LATIN AMERICA REGIONAL HIGHLIGHTS

Each community update will feature a different region to get a feeling what it’s like to live, study and work there as a health professional.

Interview with Paulo Marcondes

By Aricia De Kempeneer

What are the burning issues in health in your region?

Latin America is composed of 20 countries and 2 territories. We are still facing political problems. There are many countries with political instability. Only a few have strong institutions to support the society as a whole. The main problem remains into financing what is important to ordinary people. We have three large groups of countries: those who speak Spanish, Brazil (where they speak Portuguese) and those who speaks other languages (like French, English and many others). Those groups have differences. Implanting a large and comprehensive primary care system is mandatory. Dealing with violence, drug abuse, infant, neonatal and maternal mortality and chronicle diseases are big issues.

How is the public engaging in these issues?

Again, we don’t have a common situation among all countries. Answering inequities and addressing health problems is larger in the most developed, rich and democratic countries. PAHO is working in the region with all countries to help them.

Could you tell us about some of the main policy issues that you are working on in Health professions education in Brazil?

Brazil is facing political instability right now. Many changes have been happening in the last year and many more can happen in the near future. Health Professions Education changed in Brazil in the last decade. There are many strategies used, mainly on faculty development programs. I can say that we are making them better teachers to help students towards professional competencies in health care and social engagement.

Can you describe the journey you took within The Network: TUFH?

I worked at a medical course that changed their curriculum at the W.K. Kellog UNI Project during 90s. It was part of this project to engage institutions and larger groups. We began to attend The Network: TUFH meetings and became an institutional full member. I attended the Albuquerque, New Mexico (1998) conference and was delighted by the quality of the meeting and the proximity we can get to big names of Health Professions Education. After that I attended the meetings at Londrina (2001), Bogota (2008), Graz (2011), Thunder Bay (2012), Fortaleza (2014), Pretoria (2015) and Tunis (2017). It’s an amazing opportunity to be at an international meeting on this topic, always.

What is your role as regional representative of The Network: TUFH?

I’m trying to get everybody connected in a comprehensive network. First we need to build a way to connect and then we can start to collaborate. We are looking outside the USA and Europe for collaboration and sometimes we forget our neighbors. We must work together in Latin America. I’d like to think we are building capacity now. For sure students are the big force for this movement. They have a primary role in their institutions. They know how to communicate in the digital era.

How can The Network: TUFH improve the regional representation?

It’s a very large region of the World. Perhaps by having national representatives forming a core group for actions. We have to build a common agenda.

What would you say to encourage institutions thinking of joining or re-joining The Network: TUFH? 

This is the best place to find information and partners of quality at health sciences education!

What are your thoughts on the Student Network Organization? 

As I said previously, students are a primary force and our primary concern when we think about Health Sciences Education. Since I was elected I’ve tried hard to be a partner of SNO and the SNO student representative.

What would you say to encourage students to attend the conference and becoming an active member of The Network: TUFH? 

Be here since the beginning of your course, you will enjoy and understand what you are doing at the university. It will prepare you much better to be an excellent professional in the near future. Ask your teachers, the best ones where engaged students.

Please tell us a non-professional fun fact about yourself.

I love to see movies, nowadays on Netflix and HBO, to travel and take pictures. I wish I can be a photographer of National Geographic!

Why should people visit Latin-America?

Because here you will find the best of the World. You can find amazing people living in amazing places, eating amazing food. We are fun, we are happy, fresh and we can make you feel like in heaven… alive.

Interview with Francisco Lamus Lemus

By Aricia De Kempeneer

Francisco Lamus Lemus is a pediatrician working in public health, maternal and child health, primary health and health professions education. Through the years much of his efforts have pursued the connection of inter-sectoral community health development projects with sound international initiatives where the public sector becomes involved with communities, health education institutions and diverse types of health services.

Currently, much of his time is invested in leading the research group in family and community medicine at the Center for Studies in Community Health at Universidad de La Sabana (CESCUS). This group develops a wide array of action-research projects in communities where citizens from diverse backgrounds get involved in the pursuit of health enabling communities.

What are the mains health issues in Latin America?

Like in many other places around the world, health inequity is the major challenge for our Latin American societies, therefore, also for our health systems and our health professions education structures.

The social determinants of health inequity are at the root of our major challenges as multiethnic and multicultural societies, where health indicators have had major leaps forward with regards to the overall decrease of child mortality or the improvement of life expectancy at birth; despite polarized conflicting political environments across the region.

Can you tell us about some innovative approaches, trends, projects in the Latin American region to improve health locally and/or globally?

Speaking with a bias within my field of interest I can highlight the effective trend that the IMCI strategy ( Integtrated management of child illnesses) has had in child mortality and quality in the health services provided to infants and children under 6 years of age since its arrival to the region in 1997. IMCI provided the opportunity to connect evidence based diagnostic and therapeutic procedures, to underserved populations that could benefit from better-trained professionals delivering comprehensive health care actions with an integrated approach that improved the quality of health care and diminished the most prevalent child morbidities. An added benefit of  IMCI was the possibility that each country of the region had to adapt the strategy to its own epidemiologic priorities.

Other internationally well-known health care initiatives coming particularly from Colombia include the Kangaroo Care for the Premature, Infant and Family Care Program that has proven how premature babies have become young adults with larger brains, higher salaries and less stressful lives than babies who received conventional incubator care.

Another resourceful technique well known in trauma surgery is the “Bogotá Bag” for temporary abdominal closure initially described for trauma injuries and later used as a therapeutic technique for other types of secondary peritonitis.

What is the cost of healthcare in your country? Is it the same in other Latin American countries?

Colombian health care system has been lauded for providing nearly universal health care coverage (around 98% of the population is covered) with what is acknowledged as an “obligatory package of services”.  This is a set of health services including general medical consultations (including approved alternative medical treatments), lab tests, specialist consultations, dental, therapy and medication, hospitalization, outpatient services, surgery, and some dental treatments, lab tests, and therapies applicable to primary beneficiaries. Events considered as unnecesary or luxurious according to a national expert committee, where also economic impacts of approved procedures are evaluated, decides upon what enters or stands aside for copayments, pocket money, private extra health insurance or legal claims known as “tutelas”,  a mechanism instituted to procure citizens constitutional rights.

An outstanding feature of the health system acknowledged as that of “structural pluralism” is that both financial resources and beneficiaries are expected to belong to the system according to how they contribute financially to it. This is how employed or independent workers contribute up to 12% of their income with the obligatory premium for the basic package of services acckording to their monthly income. In the case of employed individuals, the employer contributes 8% and the employee 4% of the required premium. Generally speaking, an independent contractor would contribute up to the equivalent of US $ 200.

What is the maternal and neonatal outcomes in your country and other Latin American countries?

For Colombia this is 2015 data:

  • Neonatal mortality rate per 1000 life births for 2015 is 8.5.
  • Child (under five) mortality rate per 1000 life births is 15.9.
  • Infant mortality rate per 1000 life births 13.

Maternal mortality fell by nearly half in Latin America nd the Caribbean between 1990 and 2015, from 135 to 68 maternal deaths per 100,000 live births in women aged 15 to 49.

Source: World Health Organization, UNICEF, United Nations Population Fund and The World Bank, Trends in Maternal Mortality: 1990 to 2015, WHO, Geneva, 2015.

Where, with who and how do women usually give birth in Latin America? Is there a big difference in between countries?

In Colombia and through most Latin American countries women usually give birth in health services, although there may be a wide gap within country regions and across the whole latin american continent, especially with distant and remote rural areas where health services are not available.

What would you say to encourage institutions thinking of joining or re-joining The Network: TUFH?

The Network TUFH is an excellent forum to connect health professions education required transformations within national institutions with the experience, the know-how, the evidence and innovations of communities of practice sharing the interest to approach socially accountable health professions education.

What are your thoughts on the Student Network Organization?

SNO is where the center of gravity of the organization should prevail in order to match the needed rhythm of changes in the health systems and health professions education, with the stamina that educated cohorts of young students and new professionals can provide.

What would you say to encourage students to attend the conference and becoming an active member of The Network: TUFH? 

Come join an opportunity to become “part of the change you want to see”.

Please tell us a non-professional fun fact about yourself. 

In less than five years I saw myself in transit from being a leader of institutional positions, an outdoor adventure sportsman, and public health activist, to become an empirical cook and enchanted birdwatcher and enthusiastic facilitator of future community health leaders.

Why should people visit Latin-America?

Because visitors can submerge into the turmoil of global dilemmas, innovative social action initiatives, and the upbringing of future global solutions.

 

 

Interview with Alejandro Avelino

By Aricia De Kempeneer & Myron Godhino

Student Network Organization (SNO) President, The Network: TUFH

My name is Alejandro Avelino. Born and raised in Zipaquirá, Colombia, a city near the capital (Bogotá). I’m a fifth-year medical student at Juan N. Corpas University in Bogotá. I have been working in SNO for over a year and thanks to this experience, my professional profile change ad now I´m really interested in studying Public Health. Know I´m SNO president and I’m really motivated and I´ll work hard to make SNO even stronger and share our work with more students around the world.


What are the burning issues in health in your region?
The main health problems in Latin America are directly related to inequity and the inadequate distribution of resources that make health access really difficult for the most disadvantaged. This generates that the majority of the population is vulnerable to infectious diseases, complications of pregnancy and diseases in the childhood. During the last years, each country has worked on these issues, mainly in the period 2000-2015 with the United Nations millennium goals. Many of these problems persist but great progress has been made.


How is the public engaging in these issues?
In general, the public accepted the reforms to improve health problems. But not everything is good, new models open new doors to corruption. In the specific case of Colombia, health service providers have diverted resources for private purposes, which is why users have expressed their disagreement with the government and this has intervened in a not so efficient way. Every day that passes, the people recognize that it is necessary a united and coordinated work to pressure the government leaders to generate changes that really impact the health system in a positive way


How are students involved in these issues?
Students are very active facing health problems, especially medical students. These lead student associations and federations that seek to express the opinion of the students and to be taken into account during the reforms that are made. In fact, in Colombia, the student medical associations and the association of medical deans prepare a law that seeks to modify residences, that the residents receive a salary, to ensure their health and to provide guarantees in other modifications. Although there is still a long way to go, students in Latin America are more aware of their role in society, of their role in the country’s government, and they are generating new leaders who could lead the country in the future.

 

How is the interaction between doctors and other health professionals (nurses, etc) ?
Health professionals tend to work as a team, especially doctors, nurses and physiotherapists because in clinics and hospitals are the pillar of health care, in general, other professionals work as aggregates or when consulted in specific complicated patients.


How is the interaction between students and professionals?
The interaction between students and professionals is basically as student and teacher. In hospitals and practice clinics, most of the training of students depends on the professional physician in charge. In some cases, this relationship comes to be even with the specialists allowing the student to have contact with different levels of knowledge.


How expensive is it to go to medical school in your country?
In Colombia it is very expensive to study medicine, although there are exceptions such as public universities but they are few and cannot offer many places. At this time, the minimum payment for a medical degree, each semester, is around 3,000 USD with a maximum of 8,000 USD.


Are students being pushed to do rural and community internships?
Yes, in fact, in Colombia it is mandatory to serve in rural areas for one year after graduation


How expensive is health care in your country?
Health in Colombia is relatively cheap compared to countries like the United States or Argentina. The government, represented in the general system of health services, subsidizes a percentage of the expenses and then the companies promoting health services, which work similarly to an insurer, pay another percentage. Finally the users pay a small percentage of the total cost.


What would you say to encourage institutions thinking of joining or re-joining The Network: TUFH?
I would say that The Network: TUFH is an excellent platform to show the institution internationally and to generate strategic alliances that will allow them to strengthen their programs.


What are your thoughts on the Student Network Organization?
I would summarize it by saying that it is the option that students have to open their eyes to the reality of public health in the world and at the same time allows them to strengthen their skills and knowledge at an international level.

 

What would you say to encourage students to attend the conference and becoming an active member of The Network: TUFH?
Attending the conference and being a member of The Network: TUFH is an excellent opportunity to project your career professionally. No matter which area of medicine they prefer, they always come in contact with professionals of international level and the only limitation is how far they are willing to go

 

Please tell us a non-professional fun fact about yourself.
Although I can be very serious, I love to joke and laugh to the point that I can be unrecognizable in a fit of laughter!

 

Why should people visit Latin-America?
It is a land full of nature and traditions where the modern world meets the calm of the beach or the jungle. Latin Americans are very cheerful and they love to dance, they love to show their traditions and that the foreigners enjoy them. They are also very helpful and helpful. Latin America is a unique experience and I haven’t meet first foreigner who has not fallen in love with it.

 

Anything you want to add?
Knowing other cultures allows you to think in a different way, more flexible and it makes you easier to adapt to situations that arise. Finally, it allows you to appreciate more your own country.

 

Interview with Eduarda Felsky

By Aricia De Kempeneer & Myron Godhino

SNO Regional Representative for Latin America, The Network: TUFH

My name is Eduarda Felsky, I am born and raised in Brazil and I’m a third year medical student in a city called Blumenau. I recently joined the SNO team in the last TUFH Conference that happened in Tunisia and I’m very excited to help students from Latin American to know more about SNO, The Network and go to the conferences!


What are the burning issues in health in your region?

Brazil is a very big country, so I believe that the main issue is the many different scenarios in health according to where you are. Therefore, we have many places that have good health and things really work out and places where there are not so many doctors, nurses, or resources to manage health properly. This way, I believe that the burning issue in health here is bureaucratic – the management of resources – but also a doctors distribution problem – there are few doctors that want to work in rural areas or remote places.

How is the public engaging in these issues?
People really try to get attention to these management situations, but the most effective way to change these kind of things here is by political actions. Some people go to their political representatives, or engage in discussions at the health management council, that has a big participation of the health system users.

How are students involved in these issues?
There are a few organizations here that try to talk about these issues – mainly about the doctor distribution problem. I believe that we have a big part on these issues because basic we decide where we want to work after we graduate. So if we can develop this consciousness that we need to help where we are needed, I believe we can really improve the scenario.

How is the interaction between doctors and other health professionals (nurses, etc) ?
I see that in most places people are trying to improve the interprofessional relationship because we all depend of each other. I see many places where people build work plans that involves all the different professionals so they can help the patient in the best way he/she needs. But of course, this is not everywhere. In college, we have like zero contact with students from others health areas.

How is the interaction between students and professionals?
I believe it’s a good interaction. Mainly, students respect the health professionals because they are often teaching us something so we learn the most we can, but there are sometimes where we feel like we are not needed there or they don’t value our work. I believe this is a general student feeling, but we always try to work the best we can these interactions, because they are really important for our academic and medical formation.

How expensive is it to go to medical school in your country?
We have a lot of public universities, but it’s very hard to get in those. The competition is really big and people usually spend years studying to try the application. The private ones have really different prices. The cheapest is like 1.300 dollars and the most expensive is 2.900 dollars.

Are students being pushed to do rural and community internships?
I can’t speak for the whole country, but where I study we don’t have rural internships. We do have a lot of community internships, since the first to the last semester, the school where I study is focused on family medicine so we are always on the primary care area.

 How expensive is health care in your country?
We have SUS, that is free and attend at least half of the population. The rest usually uses private health insurances, that cost something like 100 dollars per month, depending of course how old are you and if you have any comorbidities.

What would you say to encourage institutions thinking of joining or re-joining The Network: TUFH?  
That it is a really great opportunity to take a look in all of the different scenarios and actions that are taking place all over the world. We can achieve a lot when we unite all these different opinions, plans and suggestions.

What are your thoughts on the Student Network Organization?  
It’s a great initiative to unite students all over the world, with similar interests, and I’m so happy that I’m a part of it. It’s the best place to network, to get different points of view from health systems and health education everywhere around the world and to get to know people that study the same as you in different ways.

What would you say to encourage students to attend the conference and becoming an active member of The Network: TUFH?  
The best place to network, to open your mind about the world health conditions, and to engage in discussions and plan actions. It’s a opportunity of a lifetime. One of the greatest I had in my academic formation.

Please tell us a non-professional fun fact about yourself. 
I really, really love cats!! Hahaha

Why should people visit Latin-America?
We have so many beautiful places and people here always have a warm welcome to tourists. The cultural diversity is so big and we have so much to offer. It’s really one of the best places in world. We have snowy mountains, waterfalls, rivers, the Amazonia forest, deserts, and beaches. Like, we have everything in just one place.

Anything you want to add?
I want to appeal to students: please try to make it Ireland! Work on your projects, talk to your teachers, talk to your family, ask for funding, apply for the SPFH and the GEMx-SNO internship and go to Ireland! I hope see you all there. And I’m available for anybody in Latin America that wants to know more about SNO and the TUFH conferences!!!