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This Week in The Lancet

  • Volume 377 1719 (2011)
  • May 21, 2011

Welcome to The Lancet Student!

The applications for TLS blogger has closed. The Lancet Student would like to send a big Thank You to all that applied to blog for TLS this year! If you were unlucky this year, you can still get involved by sending in your articles. For further information read our write for us section. The details for TLS blogging position for the following year will be out closer to time.

Furthermore, apologies to all TLS readers for the pause in the TLS daily blogs. At the Lancet Student, we have been busy working to redevelop the website. So watch this space for the new improved The Lancet Student - coming soon to a computer near you!

For further enquiries please email  niall.boyce@lancet.com

My Experience at The Lancet

TLS’s Blog - January 28th, 2011

Have a read at Devesh’s personal experience interning with the Lancet… Maybe this might spur you along to apply to be one of our TLS bloggers where you will have the option of interning for a period of 1-4 weeks!

The Lancet is a premier and one of the oldest and most reputed medical journals in the world with its offices located in London, New York and Beijing. The Lancet student on the other hand is an online-only journal for medical and health-sciences students with its office at The Lancet premises in London.  Both these journals provide an internship opportunity for medical and health science students and graduates at their Head Office in London for a hands-on experience with medical journalism, review, research ethics and editorial meetings to the interns.

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A Heart Elective In The Heart Of Pakistan

TLS’s Blog - January 28th, 2011

Hamza Tariq recounts his elective to The Lancet Student detailing his invaluable educational experience in Punjab Institute of Cardiology, illustrating a very attractive choice for an elective!

Lahore also known as the cultural capital or heart of Pakistan is the second largest city of the country. A myth tells us that it was founded by prince Loh, the son of Hindu lord Rama. The history of the city can be traced as far as 4,000 years ago and over the centuries it has seen order and turmoil, revolt and harmony and the rise and fall of mighty empires. The city is known for its huge gardens, local delicacies, modern education and appraised healthcare system, making it an exciting place for an elective.

Punjab Institute of Cardiology is the largest cardiac center in Pakistan and the first ISO certified hospital in the government sector. This premier health institute with 292 beds and highly sophisticated equipment has been offering world class cardiac care services to the patients for the last 18 years. The department of Continued Medical Education (CME) hosts electives for undergraduate medical students 365 days a year without any registration or tuition fee. The application process is extremely easy but one drawback is that the hospital doesn’t provide accommodation or transportation services for students. The teaching process is well organised and the students have the liberty to attend any department of their choice during their time there. The institute offers opportunities in all fields of cardiology including management of cardiac emergencies, Critical Care Unit, cardiology wards, angiography and angioplasty, Intensive Care Unit, Private Cardiac Surgical Wards, Cardiac anesthesia, Cardiac surgery, echocardiography, exercise tolerance tests, chest radiology, cardiac pathology lab and cardiac CT.

My elective began on the 20th of December 2010 when Lahore was in a blanket of dense fog. The inhabitants of the city are known to enjoy the winter season because the summers are awfully hot, long, humid and tiring. So winter is the best season to have an elective in Pakistan despite of its drawbacks of smog and harsh cold wind.

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Opening of Peking University Student-Run Free Clinic – Sunshine & Love Clinic

TLS’s Blog - January 26th, 2011

Today’s TLS blog is by a group of inspirational medical students from Peking University reporting on the latest developments of their student-run initiative: a free clinic for vulnerable people of Beijing. Their aim is to offer a service to those that would otherwise have no access to healthcare. This type of student-led healthcare is similarly being carried out by medical students across the USA- find out more about the great work they are also doing here.

On December 30th, 2010, the launching ceremony of Peking University Student-Run Free Clinic took place at the auditorium of Peking University Health Science Centre. Student leaders and sponsors presented at the ceremony, with Prof. Ke Yang, Executive Vice President of Peking University giving a concluding speech saying that the SRFC provided “love, responsibility and self-growth, what the students could not learn in class”.

The clinic is open for those who have no medical insurance and low income in Beijing. Doctors from Peking University Health Science Centre Campus Hospital and affiliated hospitals will provide diagnoses and treatment, while all the expenditure will be sponsored by society. Student volunteers are involved in the organising and management of the clinic, including but not limited to patient recruitment, volunteer training and evaluation, health outcome evaluation, and fund raising.

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3rd wheeling in a clinic

TLS’s Blog - January 24th, 2011

In today’s The Lancet Student blog entry, Arif brings to mind the all-too-familiar feeling amongst medical students of 3rd wheeling in a clinic…

“Hello, come in, I’ve got a medical student sitting in with me today, is that ok with you?”

Throughout our time in medical school, how many times have we heard the above rhetoric muttered in a mantra-like fashion? Its importance certainly isn’t lost on us, the doctors or even the patients yet what sort of influence does it exert on one of the most intimate relationships in our profession; that of the doctor and patient. Countless lectures, seminars and tutorials have taught us of the importance of “connecting” with the patient, “forming a rapport”. “making them feel comfortable”. Yet does having a third person, in effect – a complete stranger – not alter this precious dynamic in some way or another?

The patient seemingly has nothing to benefit from having a third person in the room. Often patients come in with a delicate question or sensitive piece of information, which doctors are meant to explore. Now if we imagine ourselves in a position of divulging our secrets to someone we trust, would we still do so in the presence of a ‘stranger’? Does this ‘stranger’ become acceptable to patients once labelled of ‘medical student’? This leads to the possibility that patients may in fact feel more reserved and subsequently not share their feelings or agendas with the doctors. Furthermore, a significant portion of the consultation is taken up by the patient’s reaction- be it questions, tears, denial, or even anger. With the presence of a medical student, or ‘stranger’ are patients not likely to modify their behaviour a little as they might feel embarrassed? Would they not be a little less inclined to perhaps shed tears? Do we not as human beings naturally let our guard down only when surrounded in the presence of those whom we feel comfortable with? Therefore, perhaps the presence of a medical student in the room is hindering the patient from feeling relaxed, comfortable and able to share their feelings.

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This week in TLS…

TLS’s Blog - January 23rd, 2011

Hope everyone’s had  splendid week, especially now that we’re over half way through the door to the year! (January is named after Janus– the god of the doorway– hence, January is the door to the year!)

TLS this week has included Mariam’s blog on Côte d’Ivoire’s crisis, Arif’s delightful elective report on Ancient Greek history, an insightful article on Neglected Tropical Diseases and our TLS Ten Question Challenge was obliterated by Ben Warner!

If you have any comments please get in touch at student@lancet.com or via Facebook and Twitter. And the deadline (31st Jan) is fast approaching to be considered as one of our 5 bloggers for the year- so get on it!

Laura-Jayne
Editor,

The Lancet Student

POSTS OF THE WEEK:

- Emerging Threats To Controlling Neglected Tropical Diseases

- “To look into the future, one must look back and understand the past”

- Ben’s TLS 10 Question Challenge!

- Safeguardig the right to health amidst Côte d’Ivoire’s crisis: a challenge to the Global Fund

- How to… survive a disaster

NEWS AND EVENTS-

Challenges Facing Healthcare- presented by Medsin Alumni

When?      Saturday 29th January 2011, 9am-5pm, at

Where?     The Healing Clinic, Club Chambers, Museum St, York.

Discuss issues of sustainability in healthcare and the proposed NHS reforms and to plan for coordinated action on these issues across the country.

Email alumni@medsin.org to register your interest

More info: http://www.medsin.org/events/335

Read the rest of this entry »

How To… Survive A Disaster

TLS’s Blog - January 23rd, 2011

So far, 2011 has been ridden with worldwide disaster. For whatever reasons this can be attributed to, the fact is they are becoming more and more frequent. Can we be more prepared and what can we do to reduce the post-disaster pandemonium that follows?

As I become immersed in the archive of BBC images of our world in disaster, I find myself propelled into an overwhelming sense of perspective. With an initially glazed focus I casually sift through the scenes of devastation from Brazil, Sri Lanka, South Africa, Australia, Haiti (one year on), Tunisia and Ivory Coast and I am soon pinched by the realisation that disasters – both natural and political – are increasing in frequency.

The world has seen the floods of Brazil, Australia, South Africa and Sri Lanka causing havoc, Haiti – despite great international intervention – is ridden with cholera and widespread crime and Tunisia and Ivory Coast are in severe unrest. With the media conveying a horrific picture of a world in turmoil, some questions spring to mind:

Can we try to foresee disasters, or are they to be branded each as dynamic individual cases: unpredictable and unexpected, to be dealt with when the time comes? How do you instil resilience into a community with limited resources but a high likelihood of experiencing a catastrophe?  Do you ignore the vulnerable and poor populations already present in that place and prioritise only those affected by the disaster?

In the situation of a disaster chaos and complexity will always be present – but who leads and coordinates response? The most important participation is from the government and civil society of that country. In the circumstance of disaster, you wish for simple commanding control, but this is rarely the case and the national structures are often overwhelmed by an influx of multi-dimensional aid programs even in developed countries. For greatest benefit to be elicited, engagement of international organisations needs to be deeply in sync with the local community and authority, and often the time for interaction and discussion is not taken. The intervention of externals in many cases causes problems in terms of their behaviour or appreciation of context of the disaster. Such influx of foreign agencies can often be very destabilising to the country’s government, local authorities and populations – international humanitarian agencies struggle to strike a balance between providing resources and destabilising social and political infrastructure. We are aware of the countries that are most disaster prone to flooding, earthquakes, strong migration patterns etc. so NGOs, local and national authorities should plan together prior to disasters rather than ignore the risks and wait until we are consumed by the big disaster. In recent years there has been increasing engagements of all actors coming together, for example the Red Cross act as auxiliaries to the government, negotiating different roles in response to disaster.

Because each disaster is so different from the next, preparedness and planning is difficult. But we can seek to draw commonalities and lessons learned. Countries should be encouraged to put themselves in position to adequately respond to a disaster. Promoting community engagement and education through setting up warehouse centres and facilitating early warning sessions such as school drills would be a more fruitful way of investing finances. A disaster protocol system should be instated and this would equip people on the ground with a clear direction in a crisis, whilst harnessing expertise at a community level rather than numerous foreign agencies simply trying to take control of the situation.

The role of foreign media is crucial in generating world attention and recruiting global donor support. Unfortunately, it seems that if you’re from a rich country the media see you as more worthy of attention (for example, media coverage of the Queensland floods seem to have eclipsed that of other disasters). If you’re not, you’ll be a twenty second jumble of images on the evening news in someone else’s living-room. The media can get it wrong. News channels want you to tune into their station so they churn out the shocking stories to grasp your attention, and sometimes they can perceive a situation to be much worse than it is. Charlie Brooker raises an example of this here.

Over 100 hundred cities worldwide have already joined the UN’s campaign, “Making Cities Resilient” as UN International Strategy for Disaster Reduction (UNISDR) continues to work with local governments and organisations to build disaster resilient communities.(1)  A major lesson we’ve learned is that recovery is not just to recover normalcy because these people are often living in starvation, abysmal poverty and antisocial activity, but recovery is a challenge of building back better and making opportunity. In the post-relief phase, there is a challenge of enhancing the local capacities to respond more effectively and to support relief camps until living conditions are adequate, allowing hand over to local capacities to rebuild their lives. An exit strategy is to look for resiliency to disaster and this should incorporate first aid training, natural disaster response training and instil preparedness and models of urban renewal. (1)

I can feel desolation that radiates so strongly from these people as they wrestle with the daily terror the world has thrown at them and it seems this is becoming an all too familiar picture. The challenge: can we be more prepared to reduce such large-scale catastrophe blighting 2011?

References

(1) http://www.unisdr.org/news/v.php?id=17503

“To look into the future, one must look back and understand the past”

TLS’s Blog - January 19th, 2011

Today Arif Khokhar shares an enthusiastic account on his elective expedition to Greece, bringing us along on his voyage into ancient Greek medical history…


Winston Churchill’s words sum up what I learnt from my unique medical SSM experience, which I undertook in my 5th year at medical school. Feeling like I needed a break from what felt like an on-going escalator I embarked on a journey to Ancient Greece armed only with a professor whose knowledge of the ancient medical world was nothing short of impressive. Greece was our destination as we set out to discover the origins of our medical fountain of knowledge. Despite the current economic climate in Greece, the wealth of history, art and culture at its disposal is second to none.

The roots of the medicine we practise today can be traced back to the Ancient Greeks, and more specifically to Hippocrates (460BC-370BC): the father of modern medicine. [1] Under his guidance medicine prospered as an independent field, divorced from religion. Previously illnesses were thought to arise as a result of punishments from the Gods, but the Ancient Greek physicians tried to find a natural explanation as to why someone got ill and died. The Hippocratic school of medicine is also famous for introducing strict professionalism, discipline, and rigorous practice into the field of medicine [2]; values which the medical profession today endeavours to uphold.

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Safeguarding the right to health amidst Côte d’Ivoire’s crisis: a challenge to the Global Fund

TLS’s Blog - January 18th, 2011

Today’s TLS blog entry is by Mariam O. Fofana, studying at Johns Hopkins School of Medicine. Mariam’s blog entry addresses the ongoing political unrest in Côte d’Ivoire, the emergence of a human rights crisis and the decision to freeze funding in the country

Since the November 28 elections that were meant to put an end to a decade-long political and military crisis, the fate of Côte d’Ivoire seems more uncertain than ever [1]. With the incumbent Laurent Gbagbo and the opposition candidate Alassane Ouattara both claiming to be president, the country is mired in a crisis that is taking an increasingly devastating toll on the civilian population, with mounting human rights violations. As of mid-January, the UN Operations in Côte d’Ivoire reported 247 deaths and 61 disappearances, in addition to an estimated 25,000 refugees in Liberia and 16,000 internally displaced persons along the border [2,3].

The European Union, the UN and the United States have all declared sanctions against the government of Gbagbo, who is widely regarded by the international community as having usurped power [4,5,6]. Joining the fray, the Global Fund to fight AIDS, Tuberculosis and Malaria has announced that it is withholding a portion of funds and supplies in Côte d’Ivoire, most of which were earmarked for malaria control efforts [7]. Although “life-saving” medications will still be disbursed, according to Global Fund spokesperson Veronique Taveau [7], the decision is troubling in that, unlike the freezing of bank assets or travel bans, its effects will likely be felt disproportionately by needy populations rather than by Gbagbo’s government. In fact, the harm of withholding aid can be exacerbated in a time of crisis and conflict, when government facilities and services are weakened.

It is also questionable whether the Global Fund should take a political stand in such situations. Funding has been withheld in countries where they were found to be misappropriated [8], but in the case of Côte d’Ivoire the funding freeze has clearly political aims. Is this decision justified when it threatens the fulfillment of the right to health? Reaching a peaceful resolution in Côte d’Ivoire should absolutely be a priority for the international community, and it will undeniably help civilian populations who, for years, have suffered from deteriorating economic and social conditions [6]. But at what cost? Who is truly being punished by the Global Fund’s decision? Is withholding bednets more likely to oust a president than it is to deprive children of protection from malaria?

The Global Fund’s decision is worrisome because it puts needy civilians’ health on the betting table of politics, potentially setting a precedent for future political crises.  With the mounting humanitarian toll in Côte d’Ivoire, the Global Fund has a chance to stand by those who need its help. In times of crisis the Global Fund should not further deprive those whose civil and political rights are endangered, but rather protect more fervently than ever their right to the “highest attainable standard of physical and mental health” [9]. With what will likely be a long road to a resolution in Côte d’Ivoire, the Global Fund has a chance to reset its course and reaffirm its commitment to the health of those in “greatest need” [10].

References
[1] Airault, P. Compte-rendu des six jours qui ébranlèrent Abidjan. Jeune Afrique 2010 Dec 10. Available from: http://www.jeuneafrique.com/Article/ARTJAJA2604p027-031.xml0/
[2] ONUCI-Opération des Nations Unies en Côte d’Ivoire. L’ONUCI réitère son appel au calme face aux violences croissantes [press release]. Abidjan: ONUCI 2011 Jan 13. Available from: http://www.onuci.org/spip.php?article5440
[3] Number of Ivorian refugees in Liberia tops 25,000 – UN Agency. UN News Centre 2011 Jan 11. Available from: http://www.un.org/apps/news/story.asp?NewsID=37243&Cr=Ivoire&Cr1=
[4] Côte d’Ivoire: Financial Sanctions [press release]. Washington, DC: US Department of State 2011 Jan 6. Available from: http://www.state.gov/r/pa/prs/ps/2011/01/154065.htm
[5] Côte d’Ivoire: EP backs EU sanctions and calls on Gbagbo to step down [press release]. Strasbourg: European Parliament 2010 Dec 16. Available from: http://www.europarl.europa.eu/en/pressroom/content/20101215IPR10428/html/C%C3%B4te-d%27Ivoire-EP-backs-EU-sanctions-and-calls-on-Gbagbo-to-step-down
[6] Côte d’Ivoire: The economic squeeze [briefing]. Dakar: Integrated Regional Information Networks (IRIN) 011 Jan 7. Availabe from: http://www.reliefweb.int/rw/rwb.nsf/db900sid/MMAH-8CW2HB?OpenDocument&RSS20&RSS20=FS
[7] Doherty, D. Ivory Coast sees some aid frozen by Global Fund to Fight AIDS. Bloomberg 2011 Jan 11. Available from: http://www.bloomberg.com/news/2011-01-11/ivory-coast-sees-some-aid-frozen-by-global-fund-to-fight-aids.html
[8] Global Fund suspends two malaria grants, terminates TB grant to Mali [press release]. The Global Fund to Fight AIDS, Tuberculosis and Malaria 2010 Dec 7. Available from: http://www.theglobalfund.org/en/pressreleases/?pr=pr_101207
[9] International Covenant on Economic, Social and Cultural Rights. United Nations General Assembly resolution 2200A (XXI). Available from: http://www2.ohchr.org/english/law/cescr.htm
[10] The Global Fund to Fight AIDS, Tuberculosis and Malaria [Internet]. [cited 2011 Jan 15]. Available from: http://www.theglobalfund.org/en/whoweare/?lang=en

Mariam O. Fofana

Would you like to be a Lancet Student Blogger?

TLS’s Blog - January 17th, 2011

We’re looking for five medical students, from any country, and in any year, to blog for us for twelve months. Potential topics include yourself, your course, your thoughts on the latest medical news, global health, technology, and more. We’d want at least two 300-500 word blogs a fortnight, and you’d have to be willing to have your name and photograph on our website.

In return, we can offer you a year’s free subscription to The Lancet online, and work experience for 1-4 weeks in The Lancet offices in London.

It’s easy to apply – we just need two things:

  1. A copy of your CV, including details of your name, the country where you study and your current year in medical school.
  2. Two or three 300-500 word writing samples, written in the style of a blog.

Please email these to niall.boyce@lancet.com , preferably from your medical school email account, by midnight (UK time) on the 31st of January, 2011. We will contact the successful candidates by the end of February. Please note that if you are successful, we will require verification of your medical school place.

This week in TLS…

TLS’s Blog - January 14th, 2011

Hope everyone’s had a wonderful week filled with January jollity!

This week’s issue has covered a range of topics, including a Helen clark interview, some super interesting elective tales, Melissa’s 10 Questions and Tom blogs on advancements in global health for 2011…

If you have any comments please get in touch at student@lancet.com or via Facebook and Twitter. Keep writing your blogs, elective reports, articles or anything at all you feel relevant- we’re always delighted to hear from you!

Have a great weekend!

Laura-Jayne
Editor,

The Lancet Student


POSTS OF THE WEEK:

- Interview with Helen Clark- sharing her comments on the MDGs and the role of academic institutions in international development.

- Elective report: Health as a Bridge to Peace- Mohammad, a 6th year medical student from Jordan takes us along his remarkable journey of his elective program in Toronto

- Elective report: An Orthopaedic Experience in Bangalore- Kanai Garala had a remarkable experience of the two extremes of wealth in India’s health system

TLS 10 Question Challenge- Melissa Kah Poh Loh shares with TLS her personal experiences in medicine thus far.

- What does 2011 hold for advancements in global health?Tom Fletcher explores what is in store for 2011 that will make a difference in global health…


NEWS AND EVENTS-

Challenges Facing Healthcare- presented by Medsin Alumni

When?      Saturday 29th January 2011, 9am-5pm, at

Where?     The Healing Clinic, Club Chambers, Museum St, York.

Discuss issues of sustainability in healthcare and the proposed NHS reforms and to plan for coordinated action on these issues across the country.

Email alumni@medsin.org to register your interest

More info: http://www.medsin.org/events/335

Read the rest of this entry »