terça-feira, 16 de dezembro de 2008

A questão envolvendo formandos de Medicina da UEL

Posicionamento da Regional Sul II da Associação Brasileira de Educação Médica a respeito dos incidentes envolvendo alunos do 6º ano médico da Universidade Estadual de Londrina (UEL).

Associação Brasileira de Educação Médica
Regional Sul II - Paraná e Santa Catarina
Curitiba, 13 de dezembro de 2008.

Carta de Apoio ao Colegiado do Curso de Medicina da Universidade Estadual de Londrina

A Regional Sul II da Associação Brasileira de Educação Médica (ABEM), reunida nesta data na Faculdade Evangélica do Paraná em Curitiba decidiu pela manifestação abaixo:
Considerando os recentes acontecimentos envolvendo formandos do Curso de Medicina da Universidade Estadual de Londrina (UEL), a Regional Sul II da ABEM vem a público manifestar seu total apoio a esta instituição.
A Universidade Estadual de Londrina sempre se situou na vanguarda do movimento de transformação na Educação Médica e primou pela qualidade de ensino médico com grande responsabilidade. Ao longo de quase meio século de história, a UEL forma profissionais médicos que se destacam no cenário brasileiro pela qualidade profissional e ética reconhecida pela sociedade.
Esses acontecimentos são muito preocupantes e merecem uma reflexão mais aprofundada. Contudo, não devem colocar em dúvida a competência da instituição em formar um médico ético, humano e comprometido com a sociedade, nem servir como argumento contra o processo de mudança na formação médica preconizado pelas Diretrizes Curriculares Nacionais para a graduação em Medicina.

Ademir Garcia Reberti
Coordenador Docente do Núcleo da Regional Sul II da ABEM

Mayla Gabriela Borba
Coordenadora Discente do Núcleo da Regional Sul II da ABEM

domingo, 7 de dezembro de 2008

Atenção primária à Saúde na China

Bulletin of the World Health Organization | December 2008, 86 (12)

China’s village doctors take great strides
Village doctors have dramatically improved access to health care in China’s rural
communities over the last few decades.

China’s barefoot doctors were a major
inspiration to the primary health care
movement leading up to the conference
in Alma-Ata, in the former Soviet
Republic of Kazakhstan in 1978. These
health workers lived in the community
they served, focused on prevention
rather than cures while combining western
and traditional medicines to educate
people and provide basic treatment.
Dr Philip Lee, then a professor
of social medicine at the University of
California in San Francisco, wrote glowingly
in the Western Journal of Medicine
about China’s primary health care system
after visiting the country in 1973
as part of a United States of America
(USA) medical delegation. He said
prior to the founding of the People’s
Republic of China in 1949, epidemics,
infectious disease and poor sanitation
were widespread. “The picture today is
dramatically different … there has been
a pronounced decline in the death rate,
particularly infant mortality. Major
epidemic diseases have been controlled
… nutritional status has been improved
[and] massive campaigns of health
education and environmental sanitation
have been carried out. Large numbers
of health workers have been trained,
and a system has been developed that
provides some health service for the
great majority of the people.”
Dr Zhang Zhaoyang, the deputy
director general of China’s Department
of Rural Health Management,
says the barefoot doctor scheme had
a profound influence on the Declaration
of Alma-Ata. “WHO research in
the 1970s found problems relating to
the health-cost burden and unequal
distribution of health resources. To try
to solve the inequality, it did research
in nine countries, including four
cooperation centres in China. China’s
experience inspired WHO to launch
the health for all by 2000 programme.”
Zhang says the barefoot doctor
scheme, initiated by central government
but largely administered locally,
had its origins in the 1950s. “The
name barefoot doctor became popular
in late 1960s after an editorial in the
People’s Daily by Chairman Mao in
1968,” he says. “The name ‘barefoot
doctor’ originated in Shanghai because
farmers in the south were often
barefoot working in the paddy field.
But China’s village doctors had been
there long before. In 1951, the central
government declared basic health care
should be provided by health workers
and epidemic prevention staff in
villages. In 1957, there were already
more than 200 000 village doctors
across the nation, enabling farmers to
receive basic health care at home and
work every day. The barefoot doctor
scheme was simply the reform of medical
education in the 1960s. In areas
lacking medicine or doctors, village
doctors could go through short-term
training – three months, six months, a
year – before returning to their villages
to farm and practise medicine.”
China now has more than 880 000 rural doctors,
about 110 000 licensed assistant doctors
and 50 000 health workers.
Dr Zhang Zhaoyang
Zhang says the scheme has evolved
over the decades, though the term
barefoot doctor is no longer used. “The
scheme has never stopped. In the early
1980s, the State Council (the Central
People’s Government, the highest
executive organ in China) directed
that barefoot doctors, after passing an
examination, could qualify as a ‘village
doctor’. Those who failed would be
health workers and practise under the
guidance of the village doctors. The
village doctors and rural health workers
still undertake the most primary
health work – prevention, education,
maternal and child health care, collecting
disease information. The quality
of [care provided by] rural doctors
keeps increasing in line with social and
economic development.”
Dr Liu Xingzhu, the programme
director at the Fogarty International
Centre at the National Institutes of
Health in the USA, was a barefoot
doctor from 1975–1977. Aged 19,
his senior secondary school classes
were interrupted during the Cultural
Revolution drive to equip people with
practical skills. “The county’s health
bureau organized medical training in
my school and provided free accommodation
and food. The trainers were
the best from the county’s central
hospital in various fields. Many of the
doctors were dispatched from the urban
hospitals during the Down to the
Countryside Movement (when Mao
decreed ‘privileged’ urban youth go to
rural areas to learn from workers and
farmers) and showed great professionalism.
They were very good trainers
and doctors.
“After graduating in June 1975,
I became a barefoot doctor at the
Suliuzhuang commune (in northwestern
Shandong Province, south
of Beijing) serving 1800 residents.
Despite the knowledge I learned from
the strict training, the conditions and
equipment in the countryside were
very limited. I was given only a bag of
some basic medicine with two syringes
and 10 needles.”
Therein lay both the strength
and weakness of the barefoot doctor
scheme. It provided the rural poor
with health care not known in pre-
Revolution days, but the doctors’ limited
training, equipment and medical
supplies meant they could not do a lot.
Another of the barefoot brigade,
Dr Liu Yuzhong, still offers basic
health care to his fellow villagers after
43 years’ service. Now 69, he is known
by patients as a caring, skilful doctor,
though he says, “I learned something
of everything, but specialized in
nothing.” He adds: “There are great
advantages to having a barefoot doctor
in the village. The patients are all my
neighbours. I know each family’s situation,
lifestyle and habits. Since I see
my patients very often, even if I cannot
diagnose precisely the first time, I can
follow up closely and give a better
diagnosis the next time.”
When the rural cooperative healthcare
system was dismantled in the
1980s as a result of China’s economic
liberalization, Liu Yuzhong was hired
by the local Dingfuzhuang Health Centre
on the eastern outskirts of Beijing.
“I was lucky because I had passed a
Ministry of Health exam in 1981 and
acquired the certificate to practise as a
village doctor.”
Liu Xingzhu believes health-care
services did suffer in the late 1970s and
early 1980s when the agricultural sector
was privatized. “The barefoot doctors,
who were paid collectively by the
commune, lost their source of income.
Many turned to farming or industry.
The most direct effect was that few
did inoculations or provided primary
health care for the peasants. Many diseases
that had been eradicated emerged
in the countryside again.”
I was lucky
because I had
passed a Ministry
of Health exam in
1981 and acquired
the certificate to
practise as a village
Dr Liu Yuzhong
The user-pays system introduced
in China in the 1980s left many out of
pocket or unable to afford treatment.
The government in recent years has
recognized the need to increase health
spending and promote new health
insurance schemes, a reflection perhaps
of China’s special commitment to a
primary health care system that “everyone
can enjoy, reflects social equality,
is affordable for everyone and matches
social and economic development,” according
to Zhang. Dr Lei Haicho of the
Department of Health Policy and Regulation
at the Ministry of Health, says
the New Rural Cooperative Medical
Scheme introduced in 2003 now covers
more than 800 million rural residents,
while public financing of the health
system has increased substantially.
Zhang maintains, however, healthcare
standards have risen steadily in
China, thanks in part to the work of
village doctors and health workers, who,
he says, receive excellent training and
support. “The maternal mortality rate
in rural China has decreased from 150
per 100 000 before 1949 to today’s 41.3
per 100 000. The infant mortality rate
for the same period has decreased from
200 per 1000 to 18.6. China now has
more than 880 000 rural doctors, about
110 000 licensed assistant doctors and
50 000 health workers.” He believes
primary health care has also helped
reduce poverty in China. “Only with
a health body can people undertake
education and production activities and
improve their living standards. Village
doctors have played a significant role
in preventing people from becoming
Despite the challenges China faces
in providing a modern health-care service
to all of its 1.3 billion people, the
barefoot doctors and their successors
can still show the way to the rest of the
world in primary health care, according
to Zhang Lingling. Writing in the
Young Voices in Research for Health
2007 essay competition sponsored by
the Global Forum for Health Research
and the Lancet, the doctoral student at
the Harvard School of Public Health
said: “The impact of barefoot doctors
in rural health-care services still exists.
Today, both researchers and policymakers
have widely acknowledged it is
hard to bring people to work in rural
areas. Even the developed countries
have experienced a difficult time attracting
medical professionals to rural
places [so] training local people seems
to be the optimal solution [in] building
sustainability in rural health-care
Liu Xingzhu also believes the
Chinese model can inform other countries’
approach to primary health care.
“Chinese experience showed that to
promote primary health care, the key
issues are human resources and medicine.
Chairman Mao advocated there
was no need for five years’ training;
one year was enough to train a doctor.
Short-term training focusing on
specific types of work, such as antiviral
treatment or prenatal care, is sufficient
to meet the demands of primary health
care, especially in the countryside or
poverty-stricken areas.” ■

segunda-feira, 1 de dezembro de 2008

"Exame de Ordem" na Arábia Saudita

The need for national medical licensing examination in Saudi Arabia
Sohail Bajammal , Rania Zaini , Wesam Abuznadah , Mohammad Al-Rukban , Syed Moyn Aly , Abdulaziz Boker , Abdulmohsen Al-Zalabani , Mohammad Al-Omran , Amro Al-Habib , Mona Al-Sheikh , Mohammad Al-Sultan , Nadia Fida , Khalid Alzahrani , Bashir Hamad , Mohammad Al Shehri , Khalid Bin Abdulrahman , Saleh Al-Damegh , Mansour M. Al-Nozha and Tyrone Donnon

BMC Medical Education 2008, 8:53doi:10.1186/1472-6920-8-53

Abstract (provisional)

Medical education in Saudi Arabia is facing multiple challenges, including the rapid increase in the number of medical schools over a short period of time, the influx of foreign medical graduates to work in Saudi Arabia, the award of scholarships to hundreds of students to study medicine in various countries, and the absence of published national guidelines for minimal acceptable competencies of a medical graduate.

We are arguing for the need for a Saudi national medical licensing examination that consists of two parts: Part I (Written) which tests the basic science and clinical knowledge and Part II (Objective Structured Clinical Examination) which tests the clinical skills and attitudes. We propose this examination to be mandated as a licensure requirement for practicing medicine in Saudi Arabia.

The driving and hindering forces as well as the strengths and weaknesses of implementing the licensing examination are discussed in details in this debate.

Para ler o texto provisório na íntegra, clique em http://www.biomedcentral.com/content/pdf/1472-6920-8-53.pdf