic was the name of the first republic constituted by what is known today as Venezuela, Colombia, Panama and Ecuador. This nation was established in 1821. One of the major dreams of Simón Bolívar was to unify the countries under the name of Republic of Colombia. We have called it Gran Colombia to differentiate it from the beautiful country that will host the next Americas Regional Meeting. Colombia, Ecuador and Venezuela retained the tricolor flag of the Great Colombia when they broke up in 1830-1832. For those who are curious or noticed the same flag belonged to these three countries, this is the reason. But, the colors were not just picked randomly; the meaning behind them reflects the history of the three countries during the colonization, all the political processes they went through and each society that maintains unity even after each country got independent.

Yellow is on the top of the flag and symbolizes the fertility of our lands, referring to the sun and the gold. Blue is for our oceans and the blue Ecuadorian sky. And the red, which is at the bottom, symbolizes the blood of the army that fought for our independence, looking for better times for the next generations to come. Something pretty interesting and patriotic happens every September 26th at high schools around the country. There is this huge event where every senior student makes a promise to our flag, swearing that they will keep on honoring the nation by kissing the flag. Before kissing the flag the student must kneel down and scream, YES, I PROMISE! This oath means love, honour and respect for the Homeland where we were born, that gave us everything that we have and made us become what we are. We have a feeling of gratitude, union and solidarity, to get a good education, that can help us achieve a comfortable and dignified life in family and society.

In Ecuador, we celebrate The Flag Day every year on September 26th, as a grand gesture and a celebration of our nation as citizens. Each color of the flag means something related to our history I believe that this event is a tradition because and that’s why its meaning is very significant. the meaning behind it is really powerful. This “oath” encourages youth to believe in themselves, to find and use the resources that we have to create and promote a better society and nation. I want to always keep in my mind that the building of a safer, fairer and healthier place starts with us, and believing in the power that we have as the younger generation. . References: Minda, M. (2016, September 30). Juramento a la Bandera. LaHora. Raeside, R. (26 de July de 2020). CRW Flags. Obtenido de https://www.crwflags.com/fotw/ flags/host.html

Health through peace Felipe De la Garza Madrigal Mackenzie Evangelical College of ParanĂĄ ACEM Costa Rica

Beaches, mountains and biodiversity. Two oceans, seven active volcanoes, cero army. One of the happiest countries in the world, a small tree-hugging conservation giant with free healthcare for all. How did this come to be, and how is it all related? Costa Rica escaped the violent conflict and corruption that plagued the region in the XX century, sparing the nation from the political instability that its neighbors have struggled with.

zens and permanent residents. A system which has been rated as one of the best in the region, seven decades after the events that allowed it.

Quality of life in Costa Rica -attained through public healthcare and education, along with natural beauty preserved by conservationist legislature- attracts foreigners, to the extent that the tourism industry is our main source of income. Affordable and quality medical treatment is in fact a significant appeal for Latin American countries shared a similar pa- tourists. Good public education has produttern during the cold war years, where a fierce ced skillful professionals and yielded multimilitary coup would overthrow a national gover- ple breakthroughs, such as being one of the nment, subsequently establish a military dicta- largest suppliers of snake anti- venom, exportorship that would expand over decades whilst ting it as far as Sri Lanka and Papua New Guidraining the national economy, eventually drai- nea, or being a world leader in climate policy. ning it dry, leading to significant social inequality that is still evidently present now. Costa Rica, This is what Costa Rica strives for: to be a welnot unlike the rest of the region, fell into natio- coming nation that takes care of its people and nal civil war. In 1948, the national liberation natural heritage. People are easygoing, they are army fought and defeated the national govern- fond of the biodiversity their country holds (which ment. What broke the pattern and freed Costa is displayed proudly on the countryâ&#x20AC;&#x2122;s currency), Rica from sharing the fate of most of its nei- and they are glad to live in a stable republic that ghbors, was that the winning party decided to can withstand to deal with its affairs peacefully. abolish the army. Incorporating this prohibition into the national constitution, allowed a significant portion of national economical resources to be redirected towards education and healthcare, and away from bellic conflict. Thus, the small Central American nation thrived. Its literacy rates were the highest in the region and its people where healthy. It turns out that the losing party had agreed to surrender arms with the condition that the winning party would keep and expand the social guarantees that their predecessors had provided to the people. Said social programs set the bases for the current social security system that provides universal health care to all its citi-

Morrocoy, a paradise on the brink of ecocide Lynda Carolina Prato Navas, Fabiola Alexandra Gallucci Di Filippo Universidad Central de Venezuela FEVESOCEM Venezuela

The Morrocoy National Park, known as â&#x20AC;&#x153;Morrocoyâ&#x20AC;?, is located in Venezuela, specifically in FalcĂłn state, in the northwest of the country. It was created on May 27, 1974 through Decree No. 113, and consists of 32,090 hectares (1). It has an environment with a singular beauty, which attracts thousands of tourists throughout the year, mainly thanks to its beautiful beaches. Among the generalities of its flora, we can find mangroves, in which the red mangrove (Rhizophora mangle) predominates. However, you can find black mangrove (Avicennia nitida), white (Laguncularia racemosa) and buttonwood (Conocarpus erectus) (2).

considered in danger of extinction, such as sea turtles (green turtle, hawksbill turtle and cardon turtle) and the coastal caiman. Marine mammals (such as dolphins and calves) and terrestrial that use the park as a refuge, and a wide ichthyofauna, mollusks and crustaceans, among other species.

Due to its beaches, crystal clear waters, and extensive biodiversity, Morrocoy National Park is an acclaimed tourist destination by lovers of the coast. However, this tourist demand is often excessive, and more than a benefit, it ends up harming the species that live there, as well as their environment. In order to persist as a permanent tourist destination, its activities in On the other hand, in cays the vegetation many cases must be regulated by the State, so is very scarce, we can find glass grass (Sa- as not to represent a danger to the park (2). licornia fruticosa), beach bell (Sesuvium portulacastrum), saladillo (Batis maritima) But its touristic activities are not currently affecand beach uvero (Coccoloba uvifera)(2) . ting the abundant and diverse flora and fauna of Morrocoy. Venezuela has been for many An impressive variety of fauna inhabits the years an oil country, which requires constant Morrocoy National Park, maintenance of its equipment to continue its among which we production and not generate catastrophic can highlight: damage to the environment. However, at the beginReptiles ning of Au-

Its consequences are considered ecocide and it is estimated that damage to marine ecosystems may take at least 10 years to regenerate (3-4). gust 2020, when the inhabitants of Morrocoy observed traces of oil on its beaches, Venezuela turned their watch to Morrocoy in search of saving the paradise that was threatened by a serious human error. A spill of 20,000 barrels of oil from the “El Palito” refinery, located 80 km from Morrocoy National Park, was the cause of this discovery. This oil spill has been considered to affect 350 km of Venezuelan territory, mainly in Morrocoy, which maintains various ecosystems that allow the life of many species. Its consequences are considered ecocide and it is estimated that damage to marine ecosystems may take at least 10 years to regenerate (3-4). Now Morrocoy faces a struggle that no one knows how it will evolve, but volunteers and financial support are needed for the region in search of maintaining and recovering a tropical paradise.

References PDVSA. Morrocoy. Disponible en: http://www.pdvsa. com/images/ambiente/Morrocoy.pdf. Venezuela Tuya. Parque Nacional Morrocoy, Disponible en:https://www.venezuelatuya.com/parques/morrocoy. htm. José Carlos Cueto. Derrame de petróleo en Venezuela: “El mundo está preocupado por el de isla Mauricio pero en Venezuela hay uno el doble de grande”. BBC News Mundo. 14 agosto 2020. Disponible en: https://www. bbc.com/mundo/noticias-america-latina-53779454 Victoria Dannemann. Derrame de petróleo en Venezuela: desastre mayor que el de Mauricio y amenaza de peores accidentes. Deutsche Welle. 19 de agosto 2020. Disponible en: https://p.dw.com/p/3hBq1

CarnivalThe Greatest Show on Earth Melissa Jack

University of the West Indies, St. Augustine Campus TTMSA Trinidad and Tobago

their musical arrangements to life. Typically beginning in January, the public can visit these panyards to see and hear them practicing for the competition. This in itself is a big lime as some bands can practice until as early into the morning as 2am. There is also a Junior Trinidad and Tobago’s Carnival, also dubbed Panorama variation that highlights children and ‘The Greatest Show on Earth’ is a two-day schools playing the Steelpan. However, this celebration of all that we have to offer. It is does not stop many children/teens from the only place in the world, where the entire venturing into the national competition. country essentially shuts down for two whole days and Culture takes over. Carnival is Ole Mas: Traditional Ole Time Carnival usually held each year within the months of characters such as the Blue Devil, Pierrot February or March. With more than a month of activities, events and competitions leading up to the 2-day event, T&T Carnival is an experience you won’t get anywhere else. Welcome to Trinidad and Tobago (T&T), the land of Steelpan, Mas and Calypso. Our small twin-island Republic is one that is overflowing with culture, heritage and festivities. And our largest portrayal of this? Carnival!

Within these months of events, there’s something for everyone. Unlike, Carnival variations present worldwide, it is as simple as showing up, to take part and immerse yourself in the festivities. Here’s just a few events that can be experienced: Panorama: This is the main showcase of our National Instrument, The Steelpan. It is the annual competitions of steelbands within T&T. These bands practice for months to bring to

Grenade, Fancy Sailor and the Midnight Robber are paraded and continue to showcase the roots/origins of Carnival Mas. Calypso and Soca Monarch: These are two forms of music that originated in T&T. Each year Calypsonians and Soca Artistes vie for the title of Calypso Monarch and Soca Monarch. There is also a Chutney Soca Monarch. Carnival Monday and Tuesday: The climax of Carnival. Two days, hundreds of thousands of people in the streets of T&amp;T. Persons have

the option to play mas, within bands, obtaining costumes and enjoying the final days. Others choose to go into the streets to simply have a good time watching the mas and liming with friends and family. Alongside these, there are a variety of fetes (parties) that occur throughout the months leading to Carnival as early as the first week in January. One thing is certain, there is no shortage of social events around this time of year. Thereâ&#x20AC;&#x2122;s something for everyone to spectate or participate in. T&Tâ&#x20AC;&#x2122;s Carnival is one of the largest showcases of culture in the world. It is one of colour, rhythm and rich in the history that is was born out of. It has evolved over the last two centuries into a national festival. One which we invite you all to experience one day This is Trinidad and Tobago. This is Carnival. We are the Americas!

Traditional mayan health: Finding our roots Mónica Cuyun Echeverría

Universidad de San Carlos de Guatemala, Centro Universitario de Occidente (CUNOC) IFMSA Guatemala

Traditional medicine represents an important option to respond to health care needs and has been recognized by international health organizations such as Pan American Health Organization (PAHO). A recent example of a partnership between ancestral and institutional medicine in America happens in Guatemala. On November 16, 2009, “The Group for Health Care of Indigenous People and Interculturality” was created in Guatemala. This group serves as the advisory board to the ministerial office on cultural issues and the health policies for indigenous people. They are responsible for transferring guidelines and recommendations related to an indigenous perspective of health care to all departments of the Ministry of Public Health and Social Assistance. (UASPIIG, 2009) . The integration of Mayan medicine allowed for the creation of a manual by the portfolio committee of health. The text is about culture-bound syndromes, medicinal herbs, ancestral remedies as well as statistics that reveal that Guatemalans still use traditional medicine as their

first option. To share this valuable information with the medical guild and with people in general, the manual is available on the Ministry of Public Health and Social Assistance website. By 2017, the proposal of health inclusion was working in 141 health centers in the country. Additionally, several names of Guatemalan cultural diseases were accepted by the national health system, such as the “evil eye” (mal de ojo) and “estar chipe” which is represented as sensitivity, crying, and intolerance in a baby. The evil eye is caused by weakness when the mother does not eat enough, or there is a lack, or insufficient breastfeeding on the babies first years that makes the children not resist changes in temperature. It is a belief that an intense gaze of adults towards the baby unbalances their external electromagnetic charge. Many researchers support the evidence for this cultural illness by linking it to physiognomy. Physiognomic treatises are an intellectual source to justify that certain physical aspects can predispose a person to manifest stronger or more frequent emotional behaviors than others (Alvar Nuño, 2010). A lot of cultural-bound syndromes have been recognized for their scientific validity. Increasingly, more international associations support research related to Mayan Medicine.

The main goal is to transform the intolerant and exclusionary health model into an intercultural health system.

The aim is to complement the institutional methodology by exchanging knowledge between Mayan therapists, doctors, and health assistants. Each one has to work in a specific area, but with coordination and communication that allows saving lives. Unfortunately, the valuable contribution that traditional medicine brings to modern science has not been divulged enough to be understood and accepted by all physicians and part of the population.

References:

The path of integrating Mayan medicine into the national health system will not be easy. It will take many years for achieving an inclusive healthcare model, but

2. Alvar Nuño, A. (2010). El mal de ojo en el Occidente Romano: Materiales de Italia, Norte de África, Península ibérica y Galia. Scribbr. https://eprints. ucm.es/11039/1/T32197.pdf

there is no doubt that the alliance between the wisdom of the past and the actualization of the future has begun for Guatemala.

1. Unidad de atención de la Salud de los Pueblos Indígenas e Interculturalidad en Guatemala UASPIIG-. (2009). Ministerio de Salud Pública y Asistencia Social.https://www. mspas.gob.gt/index.php/ institucional/unidades-departamentos/atencion-de-la-salud-de-los-pueblos-indigenas

Myths about Peru Tito Daniel. Sevilla C, Aldair A. Mogollón. Graciela E. Malca Pinto Universidad Nacional de Trujillo Universidad Privada Antenor, Universidad Científica del Sur IFMSA Peru

Every year, Peru is visited by thousands of people, all with different expectations about what they will find in our country. Many of them erroneous or very far from our reality. Due to the large number of tourists our country receives, we realized how important it is to clarify many of these ideas. Therefore, in this article, we will try to dispel many of the myths, doubts and ideas that have been misconstrued about Peru. “There are llamas everywhere” Many tourists who come to visit our country have the illusion of seeing a llama and they believe that they will find them everywhere, walking through the streets. However, these animals are found in high altitude areas in our Peruvian highlands. We can find them

in cities such as Puno, Cusco, among others. In these places, they are found freely walking with their owners or wildly on their own, free in nature. This is something that does not happen very often. “In Peru, everyone always dresses in typical clothes” Another of the myths of Peru is that we wear traditional clothes throughout the country. Our country is multicultural, so we have many types of typical clothing that vary depending on the city you visit and even so it is rare to see. We dress like anyone else in any part of the world. Our typical costumes are used by small groups of people, usually older adults and in traditional festivals (such as the Inti Raymi in Cusco). They are more common in the highlands and jungle of our country. “Is English spoken in Peru?” Peru is a multicultural country, we have many languages within our territories. The official language is

Spanish, followed by Quechua and Aymara. However Quechua and Aymara are not frequently spoken because they belong to our ancestors and are not used in large cities such as Lima or Trujillo. We also have citizens who speak other languages such as English, French, Portuguese, etc. but communication is carried out mainly in Spanish. “In Peru they eat pigeons” One of the most popular myths in South America is that pigeon is commonly consumed as part of Peruvian meals . This is false. Our country is known worldwide for our incredible gastronomic diversity (Ceviche, Anticucho, etc.) and it is one

of our greatest attractions. CONCLUSION Peru is a country where you will be received with open arms and people will make sure you learn about our history, food, and traditions

We are ready to receive you, ¿Are you ready for the best experience of your life?

Coast, Mountains and Jungle: The millenary gastronomy of Peru María de Jesús Díaz Gonzales Carmen Mirella Ojeda Flores Universidad Privada Antenor Orrego IFMSA Peru

Peru is a country that captivates its visitor for its culture, traditions, and history; but, above All of this is exploited by each region, taking all, every visitor is fascinated by advantage of the resources of the area, and its delicious gastronomic culture. represented by multiple desserts, soups, and drinks around the country and that varies from Peruvian gastronomy has the Record Guinness region to region, from north, center, and south. 2007 for the great variety and the enormous Thus, having the most representative dishes amount of typical dishes around the world. This of the Coast such as ceviche, causa Pediversity is given by the richness of our land ruana, “cabrito”, “shambar”, “mazamorra”, and by geographic diversity which offers a “suspiro limeño”, “picarones”, “pisco sour” great variety of fruits, legumes, vegetables, and “chicha morada”; from the animals, and spices, with which they can be Mountains, “rocoto relleno”, prepared and innovated in Peruvian cuisine. “cuy chactado”, “pachamanWe have more than 2,500 ecotypes of quinoa, ca”, “chupe verde”, “queso hea diversity of exotic fruits, such as “aguaje”, lado” and “chicha de jora”; and lucuma, “chirimoya”, “camu camu”, “;cocona”; from the Jungle, “juawith more than 70 types of Andean grains and ne”, “tacacho”, “cecina”, “ta“suri”, “chonlegumes such as “pallar”, “tarwi”, “haba”, “po- cacho”, roto”; and a variety of Andean roots and tubers, ta salad”, “aguajina”, among which the most representative are among many others. “oca”, “olluco”, “mashua”, “yacón”, “arracacha”, “maca”, “camote” and “pope”, with which Our most outstanding our country has more than 3,500 varieties. dish, ceviche, is conside-

red a cultural heritage of Peru, which is why every June 28 is celebrated “Día del Ceviche” all around the country. The dish based on fresh fish, “ají limo”, hot pepper, lemon, and salt, is one of the main reasons why tourists from around the world visit our country, to delight their palates. Although ceviche is prepared in other Latin American countries too, the ingredients and ways of preparing Peruvian ceviche are wholly different and make it unique. “Picarones” are fried sweets that were offered during the religious processions of the “Señor de los Milagros” in Lima, along with other desserts such as “mazamorra morada” and “turrón de Doña Pepa”. These sweets became very popular at the time of viceroyalty and were prepared and offered by “mestizos” and “mulatos”. Until now, they are desserts that we can taste mainly in September and October.

Pisco sour is a traditional Peruvian drink, made with the exquisite Peruvian pisco based on grapes, being recognized worldwide for its unique flavor. In 2004, it was decided that every first Saturday in February will be “Día del Pisco Sour”, considering it Cultural Heritage of Peru.

Peru is a country of many wonders but above all of the exquisite pleasures for which we invite you to visit our beautiful country to enjoy our different dishes and typical drinks. And why not, to try the Peruvian fusion cuisine with other cultures of the world. We promise you won’t regret it!

Story Behind Uniforms

Pride for our uniform Rossy A. Santacruz Reales Darcy Julieth Moreno Sánchez Corporación Universitaria Rafael Núñez ASCEMCOL Colombia

The uniform is an essential element of our daily life, it is a badge that we wear everywhere we go. Wearing an antifluid uniform at very high temperatures as the city of Cartagena-Colombia can get a little annoying, however, at the end of the day it identifies the role we play in society. When a person looks at us dressed in these clothing on the street or in the practice sites and recognizes us as medical students of the Rafael Nuñez University Corporation, just by wearing the uniform or seeing the logo of the univer-

sity or reading the program to which we belong fills us with joy. It signifies our dreams of becoming a doctor coming true. Knowing that the people in our society place their trust in us when we are students is fulfilling. When we are attending, helping or serving in a hospital, doing our social work in the community or in our daily lives it is very rewarding. Let us own our uniform, wear it with pride and give the best of service for our community!

Story Behind Uniforms

The reflection of our soul, education and peace. Maria del Mar Saa Dorado Universidad Pontificia Javeriana de Cali ASCEMCOL Colombia

This photograph was taken in Murillo, Tolima a municipalitie of Colombia that portrat the state of abandonment of the Colombian countryside. Colombia, a country that screams for justice every single day of the year, justice for our social leaders, indigenous, afro- descendants, childrenâ&#x20AC;&#x2122;s, womenâ&#x20AC;&#x2122;s, teachers, students... justice for people and equal conditions. We as future practitioners have to responsibility to make a change and leave a

mark , with humane treatment, medical education, public health and community interventions with an integral and intercultural approach defeating the system of our country, because health must be universal and medicine is just not about hospitals, is about the people, about us.

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