Poverty and Disease - Breaking the Cycle

EVALUATION REPORT (SHORT VERSION) by Kim Sigaloff and Bilal Zuberi
International Training Workshop - Aalborg, Denmark, 1-12 August 2001
International Training Congress for Medical Student

IFMSA finds global health an important and pressing issue. Global health is threatened by global inequities, and therefore, as future doctors, we are concerned with the wide-spread poverty in the world. As medical professionals, we feel we should become more involved in global development debates, in international economics and trade relations, and become more knowledgeable about the root causes of poverty and its profound effects on health. We should speak out on these issues, not leaving the discussion only to economists and social development experts. The contribution of doctors, as the natural attorneys of the poor as well as the defenders of the social and economical human rights, is essential.

This was a message that the majority of participants of the international workshop on poverty and disease (7-11 August, Aalborg, Denmark) took home. The workshop was, for many students, a first opportunity to increase their knowledge on issues of poverty and health, and realize what responsibilities and possibilities they have in the field of international development. This five day training was also an opportunity to learn from each other's experiences and make valuable contacts. The wide range of invited speakers and experts provided the students with interesting sessions and excellent network opportunities. Here follows a short overview of the speakers in the workshop program:

• Day 1

  Nils Daulaire - President and CEO, Global Health Council

  Amarinder Singh Bindra - Medical Student from India

  Mike Rowson - Director, Medact

• Day 2

  David Woodward - health economist, WHO

  Mike Rowson

• Day 3

  Timothy Stamps - Minister of Health and Child Welfare, Zimbabwe

  Zafrullah Chowdhury - Coordinator, Gonashasthya Kendra, Peoples Health Center

• Day 4

  Mike Rowson

  John Yudkin & Catherine Bateman - Centre for International Health and Medical Education, University College London

  Glynis Cooper & Albert Petersen & Carlota Marchan - International Health Consortium

• Day 5

  Marianne Thompson - TCE Medical Headquarters, Humana People to People

  Connie Gates - Resource person, Jamkhed Comprehensive Rural Health Project

  Barbara Schimmer - Medical Student from The Netherlands, IFMSA-Liaison Officer for UNESCO

Besides the workshop programme other related events were held in Denmark. There were two forum discussions, open to all the international student at the International Training Congress for Medical Students in Denmark. The first was on "Poverty, Global Health and Sustainable Development" and the second was on "Global Solutions and Partnerships to Deliver AIDS Treatment". For more in-depth and policy forming discussion, a series of Round Table Discussions was also held, some topics of which were closely related to the workshop content.

Upon completion of the workshop, the participants formed the IFMSA Global Health Network, whose job is to coordinate the follow-up activities that were included in the Plans of Action from the workshop. The newly formed group within IFMSA has been given the mandate to deal with issues of global health and sustainable development, and its members share the vision of "Health for all, including the poor". We recognized the need to create a focus group within IFMSA that will be the voice of IFMSA on issues of global health and that liases with institutions such as the People's Health Assembly, the Global Health Council, the World Bank and other NGOs in planning and working out activities and projects. It is our hope, as the workshop organizers, that the proposed projects will be implemented and have the intended impact, so that IFMSA, strengthened by additional knowledge, capacity and skills, can continue "working together for a healthier tomorrow".

BOARD OF TRUSTEES

• Mohamad Akhter Executive Director, American Public Health Association
• Els Borst Minister of Health, The Netherlands
• Noam Chomsky Institute Professor, Massachusetts Institute of Technology
• Mark Danzon Regional Director, WHO-Europe
• Laurie Garrett Medical and Science Writer, Newsday
• Eveline Herfkens Minister of Development Assistance, The Netherlands
• Mario J. Molina Nobel Laureate, Institute Professor, Massachusetts Institute of Technology
• J. Pronk Former Minister of Development Assistance, The Netherlands
• Jeffrey Sachs Director, Centre for International Development, Harvard University,
• Chairman, WHO Commission on Macroeconomics and Health
• David Satcher Surgeon General, United States Government
• Amartya Sen Nobel Laureate, Master at Trinity College, University of Cambridge
• Claire Short Department for International Development, UK
  

SCIENTIFIC BOARD OF RECOMMENDATION

• Tariq Banuri Tellus Institute and Stockholm Environment Institute
• Zafrullah Chowdhury Founder of the Peoples Health Centre, Bangladesh
• Phil Clarke Director, Medicines Sans Frontières, Denmark
• Louis J. Currat Executive Secretary, Global forum for Health Research
• Nils Daulaire President and CEO of the Global Health Council
• Roger Drew HealthLink, International Poverty and Health Network
• Paul Farmer Partners in Health, Harvard Medical School
• Jim Kim Partners in Health, Harvard Medical School
• Yunus E. Kocabasoglu Collaborating Centre for Pharmacotherapy Teaching, WHO
• Jeffrey Lantis Professor of International Relations, College of Wooster, USA
• Kevin Moody Medicines Sans Frontières, The Netherlands
• Adil Najam Department of International Relations, Boston University
• Ok Pannenborg Sector Leader for Health, Nutrition & Population, Africa Region, The World Bank
• Mike Rowson Director, Medact
• Margareta Sköld Department of Health in Sustainable Development, WHO
• Marjan Stoffers Program Manager, Economic Policy and Health Group, Wemos
• Ellen Verheul Program Developer, Economic Policy and Health Group, Wemos
• David Woodward Health Economist, University of Oxford, Globalisation and Health Department, WHO
• John Yudkin Director, International Health and Medical Education Centre, UCL

In this nine-day training workshop, approximately 75 medical students attended the training programme. The programme consisted of explanatory lectures, discussions with experts in the field of poverty and health, small group discussions and debates as well as role-playing games and simulation exercises. The participants of the workshop received reading materials related to the workshop theme in advance as well as a focused training programme on the development of skills needed for work as field activists, lobbyists and medical workers.

The first two days of the workshop programme concentrated on the skills training - the idea behind this training was to develop skills in the participants so upon the completion of the workshop, they will be able to transfer their acquired knowledge into projects once they return back home. This skills training was conducted by professionals and experts who work on empowerment, management and programme development issues. In the context of the workshop theme of poverty and disease, the skills training program focused on advocacy, project design, project implementation and evaluation as well as fundraising. Not only were the basics of each of those implementation hurdles explained but practical exercises allowed the participants to practice their learned skills in smaller groups. A detailed description of the Training and resource development Programme is provided elsewhere in this report.

The third day of the workshop was also designated as the 50th Anniversary Day, on which the entire congress body came together to discuss the path that IFMSA would like to follow in the next 50 years and beyond. The day was populated with focused thematic round table discussions, an Anniversary Ceremony and a highly important forum discussion. The major theme of the entire day was to define the role of the medical students in creating a healthier tomorrow for the world. This opportunity was utilised by participants in our workshop to meet, network and consult with representatives of established health organisations, non-profit entities, international agencies and donor groups.

During this day, several activities were planned exclusively for the interest of the participants in Poverty and disease workshop. The workshop participants were allowed to choose between the various roundtable discussions that were planned and bring those more specific perspectives to the next workshop meeting. The participants delved deeper into issues such as HIV/AIDS in developing countries, malaria and tuberculosis in the world, sustainability and environmental health as well as access to drugs in very poor countries and the abject poverty in Africa.

The workshop was able to accommodate much fewer students than the interest that was showed but we planned a large forum to involve all 600 participants of the ITCMS in a discussion on global health, poverty, equity and sustainability. The forum was very well attended and the hundreds of students, medical doctors, NGO representatives, donor agencies and grass roots activists engaged in a discussion on the future of global health and the role that eradication of poverty, development of sustainable livelihoods, empowerment of local communities and an emphasis of better health as a fundamental human right will have to play.

On the fourth day of the congress, the workshop resumed with its participants focused on the multiple ways in which the cycles of poverty. The day started with a moving lecture by Nils Daulaire on an objective description of poverty and the livelihoods of people under poverty-stricken conditions. Dr. Daulaire presented us with examples of his own time spent in India, Bangladesh and Nepal where he witnessed the dire conditions of the people who were struggling barely to survive. His reflections bore down on he audience that poverty is not just a disease, it's a curse as well - at least for the people who witness it every day in their own lives and yet feel powerless to be able to change much around them. Dr. Daulaire ended his lecture by providing insights into the role of medical workers and community workers in eliminating that feeling of helplessness and bringing empowerment and smalls scale development into the communities. The need for local action was greatly stressed along with the virtues of persistence with the vision under difficult circumstances.

Next on the agenda was a real-life testimony of a medical student on the plight of the poor of India. The medical student, himself a member of IFMSA, spent time as a worker in very poor villages of India and used a multi-media presentation to share his personal experiences and difficulties during his work. The talk was very informal and very touching. Amarinder, the student giving the presentation, spoke openly about his fears on the utility of a high-ended approach to poverty when the people he saw were grappling with fears for their lives and their survival. He questioned the audience if they really understood what poverty meant. What it meant to live without food, without education, without drinking water, sanitation and in fear of dying from the next virus that visits the village. The audience was forced to ponder how to connect macro issues of global trade, international development and donor relations with the everyday lives of those living under extreme poverty.

The workshop continued with a lecture that introduced the implications of poverty on human health. Most participants in the workshop were already aware that extreme poverty existed in many parts of the world, and as medical students they were well aware of the medical diseases that are commonly found in poor societies - but this lecture brought together the two subjects by providing a look into how poverty and disease overlap, mutually reinforce each other and lead to dilemmas of human suffering. Following the brace with grim realities, there was a more informal group discussion with a leading expert on ways in which human development happens and how communities participate in the processes. We discussed not just the role of major international agencies and organizations in developing policies that aim to alleviate poverty but we also discussed the impact of local community-based projects that bring betterment very close to the lives of the suffering. Following that the workshop participants divided up into smaller groups to discuss which social, political, economical and environmental conditions are important to create a climate that protects health. These four aspects of human livelihood were a leitmotif throughout the workshop in order to study their interconnectivity with human health. The groups discussed the specific conditions that led to deterioration of health and /or contributed to poverty. Later, all groups came together, shared their findings and cross-questioned each other. It was agreed upon by all participants that poverty and disease is a systemic problem, which cannot easily be solved by dividing analytically into smaller components and working independently within them. A systemic solution would require interdisciplinary, interconnectedness with the aim to improve human living standards in the short, medium and long term.

Days five and six of the workshop were spent on an intense analysis of the influence of poverty on human health (and vice versa) from a global, national and local perspective. The main motivation of this structure was to understand the levels of influence at which different actions take place and how interventions can be made. The day consisted of lectures by keynote lectures on the universality of human rights, globalisation of trade, internationalisation of epidemics and other interdependencies of communities at international scales. The discussions, both in lectures and in small group discussions, on globalisation were very interesting and were supplemented by the diverse background of the participants. The workshop participants brought their individual views to the (sometimes heated) debate on the aspects of globalisation that affected health outcomes (social, political, economical and environmental aspects). It was evident that while a workshop participant from the economic North was concerned significantly about WTO negotiations and large scale economic changes, the participants form the economic South simply considered the existence of such large entities as a burden and their concerns revolved mostly around the availability of basic amenities to poor communities. The workshop discussed how to understand the connections between the macro and micro issues and to understand them enough to be able to prescribe more useful solutions.

One part of the afternoon was dedicated exclusively to the issue of delivery of AIDS treatment in developing countries Joint sessions were held with the workshop on HIV/AIDS in developing countries and the evening ended with a prominent panel discussion that involved all the participants of the ITCMS. The panel consisted of reputed speakers form academia, international journalism, pharmaceutical industry as well as grass roots activists and social workers. Prof. Jeffrey Sachs of the WHO Commission on Macro-Economics started the panel with a video-speech elaborating on the depth of the problem and then pitching the positive note of how the world can come together to bring relief for those who suffer or are at risk of suffering. There was a very exciting debate on the provision of cheap pharmaceuticals in developing countries and how can economies of trade be changed so that the intellectual property rights do not leave a vast majority of human population unable to provide for their health. Ms. Ludfine Opudo, a social worker from Kenya who is herself living with HIV/AIDS provided a real life testimony to how she has struggled to stand up and be counted among those who may be infected with the virus but have a right to find their place and position in the society. How she has fought to lobby for making anti-retro-viral drugs available and the difficulties, stigmas she has to face in her struggle. The audience was captivated by the presentations of all the speakers form their various perspectives but the Q&A period showed how engaged they were in the discussion. The panel lasted for much longer than the organizers had anticipated and both the speakers and the audience continued to learn from each other's thoughts and impressions on this important subject. Judging by the interest that the medical students showed in this issue, it was clear that such a candid (and informative) discussion was well overdue.

On the sixth day of the workshop, we focused on the national and local perspectives to be able to find opportunities to intervene and make a change as medical students. Our first keynote speaker discussed how the social, political, economical and environmental conditions that protect health can be influenced by national policy. Dr. Timothy Stamps, the current Minister of Health from Zimbabwe, delivered this lecture and brought real policy issues related to provision of health at a national level were discussed. The lecture and the ensuing discussion was followed by small group simulation exercises. The participatory simulation was followed by a brainstorming session on how sustainable rural development can lead to "sustainable healthiness", focusing again on social, political, economical and environmental aspects. The message of the day for the workshop participants was to understand how changes happen and how, as medical students and future doctors, each one of them can intervene at their own local, regional or national levels to bring better health to the ailing communities.

On the seventh day of the workshop, the focus shifted from region-based divisions to hierarchical issues in development work. The workshop focused on understanding the top-down approaches to combating poverty and ill health by using a case-study approach. Experts presented the case studies from various projects, such as from Jubilee 2000, and groups involved in influencing governmental policy decisions, advocacy and influencing and introducing globalisation to the medical curriculum. These cases provided an informational glimpse on how top-down approaches have sometimes worked or failed. After the case-study presentations, the workshop once again assembled into smaller groups. An intensive period was dedicated to going through the specifics of the various cases that were presented. During this case-study analysis, exciting exchange of ideas and notes took place between the students and the experts. Both had their personal and professional expertise to rely on as well the insight into how organized behavior on a large scale impacts people. The eighth day of the workshop was case-study based as well, but focusing this time on the bottom-up approaches to the fight against poverty and ill-health. The experts present from various NGOs and community action services presented cases to emphasise the issues surrounding sustainable rural development projects as well as grass-roots empowerment projects. The case-studies were once again followed by small group discussions in which the details of how to become a social worker were emphasized. Personal testimonies and experiences were found to be extremely valuable in showing what a social worker in an extremely poor community has to face. The difficulties faced did not discourage the participants from joining their ranks, but in fact, encouraged them even more since all the NGOs present were running successful campaigns. It was learned that if there is dedication, will and the availability of a strong support group, work in poor settings can be extremely rewarding, both personally and professionally.

At the end of the workshop, on the eighth day, a detailed evaluation of the workshop and its various segments was done by the participants and organisers. During a special session called the "implementation Session", the participants spent additional few hours to recapitulate on the workshop information and start with the development of actions plans for the future. The action plans of individuals and groups were peer-reviewed and displayed to the entire ITCMS. With the knowledge and skills gained from the workshop the participants were hopeful that they will be able to develop their own creative ideas for future projects. The participants created teams amongst themselves to continue the network after they left the workshop. It was agreed that an international network will be started by all the participants of this workshop to share information with each other on their individual progresses after the workshop. The ideas for new or work in existing projects were to be shared within this network and implemented through the existing networks within IFMSA.