2013 Book of Abstracts

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2013 Book of Abstracts
University of Queensland School of Medicine
GLOBAL HEALTH CONFERENCE
Book of Abstracts
Saturday, September 21, 2013
University of Queensland St. Lucia
1
University of Queensland School of Medicine
Global and Community Medicine
MEDI2044 — Global Health
The group assignment consists of an abstract followed by a presentation at the UQ School of Medicine Global Health
Conference at St Lucia campus at the end of the course. The group presentation at the conference consists of an 8minute presentation that will be assessed by staff in conjunction with the abstract.
Edited for publication by the UQ UNMDG Subcommittee
Printed by the University of Queensland Medical Society (UQMS)
Published by the University of Queensland School of Medicine
© 2013
ISBN 978-1-74272-0968
TABLE OF CONTENTS
Introduction .................................................................................................... 4
Programme ..................................................................................................... 5
N201 ................................................................................................................ 6!
Group 29: Medical tourism - benefits and risks .................................................................... 6!
Group 5: Mental health in rural and remote Australia .......................................................... 6!
Group 3: The link between population growth, climate change and armed conflict in Africa 7!
Group IPS4: The emerging epidemic of Hepatitis C ............................................................ 7!
Group IPS2: Impact of armed conflict on health .................................................................. 8!
Group IPS6: Are Millennium Villages the answer? .............................................................. 8!
Group 32: Cosmetic surgery within adolescents .................................................................. 9!
Group 20: Drug resistant malaria in Asia ........................................................................... 10!
Group 33: The Bottom Billion ............................................................................................. 10!
T203 .............................................................................................................. 11!
Group 8: Trialling new drugs in developing countries ....................................................... 11!
Group 30: Food security: challenges and responses ......................................................... 11!
Group 9: Re-emerging viral diseases................................................................................. 12!
Group 1: Comparing health service delivery to Indigenous populations in Australia,
New Zealand and North America .............................................................................. 13!
Group 17: Global eradication of polio................................................................................. 13!
Group 22: Extremely drug resistant TB .............................................................................. 14!
Group 14: Demographic transition - the ageing population ............................................... 14!
Group 27: Hepatitis B in Australian refugees and migrants ............................................... 15!
Group 34: BPA and other toxins in plastic containers: fact or fear? .................................. 15!
S201 .............................................................................................................. 16!
Group 12: Global travel as a source of anti-microbial resistance....................................... 16!
Group IPS1: Dengue in north east Queensland ................................................................ 17!
Group 39: Plain packet cigarettes – have we gone too far or not far enough? .................. 17!
Group 2: E-waste and health in developing countries ....................................................... 18!
Group 37: HIV impact on emerging economies ................................................................. 18!
Group 38: Water borne diseases and floods...................................................................... 19!
Group 35: Medical (Mifepristone) termination – an option in Queensland? ....................... 19!
Group 7: What is the role of UN and WHO in promoting and regulating global health ...... 20!
Group 25: Chronic diseases and inequality - cause or consequence? .............................. 21!
T103 .............................................................................................................. 21!
Group 4: Mental health of asylum seekers in detention ..................................................... 21!
Group IPS3: Vending machines to hospital dinner – food offerings in health facilities ...... 22!
Group 13: The increasing threat of pandemic influenzas .................................................. 22!
Group 10: Refugee health in Australia ............................................................................... 23!
Group 19: Training health workforce in developing countries ............................................ 23!
Group 11: Are GM crops the answer to solving world hunger? ......................................... 24!
Group IPS7: The Grameen bank experience - impact on gender equity and health ......... 24!
Group 31: Losing the antibiotic resistance battle – how can this be turned around? ......... 25!
Group 16: Role of social media in health promotion .......................................................... 25!
T105 .............................................................................................................. 26!
Group 18: Generic medicines ............................................................................................ 26!
Group 23: Global travel and disease transmission ............................................................ 27!
Group 26: What is the role of health NGOs in development of sustainable health care? .. 27!
Group 28: Fukushima and Chernobyl - looking back to look forwards .............................. 28!
Group 15: Investments in vaccine development and access by Global health initiatives .. 28!
Group 6: TB in PNG and Australia ..................................................................................... 29!
Group 36: D8 Promoting a healthy lifestyle: what does it mean for urban developments in
Southeast Queensland .............................................................................................. 29!
Group 24: Is the “War on Drugs” winnable? Is it a law and order or a health problem? .... 30!
Group IPS5: Measles control in South Africa ..................................................................... 30!
Group 21: DSM V – are we over medicalising mental health? .......................................... 31
INTRODUCTION
Welcome to the UQ School of Medicine 2013 Global Health Conference!
In 2012 the UQ School of Medicine Global Health Course was launched as an
inseparable part of the curriculum of a global medical school. Although new in
our curriculum the course builds on a long tradition. When it was established in
1936 our medical school had a focus on “social medicine”. This included
attention to prevalent infectious diseases (including malaria and TB) but also
equity of access to health care, intended to improve the health of Queensland’s
population. Since those early days our school has grown and now graduates
doctors from many different backgrounds and all over the world. So, a course
for global doctors makes sense. But why should we bother about global health?
Today’s world is a global world where natural disasters such as floods or fires
and political events impact on the lives of people living far away. In recent years
we have seen people fleeing their homes out of desperation or fear for their
lives. We have seen global alerts for pandemics of infectious diseases such as
influenza, requiring action across national boundaries. And the media, internet
or travel have given us insight in the huge equity gap that still exists between
and within the developed and the developing world. As health professionals we
cannot ignore this.
The Alma Ata Declaration of 1978 defined health as a “fundamental human
right” and it’s ambition was that by the year 2000 the world would have made
sufficient advances towards achieving “health for all”. However, by the turn of
the century there was still a long way to go and world leaders decided it was
time to act. The eight Millennium Development Goals (MDGs) to be achieved
by 2015, provide a framework for understanding and addressing the roots of ill
health and untimely death at a global, national, and local level. Health
professionals can play a key role at all levels. Only two years away from the
target of 2015, the year you will graduate as doctors, much remains to be done
and the world counts on you. UQ medical students are already leading the way.
The Manali Project and TIME (Towards International Medical Equality) are
inspiring examples of your engagement with global issues.
In this course you have learned about the eight MDGs and you have seen how
they relate to your world and the patients you encounter in day to day clinical
practice. Clinicians have shared their experiences, their doubts and their
passions while working in remote and underserved places at home or abroad.
This conference is your chance to contribute and reflect on a wide range of
topics concerning health and health care in our global world.
We hope you have enjoyed preparing your group’s topic and that you will be
inspired by others.
Thanks to all who have made this a day to remember.
Have a great conference!
Professor Mieke van Driel
Global Health Course Coordinator
Programme – UQ Global Health Conference
Raybould Lecture Theatre 50-T203
08:00
08:20
REGISTRATION in the Foyer
Welcome: Professor Mieke van Driel, GCM course coordinator
Global Health and Global Doctors at UQ: Dr Jennifer Schafer, Director MBBS Program
UQ UNMDG Project: Ian Anderson, Convenor
N201
T203
S201
T103
T105
09:00
Group 29: Medical tourism – benefits
and risks
Group 8: Trialling new drugs in
developing countries
Group 12: Global travel as a source of
anti-microbial resistance
Group 4: Mental health of asylum
seekers in detention
Group 18: Generic medicines
09:15
Group 5: Mental health in rural and
remote Australia
Group 30: Food security: challenges and
responses
Group IPS1: Dengue in north east
Queensland
Group IPS3: Vending machines to
hospital dinner – food offerings in health
facilities
Group 23: Global travel and disease
transmission
09:30
Group 3: The link between population
growth, climate change and armed
conflict in Africa
Group 9: Re-emerging viral diseases
Group 39: Plain packet cigarettes – have
we gone too far or not far enough?
Group 13: The increasing threat of
pandemic influenzas
Group 26: What is the role of health
NGOs in development of sustainable
health care?
09:45
Group IPS 4: The emerging epidemic
of Hepatitis C
Group 1: Comparing health service
delivery to Indigenous populations in
Australia, New Zealand and Nrth America
Group 2: E-waste and health in
developing countries
Group 10: Refugee health in Australia
Group 28: Fukushima and Chernobyl looking back to look forwards
10:00
Group IPS2: Impact of armed conflict
on health
Group 17: Global eradication of polio
Group 37: HIV impact on emerging
economies
Group 19: Training health workforce in
developing countries
Group 15: Investments in vaccine
development and access by Global
health initiatives
Group 22: Extremely drug resistant TB
Group 38: Water borne diseases and
floods
10:15
10:30
Break
Morning Tea and
Trade Show
Break
Break
Morning Tea and
Trade Show
Morning Tea and
Trade Show
Break
Morning Tea and
Trade Show
Group 11: Are GM crops the answer to
solving world hunger?
Group 6: TB in PNG and Australia
Group 36: D8 Promoting a healthy
lifestyle: what does it mean for urban
developments in Southeast Queensland
10:45
Group IPS6: Are Millennium Villages
the answer?
11:00
Group 32: Cosmetic surgery within
adolescents
Group 14: Demographic transition - the
ageing population
Group 35: Medical (Mifepristone)
termination – an option in Queensland?
Group IPS7: The Grameen bank
experience - impact on gender equity and
health
11:15
Group 20: Drug resistant malaria in
Asia
Group 27: Hepatitis B in Australian
refugees and migrants
Group 7: What is the role of UN and
WHO in promoting and regulating global
health
Group 31: Losing the antibiotic
resistance battle – how can this be turned
around?
Group 24: Is the “War on Drugs”
winnable? Is it a law and order or a
health problem?
11:30
Group 33: The Bottom Billion
Group 34: BPA and other toxins in
plastic containers: fact or fear?
Group 25: Chronic diseases and
inequality - cause or consequence?
Group 16: Role of social media in health
promotion
Group IPS5: Measles control in South
Africa
Morning Tea and
Trade Show
Group 21: DSM V – are we over
medicalising mental health?
11:45
Wrap-up
12:00
Break
Wrap-up
Wrap-up
Wrap-up
Wrap-up
N201
Group 29: Medical tourism - benefits and risks
Maxwell Braddick, Navjot Brar, Johnson Cheng, Matilda Gunalan, Andrew Koo, Amy Leeder, Noble McNaughton,
Nisha Menon, Tukten Rolfe, Kim Tran
Medical Tourism – Breaking Down Borders
Background: Medical tourism is a term used to describe cross-border travel to receive medical care.
Medical tourism has increased in the recent years due to the promotion of such a market in developing
countries. The most common destinations for medical tourists include India, Thailand and Singapore.
Presenting Issue(s): There are many advantages and disadvantages for both the medical tourist and the
population of the country providing the medical care.
Low cost, no waiting lists and the unavailability of certain procedures in their home country are the main
benefits to patients seeking overseas treatment. Risks to the medical tourist include the possibility of
receiving sub-standard medical care, unforseen costs due to medical complications and the differences in
malpractice laws.
The most significant advantage for the country providing the care is the increased revenue from the export
of medical services. Negative impacts may include removal of medical resources from the local population
and that only a small portion of the population may benefit from the medical tourism enterprise.
Ethical issues with regards to medical tourism include the concept of autonomy and informed consent,
rewards for organ donation and surrogacy, the use of unproven/illegal treatment and depriving the local
population of adequate healthcare.
Analysis: There is a need to address UNMDG8 – ‘Global Partnership for Development’ as the
management of medical tourism in the global setting can contribute towards equality in the delivery of
medical services to the individual. Alternatively, if managed incorrectly, it can have the effect of widening
the gap between the medical care received by those in industrialised and developing countries.
Suggestions for the Future: Strategies to ensure there is equitable delivery of health care include placing
stronger regulations on the quality of care provided and also on the distribution of funds towards developing
infrastructure, both medical and otherwise for the local population.
Role as Global Doctors: As future global doctors, it would be appropriate to stay up to date with the
quality and sustainability of medical tourism. The ability to provide advice to patients seeking treatment
overseas regarding the advantages and disadvantages of such treatment should also be facilitated.
Group 5: Mental health in rural and remote Australia
Kofi Afari, Jacob Allen-Ankins, Jack Bennett, Greer Conomos, Anthony Franklin, Tashika Jayasuriya, Shaina
Rodriguez, Anton Sheptooha, Xi May Zhen
Background: Mental health in rural and remote Australia is not a very popular topic discussed by residents
of these communities. The little research into this issue has elucidated the severe impacts mental illness
has on the people of these small towns. A barrier keeping people in rural areas from addressing mental
health is the stigma around it as well as the stoic culture that seems to permeate these areas.
Presenting issue(s): Those with mental illnesses in rural areas are much less likely to seek help from
medical professionals, friends or family than those in the cities.
Analysis: Factors that contribute to the prevalence of mental health disease include high unemployment
rates, lack of opportunities for social interaction and ostracism by the community for not conforming to
social norms. Another issue is that people are physically distant but socially proximate making it hard for
those with mental illness to open up about their issue for fear of the town finding out. This lack of
confidentiality and social stigma surrounding mental disease results in less support and more exclusion for
sufferers. Even family who are potential support providers can feel ashamed at this apparent display of
weakness. It is clear that rural Australia requires more professional help as distance to mental health
providers is a major issue.
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University of Queensland School of Medicine Global Health Conference
How can Australia be a world leader in health with its own rural communities suffering from significant
mental disease? UNMDG eight endeavours to create global partnerships for development, and Australia’s
approach to improving the health of isolated communities will be invaluable in working with other countries
to achieve the other seven UNMDGs.
Suggestions for the future: Persuade Community leaders encourage the discussion of mental health in
these areas would be a huge benefit. The government should provide culturally sensitive and
geographically appropriate mental health services.
Your role as a global doctor: Rural health practitioners must become more aware of the resistance to
discussing the mental health of their patients and find ways to help them divulge more information in
consultations that may not be primarily mental health related.
Group 3: The link between population growth, climate change and armed
conflict in Africa
Samantha Jackson, Casey Linton, Mitchell Walmsley, Kewei Xu, Kathryn Dayaram, Ernest Tee, Scott Murcko, Ben
Steiger, Korey Gendron, Tristan Phillip, Alexander Loucks
Gust, man and guns: a potpourri of catastrophe in Africa
Background: Africa is ravaged by climate change and is experiencing a population burst. It currently
houses 14% of the global population and this number is set to double by 2050. Furthermore, civil strife is
rife in Africa, costing African economies US$18 billion per year.
Presenting issue(s): The deleterious impacts of climate change on the African community range from
plummeting agricultural harvests to rising incidence of diseases. They place significant stress on an already
ecologically fragile farming landscape; populations plagued with poverty and illiteracy; and brittle political
systems. Moreover, population growth increases competition for scarce resources. The convergence of
these factors in Africa constitutes an ideal recipe for anarchy.
Analysis: Civil conflicts in Africa impede the fulfilment of the UNMDGs. Social disharmony has
exacerbated child mortality rates (UNMDG-4) and extreme poverty (UNMDG-1) in Africa. Gender-based
violence is also linked to the disenfranchisement of women (UNMDG-3). Paradoxically, tackling maternal
health issues (UNMDG-5) and HIV/AIDS or malaria (UNMDG-6) could perpetuate the unsustainable
population growth in Africa. Nevertheless, to ameliorate civil discord in Africa, investments in primary
education (UNMDG-2) and global collaborations (UNMDG-8) can create technological advancements for
the sustainable management of its natural resources (UNMDG-7).
Suggestions for the future: The drivers for political conflict in Africa are population growth and climate
change. Strategies for halting the burgeoning African demographics include implementing family planning
strategies, combating female illiteracy and empowering women financially and socially. To address the
climate change issue, collaborations between governments and other organisations in re-distributing
resources to increase Africa’s economic resilience are needed. The provision of foreign aid from developed
nations could also alleviate social upheavals in Africa.
Your role as a global doctor: Doctors working in the hostile environments of Africa must be competent in
the optimal management of diseases in a resource-tight system and also the art of conflict dissolution.
Embedding these skills in the medical curriculum is crucial in training doctors to work efficiently in such
inhospitable circumstances.
Group IPS4: The emerging epidemic of Hepatitis C
Rebekah Adams, Samantha Deaker, Salem Elkhayat, Alvin He, Jessica Hockey, Sebastian Jacob-Rogers, Wagaka
Makoyo, Rahul Snelling, Justin Thompson, Andrew Wilson
Background: Hepatitis C (HCV) is a virus that primarily affects hepatocytes. Whilst 25% infected people
recover without treatment, the remainder develop chronic infection, with many developing serious sequalae.
An estimated 350 000 people die annually of such complications.
In developing countries many people contract HCV through poor healthcare practices like insufficiently
screened transfusions or inappropriate needle handling, leading to climbing infection rates. In developed
countries, infections are more likely a result of risky practices, like injecting drug use.
Presenting issue(s): Preventing increasing rates of hepatitis C transmission.
Saturday, September 21, 2013
7
Analysis: Treatments for HCV are limited, with large side-effects, high cost, and variable efficacy, thus
preventing transmission is key. In developed countries focus should be directed towards facilitating
behavioural changes in high-risk groups, such as IV drug users. In developing countries educating
healthcare practitioners, and enhancing screening may be more beneficial.
Improving therapies is also a long-term priority, both to improve outcomes in those infected, and to
decrease transmission by maintaining low viral titres in these patients. This will require improving therapy
cost, availability, and efficacy.
Suggestions for the future: Educational institutes are key to improving education of health-care workers,
as well as the public, and high-risk groups. Governments may facilitate more general public health
promotion messages, regulate health-care practices, and provide such measures as support, and sterile
equipment for drug users. The public also play a role in lobbying for research into, and access to, treatment.
Your role as a global doctor: The role of doctors and health-care providers is also imperative in
successfully decreasing HCV transmission rates. Measures such as working to enhance education among
healthcare workers, as well as patients and high-risk groups, vigilance in screening and diagnosis of those
potentially affected, and to be aware of, and lobby for, patients to have access to the resources and
treatments available.
Such measures need to begin with practical education during training, to be maintained through resources
in practice, and sustained with an ethical, globally aware medical culture.
Group IPS2: Impact of armed conflict on health
Gonzalo Sumarriva, Takehiro Ichikawa, Caitlin Robison, Eugene Ma, Neil Kroeger, Gracia Malax Etxebarria, Katie
Jones, Nick Bieputra, Brendan Hunter
Background: Armed conflict presents many issues by misplacing people and resources into defence rather
than internal improvement. It greatly halts economic development in countries that are already struggling to
meet basic needs for their citizens. It creates an unsafe environment for civilians causing many to become
displaced, leading to issues concerning social and psychological health, infection, malnutrition and health
care. The negative impacts on infrastructure are the loss of homes, businesses, communication and
transportation. There are currently 51 armed conflict areas throughout the world.
Presenting issue(s): Our group identified the major issues involved as availability of water and sanitation,
loss of infrastructure, impact on children and long term consequences.
Analysis: Armed conflict affects all 8 UNMDG’s through the redistribution of resources that could be
allocated to the general public instead of sustaining conflict. More specifically it causes a shift of political
priorities from achieving the small steps needed towards meeting the MDG’s. War causes decreased
access to goods and services including medications, food, clean water, etc. leading to problems of
malnutrition, poor quality of care, spread of disease, all of which would have a negative impact on attaining
the MDG’s.
Suggestions for the future: It is critical to use the aid of international organizations such as UN, Medecin
Sans Frontiere, and the WHO to help bring awareness to the global community about the effects of armed
conflict. NGO’s provide an outlet for resource pooling and distribution of aid to areas of need.
Your role as a global doctor: As doctors, we can address these issues by joining organisations and
donating our time to directly provide care or by providing resources and awareness to those in our own
communities. The medical profession should try to make a stand towards influencing government spending
by educating politicians not only on the health outcomes of its citizens if money is reallocated to defence,
but the impact on those individuals who will be directly affected by war.
Group IPS6: Are Millennium Villages the answer?
David Arpon, Hardy Jennings, Sarah Kugelman, Sarah Li, Ross Lindell-Innes, Thilini Liyanage, David Mildenhall,
Lauren Phillips, Andrew Wang, Nicole Adams
Millennium Villages: Outcomes, Scalability and Sustainability
Background: The Millennium Development Goals (MDGs) provide a clear focus for the fight against global
poverty and inequality. However, many developing countries lack the resources required to concurrently
address the multitude of factors that influence MDG outcomes. In an attempt to address this inequity, the
Millennium Villages Project (MVP) was launched by the Earth Institute at Columbia University in 2006.
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University of Queensland School of Medicine Global Health Conference
The MVP aims to facilitate achievement of the MDGs through a holistic and community-led approach to
development. The project provides assistance to 14 villages in Africa, reaching a combined total of around
500,000 residents. Each village has been provided with a synergistic blend of infrastructure, tools and
training to enhance development.
Presenting issue(s): The research investigates whether the Millennium Villages have achieved their
fundamental goal of improving progress towards the MDGs.
Analysis: The MVP has delivered some benefits to village residents including improvements in food
security, sanitation, bed-net use and malaria incidence. However, the MVP has failed to have any impact
on rates of poverty, diarrhoea, measles immunisation and access to antenatal/newborn care.
Suggestions for the future: An ideal outcome for the MVP would have been to provide a successful
model which could be scaled up to deliver positive sustainable outcomes to other communities across the
globe. However, given the limited scope of the improvements delivered by the MVP so far, further work
needs to be undertaken to find an optimal and affordable mix of initiatives which can be replicated on a
larger scale.
Your role as a global doctor: Doctors across the globe can help improve outcomes within Millennium
Villages by visiting the villages to share skills with locally trained staff and to attend to patients directly. In
this context, a medical curriculum which includes coverage of cross-cultural communication skills and
expertise on diseases endemic in sub-Saharan Africa may be beneficial. The medical community in
developed countries can also play an advocacy role, such as lobbying for additional medical funding for
Millennium Villages.
Group 32: Cosmetic surgery within adolescents
Bo Bi, Robert Burnett, Cheng-Yu Chen, Brian Grundy, Nayan Kapadia, Brittany Fiorello, Yin Ting Liau, Michael
Marolda, Sheliyan Raveenthiran, Chantel Taylor
Beauty or the Beast? Cosmetic Surgery in Adolescents
Background: The decision to undergo cosmetic surgery in adolescents is primarily triggered by body
dissatisfaction. This is influenced by three main factors:
I. Social: expectations of the media and lack of support of close family and friends,
II. Cultural: inter- and intra-cultural ideals,
III. Psychological: negative emotions and beliefs.
Presenting Issues: As is the case with all controversial topics, there are both positive and negative
aspects of cosmetic surgery. Reasons for the procedure include promoting patient autonomy, aligning to
one’s cultural beliefs, and improving general well-being. Arguments against cosmetic surgery include
debates over its necessity, the justice of resource allocation, the question of maturity in adolescents,
possible poorer outcomes post-surgery, and obviously, the physical risks of any surgical procedure.
Analysis: Cosmetic surgery relates to the UNMDGs in terms of empowerment of women. Autonomy
empowers women, whereas submitting to social, cultural and psychological pressures takes this authority
away.
Suggestions for the Future: Currently, the effects and outcomes of cosmetic surgery on the body and
mind in adolescents require further research. Providing education and counseling from individuals and
society would also be beneficial to adolescents in making informed decisions.
Our Role as a Global Doctor: Doctors with a global perspective have to recognize the negative social and
cultural expectations of physical beauty and not succumb to such external pressures. It is our role as
doctors to establish communication to adequately inform and educate our patients as they make medical
decisions. Global doctors need to be competent in psychiatric assessments in order to assess patients’
potential psychological issues. Furthermore, they must be aware of available psychological support for
adolescent patients and have a sound understanding of and sensitivity towards different cultures and
religions. Doctors must be exposed to such matters early in their training to ensure that future generations
of budding adolescents do not go astray.
Saturday, September 21, 2013
9
Group 20: Drug resistant malaria in Asia
Ashvini Abeysekera, Ellen Coonan, Valere Chang, Georgina James, Rebecca Jenish, Jack Liao, Mora Violeta
Puertolas Lopez, Mikael Lee Riess, Alexander Tedman, Edward Zhong
Resisting the urge to prescribe – combatting antimalarial resistance in Asia
Background: Malaria is a major contributor to the global burden of disease. Mitigating the spread of
malaria is achieved by removal of mosquito breeding sites, insecticides, bednets and antimalarial
medications. An important barrier to effective malaria control is antimalarial drug-resistance. Historically,
the south-east Asian region has been a prominent source of resistance
Presenting issue(s): Recently, malarial disease within Asia has been rising due to resistance to
antimalarials. Randomized control trials along the Thailand-Cambodia border have confirmed the declining
efficacy of Chloroquin. Recently, evidence of Artemisinin resistance along the Thai-Cambodia border is
also concerning.
Analysis: Resistance has developed in these regions due to overprescription, monotherapy, counterfeit
antimalarials, mobile populations and poor adherence to treatment. The current UNMDG for malaria is to
halt the disease by 2014, and begin to reverse its incidence. While there have been many gains towards
achieving this goal in Asia, antimalarial drug-resistance is still a barrier.
Suggestions for the future: On-site doctors should be educated about drug-resistant malaria. Screening
and management should follow strict protocols to reduce malaria transmission within households. Local
governments could implement malaria prevention education. These efforts rely heavily on international
funds and there is need for global leaders to be concerted in supporting the movement against drugresistant malaria. Identification of molecular markers for resistance will also aid to monitor its spread &
evolution. Finally, a global network on antimalarial resistance could streamline elimination programs,
facilitating real-time information transfer between affected regions and researchers.
Your role as a global doctor: We must raise awareness in at-risk patients about malarial drug-resistance,
advocate for proper detection and prevention and be active in clinical malaria research where possible.
Medical students should have some exposure to malaria through infectious disease modules and at a
global health level. As anti-malarial drugs are often given without proper diagnosis, we must focus on
interventions associated with malaria, including their mechanism of action, efficacy, adverse effects and
appropriate decision-making in antimicrobial therapy. Knowledge about product authenticity is also
paramount in regions where substandard malaria treatments can favour the evolution of resistance.
Group 33: The Bottom Billion
Thomas Cavaye, Robert Chamberlain, Sei Ting Chui, Sabiha Deol, Aneesh Gupta, Alison Huynh, Wei Ching Lee,
Tammy Lin, Marlis Ryan
Background: The ‘Bottom Billion’ are found in approximately 60 countries around the world, mostly located
in Africa and Asia. Despite receiving more than $100 billion every year from nations with the power to help,
these underdeveloped countries have experienced almost no economic growth over the past decades.
Presenting issue(s): Part of the problem may be the diminishing financial aid donated over recent years,
however economist, Professor Collier, believes there are four main reasons why these countries fail to
improve:
1.
2.
3.
4.
The Conflict trap - high rates of civil war
The Natural resource trap - causing conflict and overdependence on one resource
Landlocked status - limited market for trade, with only poor neighbouring countries
Bad governance - corruption and neglect of infrastructure and education
Analysis: Addressing Collier’s four traps give us a better focus on which to address many of the UNMDGs.
By focusing on reducing conflict, lifting tariffs, providing better infrastructure and addressing bad
governance, we can increase economic growth in these nations (MDG8), thereby reducing hunger and
poverty (MDG1) and providing these countries the opportunity to invest in education, healthcare, gender
equality and sustainability.
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University of Queensland School of Medicine Global Health Conference
Suggestions for the future: Financial aid is unlikely to be able to address the problems of the bottom
billion completely, but it is part of the solution. Collier argues that further aid can be offered in the context of
three other instruments: military intervention, changes to laws and charters, and changes to trade policy to
reverse marginalization. The players involved include the public, aid agencies, Western governments,
Non-Governmental Organisation, Organisation for Economic Co-operation and Development, as well as the
World Trade Organisation.
Your role as a global doctor: Addressing the bottom billion requires multidisciplinary action and international
cooperation in working towards the same goals. Perhaps the best way we can act as global doctors is to
educate ourselves, the community and actively advocate to the political, military and economic
organisations who have the capability to resolve these issues.
T203
Group 8: Trialling new drugs in developing countries
Emily Carter, Ryan Cheng, Ryan Droney, Jolyn Khoo, Peter Moritz, John Romano, Amy Schmidt, Michael Ting,
Ashley Walsh, Mark Wang, Rebecca Yang, Sam Yuan
Our Patients vs Tomorrow
Background: A significant portion of medical research is conducted in developing nations outside of the
sponsoring institution’s home country. The healthcare system of these host countries is frequently
inaccessible, of a lower standard or absent to portions of the population.
Presenting issue(s): There is concern that performing this research in developing countries is exploiting
the vulnerable population. Some of these studies may not receive ethical approval if conducted in the
institution’s home country due to their violation of clinical equipoise. A key issue in the debate is whether a
wordwide of nation-specific standard of care should be applied in these situations.
Analysis: Ideally, a worldwide standard of care would be applied to all research, however, as there are
inherent healthcare inequalities between the sponsoring and host nations, this is not always feasible. There
are many instances where it is necessary to implement a lower standard than present in the home
institution’s national guidelines. Especially in drug trials designed to benefit the local community, it may be
necessary to use placebos or the local standard in the control-arm in order to assess the benefit of the
proposed treatment while taking into consideration economic and geographical limitations, even if a known
better treatment exists in developed countries.
Suggestions for the future: Multiple publications exist that propose logical recommendations that balance
equity and clinical obligations to patients, while acknowledging the constraints inherent in developing
countries’ healthcare. Unfortunately, a global approach is required to ensure these guidelines are adhered
to, since up to half of HIV/AIDS research does not receive ethical approval from both the host and
sponsoring nations.
Your role as a global doctor: As future clinicians and scientists, it is necessary to respect both the
research objectives and the best interests of our patients. This issue highlights the potential conflicts
between these responsibilities and emphasises the importance of promoting our patient’s health first where
possible.
Group 30: Food security: challenges and responses
Ian Borsecnik, Benjamin Buffington, Sara Campbell, Liam Couthard, Yevgen Demidenok, Robyn Kinsey, Mei Fern
Quah, Vinay Ramineni Goutham Sivasuthan, Jason Tong, Lu Zhang
Background and presenting issue: The United Nations Millennium Development Goals (UNMDG) place
a heavy emphasis on developing reliable access to food and water for a globally burgeoning population.
This ambitious goal is not without challenges; the proponents face political, logistical and natural hurdles in
attempting to bring about global food security. Here we have identified the four major obstacles to food
security and elaborate on the responses suggested thus far.
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Analysis: The global population is predicted to rise to 8.3 billion by 2030, increasing agricultural demand
by 50%. However, the urbanisation and deforestation that inevitably comes with the increasing global
population causes greater competition for agricultural land. In addition, agriculturally-protectionist and expansionist policies of national governments, or economic zones, can adversely affect the food security of
developing counties. There are logistical challenges in addressing the waste and inefficiencies in the
current global food supply chain; around 30% of global food production is wasted as it travels from field to
fork. Finally, the changing climate is set to become the most pressing issue for food security, as the
unpredictability of weather patterns will increase variability in annual production.
Suggestions for the future: We have outlined four broad challenges to the UNMDG of food security, that
of policy, competition, waste and climate. Each of these challenges is intrinsically linked to the other and,
therefore, the response to food security requires a coordinated, global response to address each of these
challenges simultaneously.
Your role as a global doctor: The challenge of food security should be a priority for the global health
profession as both under- and over-nutrition lead to chronic disease. With the successful initiatives over the
past few decades to lift substantial portions of the global population out of poverty, we are now seeing a
strange dichotomy of starvation and obesity occurring side by side. This is a challenge for health, and one
in which successful initiatives in food security can help address the balance.
Group 9: Re-emerging viral diseases
Chris Bailie, Annabel Chau, Tim Diprose, Vivienne Fok, Alex Ho, Brendan Kaufman, Jennifer Martini, Matthew
Marzurka, Ehsan Panahi, Julia Sullivan, Chad Todd, Michael Williams
Background: Reemerging viral diseases (REVD) are viral diseases previously considered controlled in a
geographical location but which are now increasing in incidence. Examples include Poliomyelitis, avian
influenza, West Nile and Dengue virus. Emerging and REVD can have devastating and unforeseen impact
such as the 1918 H1N1 influenza epidemic that killed an estimated 3-6% of the world’s population.
Presenting Issues: Factors thought to promote the REVD include: increased travel, migration and
commerce; climate change and extreme climatic events; environmental impacts such as land clearance for
forestry or agriculture; population growth; urbanization; breakdown of public health measures; and viral
factors such as mutation and adaptation.
Analysis: REVD are intimately coupled with the success or otherwise of the UNMDGs. Targeting REVD
will reduce child mortality (UNMDG 4), as 58% of child mortality is due to infectious diseases. It will also
help to improve maternal health (UNMDG 5). Ensuring environmental sustainability (UNMDG 7) and
developing global partnerships (UNMDG 8) are essential to reducing the reemergence of viral diseases.
Suggestions for the future: In order to combat the REVD the factors that promote reemergence must be
addressed. Options include: increasing surveillance; technological advances in diagnosis, vaccination,
insecticides and antiviral medications; and further research into the ecological impact of human activity.
Such initiatives are best achieved through collaboration with the World Health Organisation, nongovernment organisations, national governments, universities, the pharmaceutical and medical technology
sectors, and industries with significant ecological impact, for example; forestry.
Your role as a global doctor: As a practitioner it is important to know about REVD including epidemiology
and life-cycle. Doctors should be able to diagnose quickly and accurately and notify the relevant authorities.
They should have the ability to recognize the need for and implement measures to prevent spread and
have a role in educating the community about REVD, for example, vector control. Training in these skills
begins in medical school but doctors also need to be provided with up to date and locally relevant
information and training while on the job.
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University of Queensland School of Medicine Global Health Conference
Group 1: Comparing health service delivery to Indigenous populations in
Australia, New Zealand and North America
Juliet Affum, Mohamad Alshurafa, Roger Baker, Tim Edwards, Katherine (Nicole) Graves, Phillip La, Marie-Claire
Lamb, Hannah Redman, John Shaffer, Tommy Tseng
Indigenous health in Australia, New Zealand, Canada and the US: addressing disadvantage and
improving outcomes
Background: The checkered colonial histories of Australia, New Zealand, Canada and the US lingers on in
all four nations, manifesting as discrimination and disenfranchisement of their Indigenous citizens. Despite
ongoing efforts to combat Indigenous disadvantage, grave disparities between Indigenous and nonIndigenous health outcomes persist.
Presenting issue(s): Determinants of health - why are we here? The determinants of Indigenous health
common to all four nations include poverty, cultural estrangement, substandard housing, barriers to
education and high rates of domestic violence. Unrectified injustices of yesteryear are inherited as a form of
transgenerational trauma. In some countries, geographical isolation poses a significant barrier to accessing
health care.
Delivering health care – where are we going? All four countries have endeavoured to provide free health
services to their Indigenous citizens. In reality, these services are overstretched and in some instances
misguided, limiting their accessibility and utility.
Analysis: The MDGs were established to “encourage development by improving social and economic
conditions in the world's poorest countries.” The aspiration of Closing the Gap and similar programs in
other countries can accurately be described as eliminating disadvantage by improving social and economic
conditions amongst Indigenous peoples. The choice of targets and performance tracking is as important in
the provision of Indigenous health services as it with the MDGs. Criticisms of the MDGs, such as a lack of
analytical rigour and local community involvement, can guide the development of Indigenous health
strategies.
Suggestions for the future: In order to continue providing meaningful advances in Indigenous health,
clearer identification of goals and better funding of existing Indigenous initiatives are required. Many of the
social determinants of health are yet to be addressed.
Your role as a global doctor: A global doctor must recognise that the cause and treatment of illness
needs be considered within specific cultural contexts. In particular, the social determinants of disease and
disadvantage must also be treated as well as the medical symptoms.
Group 17: Global eradication of polio
Ashley Sui-Yi Moon, Eric Le, Gowthri Ragunathan, Harrison King, James Lee, Joel Ling, Mahmoud Hamzi, Nicholas
Tong, Patrick Hodgson, Rafid Karim, Rozanne Visvalingam, Xiaojia Fu
Background: Poliomyelitis (polio) is an infectious disease that mainly affects children. 95% of polio
infections are asymptomatic while 4% develop minor illnesses. In 1% of infections the virus enters the
central nervous system, destroying motor neurons and causing muscle weakness and paralysis.
In the early-mid 1900s, polio was prevalent worldwide. In Australia, 20,000-40,000 individuals developed
paralytic polio between 1930 and 1988. In the 1950s, mass immunisation with the inactivated polio vaccine
began in Australia and the United States. Since the Global Polio Eradication Initiative launched in 1988, the
incidence of polio has decreased from 350,000 cases to a reported 223 cases in 2012.
Presenting Issue(s): Currently, polio remains endemic in three countries – Afghanistan, Nigeria and
Pakistan – down from 125 countries in 1988.
Challenges to eradicate polio in these countries include failure to vaccinate, vaccine inefficacy, and
epidemiological profiles. Political, social, and security issues restrict the effective implementation of public
health strategies. Vaccine inefficiency is evident with the oral polio vaccine demonstrating poorer
immunogenicity in certain populations. High population densities and poor sanitation contribute to
heightening transmission and reducing vaccine efficacy.
Analysis: Since polio has no cure, prevention of disease dissemination and vaccination are the best
solutions towards a permanent polio-free world. Polio eradication falls under the goal of combating
diseases (UNMDG #6) but requires progress of the other MDGS to succeed.
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Suggestions for the future: Socioeconomic conditions that contribute to viral transmission need to be
improved: poverty, access to clean water and sanitation, and education. Vaccination programs involving
partnerships between local governments and developed countries should consequently be promoted in
these regions.
Our role as a global doctor: It is crucial for the medical profession to spread awareness of polio
eradication through educating all levels of populations so that funds are raised for program implementation
and research, local health professionals are trained and at-risk individuals understand the importance of
vaccines in disease prevention.
Group 22: Extremely drug resistant TB
Jordan Valle, Andrew Brazier, John Sisney, Alfred Liu, Shirrie Krishnan Pillai, Rathi Asokan, Jenny Duke, Thy Nguyen,
Sachin Kumar
Extensively Drug Resistant Tuberculosis: Methods and Considerations for Improved Global Management
Background: Extensively Drug Resistant TB (XDR-TB) is defined as disease due to M. Tuberculosis that is
resistant to first line therapies isoniazid and rifampicin (MDR-TB), as well as any quinolone and at least 1
one of the 2nd line therapies (amikacin, kanamycin, or capreomycin).
It has been reported in 84 countries worldwide, primarily in the former Soviet Union countries of Eastern
Europe. Outbreaks were also seen in South Africa in 2008. Additionally, there is limited data on XDR-TB
from sub-saharan African nations due to resource limitations, and the extent of global prevalence for this
reason may not really be known.
Presenting issue(s): The complications prohibiting adequate management of XDR-TB can be, broadly,
considered according to their developed and developing world settings. In developed nations, XDR-TB
emerges due to poor disease management of standard TB and MDR-TB, as well as misuse of stock TB
drugs. Patients in developing nations, in contrast, will contract and die from XDR-TB without ever having
been treated for TB in the first place, suggesting that XDR-TB surveillance is itself lacking. XDR-TB is also
noted to be an outbreak risk in areas with high HIV prevalence.
Analysis: XDR-TB management, when viewed according to UNMDG goal target 6C, is currently lacking.
Many of the challenges centre around detection and diagnosis, appropriate funding, as well as treatment
success rates.
Suggestions for the future: Suggestions for improved management of XDR-TB are (1) better basic
control of standard and MDR-TB, (2) investing in more effective drug and vaccine regimens, (3) expand
and improve surveillance, (4) newer and more rapid diagnostic tools, (5) better infection control measures,
especially in high risk areas, and (6) promotion of advocacy and resource mobilisation at all global, regional
and country levels.
Your role as a global doctor: Doctors need to be adequately trained to recognise and treat TB early to
reduce transmission and limit progression to MDR-TB and XDR-TB. This can be achieved by regularly
updating and refreshing knowledge on TB via available free courses. Since drug-resistant TB is more
common in patients who do not adhere to their drug regimen, doctors need to be skilled in helping patients
follow their treatments. Given that detection of MDR-TB and XDR-TB is also limited, doctors need to be
well-trained in making accurate diagnosis of drug-resistant TB, including the use of new diagnostic
technologies. Well-trained doctors should also be encouraged to go to areas in which TB is endemic.
Group 14: Demographic transition - the ageing population
Angus Crombie, Juliana Ding, Andrei Garcia Popov, Geraldo Guimaraes, Mariya Farah Hamid, Kelsey Hawryluk,
Luke Huang, Geraldine (Wen Bin) Kong, Stephanie Lau, Patrina Liu, Ivan (Hung-Yui) Ng, Sachinka Ranasinghe
Background: Over the past 100 years, both developed and developing countries have shifted towards an
increasingly older population demographic. It is predicted that by 2050, 394.7 million people worldwide will
be 80 years or older, whereas in 2009 there were 101.9 million. Improved living conditions, education,
technologies, and healthcare access have contributed to this increased life expectancy.
Presenting issue(s): The ageing population issue is compounded by falling fertility rates and increasing
life expectancy, affecting: (i) government & institutional healthcare cost & resource allocation due to
increased morbidity from non-communicable disease, (ii) patients’ access to healthcare as the quantity of
older people places stress on available infrastructure, in rural and urban settings, and (iii) doctors’ approach
to patient care, with a focus on management of preventable risk factors.
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University of Queensland School of Medicine Global Health Conference
Analysis: The ageing global population has consequently stressed health systems and has resulted in a
reduction of individuals’ pension values. This leaves more individuals without health care coverage, yet
demanding more of health care systems. As health expenditures on CVD, stroke and diabetes are
expected to double worldwide (WHO) and the cost of dementia 33 times greater than in 2001, it is clear that
chronic diseases compete with communicable diseases such as HIV for global expenditures (UNMDG 6).
Suggestions for the future:
(1) Research institutions: Create a collaborative multi-national approach to researching population
aging in order to formulate a cohesive plan for reducing global costs (UNMDG 8)
(2) Health Care Sector: Minimise long-term costs with a community-based preventative chronic care
focus (vs. hospital-centered)
(3) Government and Economic Sector: Funding for improved rural health care (equality of access)
(4) Educational Institutions: Chronic disease management education in allied health professions
(5) Workforce business: Keep older people in the workforce longer to enable financial selfsufficiency
Your role as a global doctor: Medical improvements prompted a shift in patient presentations from acute,
communicable complaints to chronic, non-communicable diseases. Consequently, medical curriculums
should focus on management of multiple chronic health issues, polypharmacy and palliative care, in a
context of physical and/or cognitive decline. Students must learn skills to handle complex medical
presentations, rather than simplified cause-effect relationships. Guidance by experienced doctors is
suggested to improve students’ thought patterns and communication skills with elderly patients.
Group 27: Hepatitis B in Australian refugees and migrants
Brady Bonner, Ivana-Aleksandra Jovanovic, Josefina Lam, Nicholas Latuso, Jacqueline Luk, Brendon Morden,
Brendan O’Reilly, Jeremy So, Rory Townend, Sophie Turner, Jialin Yee
Globalisation Contributing to Increasing Incidence of Hepatitis B in Australia
Background: Hepatitis B in Australia is currently well managed in Australian born citizens through
vaccination and education. A large proportion of Australian immigrants come from areas with high
prevalence of Hepatitis B, such as the Asia Pacific region. This influx of immigrants has created growing
concerns including the cost of chronic hepatitis management. This problem is also due in part to the fact
that there is no mandatory screening procedure for hepatitis B on immigration.
Presenting issue: The introduction of Hepatitis B into Australia via immigrants due to a lack of appropriate
screening.
Analysis: Regarding Hepatitis B screening there is a lack of intervention by the department of immigration
and citizenship, and department of health and ageing. It is currently up to the discretion of the medical
officer of the commonwealth as to whether or not immigrants are screened for Hepatitis B. The lack of
mandatory screening has resulted in preventable, undetected hepatitis B in the community. This has led to
an inappropriate distribution of health care resources that could otherwise be avoided. The current policy is
contradictory to UNMDG 6, and the goal of reducing the spread of transmissible disease.
Suggestions for the future: Implement a mandatory hepatitis B screening process for Australian
immigrants arriving from high risk countries in hopes of improving the distribution of funds and improving
individual patient outcomes. This will involve cooperation between the Department of Immigration and
Citizenship, and the Department of Health and Ageing.
Your role as a global doctor: Increase your index of suspicion by encouraging patients born in high risk
countries to be screened for Hepatitis B. All that is needed to accomplish this is a familiarity with the
relevant epidemiology and screening techniques which is a part of our core medical curriculum.
Group 34: BPA and other toxins in plastic containers: fact or fear?
Subbuh Choudhry, Mark Gobbin, Jesse Hunt, Bridget Johnson, Elliott Kwan, Kendra Losch, Giuseppe Pastore, Akila
Ratnavadivel, Robert Renjel, Daniel Yew
BPA: Life in plastic, it’s fantastic?
Background: Bisphenol A (BPA), is widely used as a hardening agent in manufacturing food and drink
containers, baby bottles, and dental sealants. It is believed to be disruptive to the endocrine system, and
high levels of exposure are therefore a concern.
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Presenting issue(s): There are mounting fears that BPA can cause adverse effects on human health –
with particular concern for foetuses. With nearing-universal use in food and beverage containers, there is
widespread exposure to BPA. The negative media attention towards BPA has brought the issue to the
forefront; however, thus far there is scant evidence to support their claims.
Analysis: BPA is rapidly metabolised and excreted by humans (T½ <6h). Until 2013, most studies had
been performed in animal models, causing many to speculate about the applicability to humans. Links have
been found between high BPA exposure and lower sperm count in male rodents, but this has not been
demonstrated in humans. These studies also used levels of exposure well beyond actual environmental
levels. 2013 studies, however, are showing that levels more representative of human exposure can still
cause adverse effects. As an endocrine hormone disruptor, it has been shown to be involved in many key
mechanisms in diabetes development. In foetuses, as targeted by UNMDGs 4 and 5, BPA levels are higher
due to a lower metabolic rate, with pre-natal exposure being associated with altered birth weight. There are
also concerns about the environment, pertaining to UNMDG 7. There has been minimal research into
safety as these types of chemicals are considered safe until proven otherwise by the Environmental
Protection Agency.
Suggestions for the future: More human research is needed. Further, governments should make
manufacturers responsible for proving the safety of chemicals. Also, safer materials as a replacement for
BPA in food and drink containers should be explored.
Your role as a global doctor: As doctors, we need to be aware and able to provide up-to-date information
to the community. Training and curricula should be tailored to ensure we are equipped with the most
current recommendations.
S201
Group 12: Global travel as a source of anti-microbial resistance
Ben Cahill, Kate Engelke, Simon Gardner, Katharine Hall, Nabil Hasan, Brian Lai, Bonny Lee, Yemi Omotoso, Katrina
Ng, Ji Won Seo, Chih-Han Tseng, Tiffany Wang
Australia to Angola...the Emergence/Re-emergence of antimicrobial resistance
Background: Antimicrobial resistance (AMR) reduces the effectiveness of drug therapy in treating the
diseases caused by these organisms. This increases the burden of cost, morbidity and mortality. As
globalization is becoming more prominent and international travel more accessible, the spread of AMR is
an imminent health concern.
Presenting issue(s): Increasing evidence has shown various infective organisms tracing back to less
developed countries. Several AMR agents of note include MRSA, antibiotic resistant Neisseria Gonorrhoea
and drug resistant Tuberculosis. Increasing incidences of AMR organisms have lead to increased mortality
and healthcare costs during their treatment.
Analysis: Many factors have contributed to the spread of AMR; among them being increased international
travel, clinical misuse and antibiotic use in agriculture. Reasons for clinical misuse include education and
medication costs, including the use of expired, counterfeit or incomplete regimens resulting in subtherapeutic dosages. Agricultural antimicrobial naturally selects resistant organisms in the wild. Organisms
from resultant community reservoirs are spread to the developed world via increasing trends in tourism and
immigration. Slow development of newer microbial agents has limited the drugs clinicians have to combat
AMR organisms. MRSA, N. Gonorrhoea and TB are particularly problematic due to their ability to be carried
asymptomatically.
Addressing AMR spread is in line with the United Nations Millennium Declaration Goal. This includes
achieving affordable antibiotics for full therapeutic regimens (Target 8.E) and in doing so reducing the
incidence of major diseases globally (Target 6.C)
Suggestions for the future: Intervention should take place globally on all scales. Local measures include
educating prescribers and patients about judicious and therapeutic antibiotic use. Hospitals should enact
guidelines and audits for antibiotic use and infection control. Governments need to limit agricultural
antibiotic use and drive pharmaceutical development.
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University of Queensland School of Medicine Global Health Conference
Your role as a global doctor: Doctors trained in the developed world are generally leading in infection
control and judicious antibiotic use. As a global doctor, one should introduce this to developing countries by
engaging in educational exchanges and educating domestic travellers.
Group IPS1: Dengue in north east Queensland
Kobi Haworth, Anne Tufton, Jemma Nokes, Rebecca Carpenter, Alyssa Tang, Natalie Niap, Justin McMahon, Yo
Kawaguchi, Edward Lee, Michael Jokic, Henry Harman
Background: Dengue fever is transmitted by the Ae. aegypti and Ae. albopictus mosquitoes and is now
endemic in over 100 countries worldwide. In the last 50 years the incidence of dengue has increased by
over 30-fold globally. Fortunately dengue is not endemic to Australia and local epidemics are currently
confined to North East Queensland.
Presenting issue: Dengue is an important public health issue resulting in almost 4 per 100 000 population
hospitalisations in North Queensland in 2011. Whilst the spread of dengue is currently limited by the Ae
aegypti distribution, an emerging local threat is the establishment of Ae. albopticus in the Torres Strait. This
vector has a higher tolerance to cold and can potentially spread dengue further south throughout coastal
Australia.
Analysis: The sixth Millennium Development Goal aims to combat diseases of global significance such as
dengue fever. The World Health Organisation has shown that through a coordinated approach it is feasible
to control and reverse the worldwide spread of dengue.
Locally, Queensland Health has developed the Dengue Management Plan, focusing on three elements
recognised as international best practice: namely ongoing prevention, sporadic case response and
outbreak management. The “Defend against Dengue” campaign, is a notable local dengue prevention
strategy.
Suggestions for the future: Community engagement is critical to ensuring the ongoing expansion and
success of the “Defend against Dengue” campaign. Local ownership of dengue prevention initiatives, such
as dengue education in schools, strengthens their impact.
Your role as a global doctor: Effective disease prevention relies on doctors notifying the public health unit
of suspected dengue cases. The UQ School of Medicine prepares students to be global doctors by
incorporating dengue diagnosis and outbreak management into the medical curriculum. Doctors must take
a proactive approach in educating the community on dengue’s importance, its symptoms, and the
preventative campaigns being undertaken.
Group 39: Plain packet cigarettes – have we gone too far or not far enough?
Nina Preet Kaur Dhillon, Tiffany Hoang, Hayley Man, Bonnie McInturf, Thomas Mulcahy, William Nicol, Hyunsu Oh,
Alexander Robinson, Yong Hao Tan, Alexandra Walton
Background: New legislation in 2012 has made it mandatory for all tobacco products to be sold in plain
packaging. This has reduced the appeal of smoking and had significant impact on smoking behaviours.
Presenting issue(s): Studies have shown that plain packaging has decreased the appeal of smoking, thus
reducing tobacco consumption. However, the current rate of taxation on tobacco products fails to cover the
health costs incurred as a result of tobacco consumption.
Analysis: Since the legislation is relatively new, more research needs to be conducted to show the long
term effectiveness of plain packaging. However, some thought should go into increasing taxation in
conjunction with plain packaging as there is evidence that increased taxation has reduced tobacco
consumption in other countries.
How does this relate to UNMDGs: Goal 8 of the UNMDG aims to develop a global partnership for
development. Through our efforts, we can benefit countries that heavily rely on the tobacco industry and
are therefore exposed to a greater degree of social and physical harm. Also, we can provide an example
for other countries to follow thereby promoting global health.
Suggestions for the future: Regarding future changes in reducing tobacco consumption, we propose
increasing taxation of tobacco products and broadcasting the dangers of tobacco consumption.
Furthermore, we suggest reducing the number of places where cigarettes can be sold. Finally, we propose
using famous people as role models to publicly denounce tobacco use thereby further diminishing its image
and appeal.
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Your role as a global doctor: As doctors, we should constantly keep our patients apprised of the dangers
of tobacco use and provide ready advice and support. To ensure we properly handle these issues, we
should have more training and practice in communication skills as well as training for current doctors. A
standardised list of questions would also help direct our approach towards these issues in the most efficient
way.
Group 2: E-waste and health in developing countries
Ian Anderson, Emily Choong, Alexandra Hand, Justin Jin, Thomas Lynch, Korinne Northwood, Charlotte Ramin,
Stephen Switzer, Thomas Vos, Don Zhang
The harmful end of the information highway: e-waste disposal health impacts in low-income countries
Background: In 2011, approximately 40 million tonnes of e-waste were produced from disposal of
electronic products. This waste was mainly transferred to lower-income countries such as China and India.
In these countries, disposal is either formal, in recycling centres/landfills, or informal via illegal
dumping/burning. Economic benefit from these processes creates a significant demand for e waste.
Presenting Issues: In lower-income countries, formal facilities suffer from poor policy guidance and weak
regulatory mechanisms. Informal sites are not monitored. The inappropriate disposal of e waste can have
detrimental effects on individual and population health through direct exposure to hazardous material and
also through the contamination of soil, water and air. Heavy metals, persistent organic pollutants, flame
retardants and radioactive material pose the greatest threat to human health.
Analysis: Unregulated importation and poor disposal techniques disproportionally affect the health
outcomes of poor populations. Unregulated sites mean that children may work instead of attending school
(UNMDG 2), pregnant and breast-feeding women exposed to toxins can result in harm to foetuses and
breast-fed neonates (UNMDG 4 & 5). Furthermore, poor practice can threaten environmental sustainability
(UNMDG 7). While the redistribution of e-waste to poor societies may have some altruistic value by working
to alleviate poverty (UNMDG 1) and promote supplementary incomes for women (UNMDG 3), without
proper education regarding the dangers of toxins and access to appropriate protective equipment, the
harms of exposure outweigh these benefits.
Suggestions for the Future: A multifaceted approach with a global consensus on the risks is required to
adequately address the problem. In higher-income counties, strategies should include industry
responsibility, regulation of exports, and increased consumer awareness. Lower-income countries require
compatible domestic policy and regulation coupled with increased education on the risks of e-waste
handling. In general, improving socioeconomic factors that contribute to the pull factors for people working
in e-waste disposal are required.
Your Role as a Global Doctor: Doctors should speak on behalf of patients affected by e-waste handling
and advocate for policy change on an individual and population basis. Medical students should learn about
the risks, health outcomes and protection methods regarding e waste handling.
Group 37: HIV impact on emerging economies
Linda Guo, Lucy Hempenstall, Sean McKeague, Curtis Dao, Sarah Donnell, Duy Huu Huynh, James Cochrane,
Georgie Kerin, Jessica Way Lozier, Zhijing Tan
Background: Of the thirty-three million people living with HIV, more than 95% are living in developing
countries. Two-thirds of patients with HIV live in Sub-Saharan Africa, where the disease reduces gross
domestic product by ten percent per capita. The impacts of this disease on emerging economies are
extensive and multi-factorial.
Presenting issue: Workers infected with HIV and their families experience loss of productivity and income,
and family assets are often depleted to pay for healthcare. The high mortality caused by HIV/AIDS
drastically reduces labor supply and at a national level, results in loss of gross domestic product and tax
revenue. Overall, this impairs the government’s ability to finance public expenditure, not only in relation to
healthcare, but also other sectors, including education. This is amplified by the high costs of HIV testing
and treatment.
Analysis: The Millennium Development Goals aim to halt and reverse the spread of HIV/AIDS, which
would undoubtedly reduce the disease burden on the economy. Universal access to HIV/AIDS treatment is
also part of this goal. The flow-on effects of this would include benefits to other Millennium Development
Goals, such as education, the reduction of child mortality and the improvement of maternal health.
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University of Queensland School of Medicine Global Health Conference
Suggestions for the future: Because there is latency between HIV infection and the onset of AIDS, the
implications of this pandemic on emerging economies are yet to fully evolve. Hence, it is pertinent to
develop strategies to anticipate these countries’ growing fiscal and healthcare needs, such as the
improvement of education, testing and treatment. It is particularly relevant to aim these initiatives at a
community level as it has been proven to be more efficient and sustainable than continuous foreign aid.
Your role as a global doctor: It is important as doctors to advocate for the health of patients with HIV and
raise awareness about this pressing issue, particularly because HIV is highly prevalent worldwide and
transmission rates remain high. It is important for students to learn about these global health issues as part
of the medical curriculum and become aware of the opportunities to work with international foreign aid
organisations.
Group 38: Water borne diseases and floods
Deepthi Yeturu, Alex Leasure, Thomas Cooper, Louise Waterhouse, Micah-Lynn Truant, Hasitha Karunaratne, Yue
Huang, Yen Ni Toh, Aminda Nanayakkara, Donna Lu, Kiran Dhaliwal
Water borne diseases and floods – a re-emerging problem
Background: Floods and their sequelae have been an inextricable aspect of human history. Where there
are floods, water borne diseases caused by pathogenic microorganisms often follow. There is strong
evidence to support the correlation between flood exposure and higher susceptibility to infectious disease.
There are many factors involved, most notably population displacement and a compromised water source.
Many of the water borne diseases could be prevented through prophylactic water treatment programs and
more effective management of drinking water during natural disasters.
Presenting issue(s): The core issue is flood management from a public health perspective – specifically
looking the impact of cholera and prophylactic measures such as education on water sanitation/purification,
as well as acute measures taken during a natural disaster.
Analysis: The UNMDG target to halve the proportion of the world’s population without access to an
improved source of water was met 5 years ahead of schedule, however cholera outbreaks have still been
steadily increasing since 2005. The UNMDG target to reduce by two-thirds the under-5 mortality rate has
already seen a decrease from 12.4 million in 1990 to 6.9 million in 2011 but still has a long way to go.
Leading causes of death in under-five year old children include pneumonia, diarrhea, and malaria, which
can be decrease with better flood management.
Suggestions for the future: There is a need to shift the emphasis from response to prevention in order to
avert outbreaks – this would need to be implemented across the board from local governments down to the
individual. Areas to focus on are expansion of access to improved sources of drinking water, improvement
sanitation, and development of programs within communities to encourage behavioural change to diminish
the risks of infection.
Your role as a global doctor: Global doctors need to understand the widespread effect that floods along
with their water borne diseases have on a community. Integrating the physical, social and economic impact
of these issues into the medical curriculum will allow for medical practitioners to be better equipped in
assessing and solving these problems quickly.
Group 35: Medical (Mifepristone) termination – an option in Queensland?
Alanna Platz, Rebecca Conrick, Camille Savoia, Clyde Ong Nan, Courtney Fox, Dennis Conlon, Edgar Chan Wong,
Bung-Kook Ko, Karan Gupta, Nyree Littler
The pressing issues of medical termination in Queensland
Background: Mifepristone was registered for use in Australia in 2012 and listed on the Pharmaceutical
Benefits Scheme. However, it is only supplied to practitioners registered with an accredited health provider
and can only legally be prescribed up to forty-nine days of gestation.
Queensland has one of the most restrictive abortion laws in Australia. It is a crime to perform, access or
facilitate an abortion except to prevent serious harm to a women’s health.
Presenting Issues: Access and equity gaps of medical abortion in Queensland and related ethical and
legal matters.=
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Analysis: Medical termination is available in more than fifty countries and is listed by WHO as an “essential
medicine”. Yet in Queensland, abortion services are limited to urban centers in the southeast area and
mifepristone is only available via specific pharmacies that subscribe to the sole distributor of the drug.
There is also no compelling reason why the use of mifepristone is restricted. The majority of abortion
requests are for gestations greater than forty-nine days and mifepristone can be safely used up to the sixtyninth day of pregnancy.
The United Nations Millennium Development Goals include improving maternal health and promoting
gender equality. Queensland has the resources to fulfill these goals and set a health care service example
for developing countries. Access to abortion services is vital for maternal health and safeguards against the
practice of unsafe abortions.
Suggestions for the future: Mifepristone should be more accessible by making the drug available to all
pharmacies and increasing the number of public health services providing abortions. The laws governing
abortion should be revised to address issues raised by doctors, policy makers and the general public.
Your role as a global doctor: Doctors need to be educated and understand their own moral position
regarding abortion. To address the issues of inequality of access to abortion services, doctors and health
organizations can help raise awareness to policy makers.
Group 7: What is the role of UN and WHO in promoting and regulating global health
Philip Arellano, Kuan-Yi Chen, Anna Coghlan, Drew Comeau, Irene Guo, Christopher ‘Bryan’ Huang, Winona Kwan,
Nathan Murray, Ridhwan Shams, Morgan Smith, Jane Wei, Yi Wei
A Critical Analysis of the Role of the UN and WHO in Promoting and Regulating Global Health
Background: The United Nations (UN) is an international organisation founded in 1945 following World
War II as a commitment to maintain international peace and security, to promote social progress, better
living standards and human rights. Subsequently in 1945, the UN Conference on International
Organizations voted to establish a new World Health Organization (WHO) to target malaria, tuberculosis,
venereal diseases, maternal and child health, sanitary engineering and nutrition. Since there establishment,
both bodies have played crucial roles in the promotion of global health.
Presenting issue(s): Both the UN and the WHO have expressed in their agenda a commitment to
promoting and regulating global health. Analysis will be conducted to evaluate the effectiveness of these
bodies to meet at attaining these goals
Analysis: The UN has played a strong role in advocacy, education, training and providing incentives for
governments to do their part in improving health in their states. This has been achieved through setting
well-defined millennium goals which also target the social determinants of health. However, the UN has
many branches with no clear leadership or integrated plan to address health across all domains.
Interventions are also disease-specific and donor-driven. Hence certain diseases such as infective
diseases are privileged over other diseases such as non-communicable diseases despite both being strong
drivers of mortality globally.
The WHO’s strength lies in its ability to monitor disease and measure government performance on health
whilst mapping trends and epidemics. It is unrivalled in global standard setting. However, the WHO
guidelines target a wide variety of countries, making specific and detailed information about
resources and financial costs problematic and the WHO is susceptible to undeclared interests corrupting
the WHO’s policies and processes.
Suggestions for the future: UN and WHO need coherent leadership, collaboration, transparency and
oversight in their mission to promote global health.
Your role as a global doctor: As global doctors we need to be trained on analysing and critiquing both the
scientific literature and the also the institutions that surround medicine. Training and education in health
policy legislation and advocacy should form a compulsory part of education both at medical school and in
further specialist training.
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University of Queensland School of Medicine Global Health Conference
Group 25: Chronic diseases and inequality - cause or consequence?
Madeleine Anese, Camille Dunn, David Inderias, Alexander Kingswell, Linda Lin, Antonia Morris, Joshua Mullins,
Balaranjan Pragatheesh, Stephanie Smith, Marc Vaz, Anusari Weeransinghe
How SES Inequity Causes Type II Diabetes Mellitus
Background: The worldwide burden of chronic disease is not equitably distributed. Between countries and
within a country differences in socio-economic status (SES) are a source of inequity. The inverse
relationship between SES and diabetes mellitus type II (DM type II) is an example of how inequity leads to
the development of chronic disease.
Presenting issue(s): A low SES has been shown to be associated with an increased incidence and
prevalence of DM type II. Individuals with a lower SES tend of have more risk factors associated with the
development of DM type II such as, obesity, poor diet and lack of exercise. Additionally, a lower SES is
associated with worse management as well as an increased rate and earlier onset of DM type II
complications. SES inequity contributes to the development of DM type II and to increased morbidity.
Analysis: Inequity of DM type II relates to the UNMDG goal of promoting gender equality and empowering
women. Women tend to have increased rates of DM type II. In both developing and developed countries,
rates of obesity, a risk factor for DM type II, tends to be higher in lower SES groups and women make up
70% of the worlds poor. Reducing SES inequity relates to the UNMDG goals because women feel most of
the burden of DM type II.
Suggestions for the future: There are two main strategies that can be employed. First, targeting the
increased rate of risk factors, by reducing the cost of healthy food and making physical activity more
accessible. The second strategy is to improve management of DM type II by, subsidising medications and
glucose monitoring devices and making primary care services more accessible.
Your role as a global doctor: Acting to reduce SES inequity through education, advocacy and community
program development are important roles. Medical education can play a role by including effects of SES
inequity in the curriculum.
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Group 4: Mental health of asylum seekers in detention
Ashley Richman, Benjamin Van Heerden, Charlotte Piesse, Kiat Cheng, Garbrielle Fernandez, Janice Lee, Muqtasid
Hussaini, Reuben Chen, Son Do, William Middleton
Background: Despite being a signatory to the 1951 Convention and 1967 Protocol relating to the Status of
Refugees, Australia's record regarding refugee treatment is underwhelming. Asylum seekers are detained
from months to years awaiting processing. Even prior to detainment, they have higher rates of mental
illness, with nearly a fifth having been tortured, imprisoned or witness to the murder of family or friends.
Presenting issue(s): Refugees often face severe stressors prior to leaving their countries. This together
with prolonged detention and uncertain futures puts them at greater risk for depression, PTSD, anxiety and
mental-health related disability, with long-term implications for their wellbeing.
Analysis: Although Australia is unable to alter the pre-migratory stressors of refugees, the post-migratory
ones are preventable. The issue has its roots in the governmental framework handling refugees, as well as
the social and health services available to them, the cultural contexts from which they come and also our
own cultural perceptions of refugees. Refugee health and mental health are not directly part of the UNMDG
but they do emphasise the spirit of caring for the vulnerable, such as children, women and the
impoverished; groups well represented amongst refugees.
Suggestions for the future: Evidence suggests that a sense of community and belonging, freedom from
harms, and an environment supporting development in youths can all facilitate recovery from displacementrelated trauma. Ensuring families remain together in community accommodation and expediting refugee
processing would prove invaluable in improving mental health outcomes. Furthermore, the view of
RANZCP is that standards of basic health care received by all should also be available for refugees and
that better support and training be available for care providers.
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Your role as a global doctor: Appropriate care requires healthcare training tailored toward appreciating
the complexity of refugee health; for instance refugees may be burdened by complications of female genital
mutilation, in addition to mental illness.
Group IPS3: Vending machines to hospital dinner – food offerings in health facilities
Anum Ali, Sohyb Basir, Timothy Croft, Elizabeth Daniels, Brett Duckworth, Luke Franceschini, Audrey Haboosheh,
Benjamin McIntosh, Jane Poon, Andrew Taylor, Trevor Clive
Nutrition, Satisfaction and Budgeting: Food Choices in the Hospital
Background: The availability of vending machines in hospitals has drawn criticism due to low nutritional
value and the adverse health effects of food high in fat, sugar and sodium. There has also been a negative
perception about the quality of hospital-provided food by the consumer. The driving force for these issues is
mainly due to hospital budgeting; the current cost of providing hospital food per patient per day in Canada
is $8.00 per day, or 1% of the hospital budget. Positive health benefits may emerge if slightly more funds
were directed towards meals in hospitals; this would plausibly translate to a saving in other areas.
Presenting issue(s): This presentation explores the implications and logistics of providing healthier and
satisfying hospital meals to patients, along with healthy vending machine options. It focuses on the
potential impact on the health care system, upon the wider population, and on the individual.
Analysis: By addressing nutritional requirements and patient satisfaction, the outcome should include
shorter hospital stays, a reduction in morbidity and a reduction in food waste. The resultant long term
savings to the budget would increase health care sustainability. The UNMDGs that would benefit would be
5 and 6 due to increased health benefits. UNMDG 7 would derive small benefit from waste reduction and
food efficiency.
Suggestions for the future: By direct involvement with dieticians and nutritionists, budget analysts, food
producers and culinary experts, a system that provides cheap, healthy and popular meals tailored to
general patient groups (e.g. diabetics) can be devised along with the logistics necessary to deliver them to
patients. Unhealthy vending machine choices can be substituted with healthier choices.
Your role as a global doctor: The primary goal for a global doctor would be advocacy for health benefits
of good nutrition, as well as maintaining the sustainability of the health sector. The hospital would need to
draw upon the advice of dieticians, as well as training of food preparers in logistics and customer
satisfaction. Future medical students should be taught about hospital food ecosystem interactions.
Group 13: The increasing threat of pandemic influenzas
Chris Chan, Melissa Dietz, Nathan Gray, Aditi Halder, Amanda Howland, Da Huang, Bonnie Kwok, Ho Hin Leung,
Alexandra Melon, David Pietsch, Martin Vergara
Current and future pandemic influenza management
Background: Pandemic influenza has been a persistent entity in public health policy design following the
fifty million deaths incurred during the 1918 Spanish flu epidemic. Subsequent pandemics in 1957 and
1968 resulted in two million and one million deaths respectively. Most recently, the 2009 H1N1 pandemic
resulted in an estimated 250,000 deaths, with developing countries demonstrating disproportionately high
mortality rates. This most recent outbreak provides a unique opportunity to examine Australian and global
management strategies.
Presenting issue: Australian and global management of pandemic influenza
Analysis: Australian systems for pandemic control focus on surveillance facilitating early detection and
response. This mirrors the WHO administered Global Influenza Surveillance and Response System, which
acts in concert with the Pandemic Influenza Program to integrate disparate national monitoring systems
and standardise management strategies. Despite concerns that Australian critical care infrastructure would
prove insufficient for pandemic management, the 2009 pandemic did not result in deficits in emergent or
elective care.
Suggestions for the future: Rates of disease spread have increased markedly as air travel has become
more readily available. In future events, early outbreak containment will limit spread, minimising human and
financial costs. This necessitates widespread access to primary care, as well as education programs to
facilitate early detection and minimise transmission.
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University of Queensland School of Medicine Global Health Conference
Your role as a global doctor: Previous influenza pandemics have exhibited disproportionately high
mortality rates in developing regions and countries. By improving health literacy in disadvantaged regions,
future burdens of disease can be reduced. Education regarding effective means of information presentation
and dissemination would aid in this process.
Group 10: Refugee health in Australia
Harry Baxter, Catie Epstein, Andrei Ionescu, Masnun Kayes, Victor Lim, David Liu, Drishti Madhok, Natasha van Zyl,
Leigh Waters, Doug Wills, Nick Wing
Background: Since 1945 over half a million refugees have resettled in Australia, fleeing conflict,
persecution and political oppression. Many refugees arrive with specific health issues that reflect their
experiences and country of origin.
Presenting issue(s): The long term health outcomes for refugees in Australia are poor compared to the
wider immigrant population. Health issues present in refugees on arrival are often compounded by post
arrival factors that limit access to health care. These factors include language, cultural and financial barriers,
mistrust of health care providers, misunderstanding of the health system and an inadequately prepared
workforce.
Analysis: The complex physical and psychological problems encountered in the refugee population are
often unfamiliar to Australian doctors. Refugees may also be apprehensive about accessing health care
services due to past experiences of persecution, detention and mistreatment by government authorities.
This is often compounded by differing cultural beliefs regarding health and a lack of awareness of available
services. Communication in a medical setting can be difficult as most refugees have limited English skills,
and government funded translation services are often underutilised. Financial constraints are almost
universal in refugees, limiting options for referral to services that may incur additional out of pocket
expenses.
Suggestions for the future: Increased support, education and training of health practitioners in issues
specific to refugee health is an important step in meeting the health and welfare needs of refugees.
Community refugee associations should also be engaged to provide health education and improve
familiarity with the health system, encouraging increased service utilisation and ongoing preventative health
care.
Your role as a global doctor: Doctors need to be especially sensitive to the needs and backgrounds of
refugees. Emphasising refugee health in the current medical curriculum will increase awareness of these
issues in future generations of medical practitioners. Being mindful of the global political climate and
continually changing demographics of arriving refugees is also important in improving responsiveness to
the health care needs of this population.
Group 19: Training health workforce in developing countries
Daniel Ballantine, Samuel Duncan, Matthew Fielder, Andrew French, Ian Lin, Thomas Maclaverty, Tarryn Minto, Julie
Park, Graham Pasternak, Lisa Yue
Training solutions to the health care worker deficit in developing countries
Background: Globally there is an estimated deficit of 4.3 million healthcare workers leaving millions
without access to adequate healthcare. This issue is particularly prominent in emerging market economies.
Presenting issue: WHO has identified 57 countries facing health workforce crises and although many are
attempting to develop their health workforce, several factors undermine such efforts:
1. “Brain drain” Migration of skilled healthcare professionals from their country of origin to more
developed countries. Additionally, physical migration of healthcare professionals from rural to urban
areas.
2. “Diverse workforce challenges” This includes unsafe working conditions, inadequate financial
compensation and limited career advancement opportunities
3. “Internal Health Care Disparities” Presence of health care workers not suited for their respective
country health care needs. For example highly specialized doctors may lack experience for broad
primary care needs.
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Analysis: Despite three UNMDGs being directly health related, many low income countries will not meet
these goals. This is partly due to the healthcare systems already in place within these countries, particularly,
the insufficient number of health workers required to successfully implement interventions.
Suggestions for the future: Improving healthcare accessibility in rural and developing countries
necessitates the recruitment of doctors to under serviced areas and also retention of doctors already in
these areas. Interventions designed to achieve this include:
- Facilitating positive rural training experiences
- Providing incentives to medical students for rural commitments
- Creating a supportive clinical workplace in rural/remote areas
Your role as a global doctor: The role of global doctors involves working towards the fair distribution of
medical resources whether by servicing these communities as a clinician or as medical educators
facilitating the training of our international peers.
Group 11: Are GM crops the answer to solving world hunger?
Michael Beukema, Elishan Aruliah, Aaron Hawkins, Melissa Deyell, Andrew Dow, Jennifer Jones, Nathan Morgan,
Liana Neldner, Emma Roberts, Brett Shannon, Campbell Tingate, Ting-Lu (Rex) Yang
Are Genetically Modified Crops the Solution to World Hunger?
Background: The first United Nations Millennium Development Goal is to eradicate extreme poverty and
hunger. It has been proposed that genetically modified crops could be used to reduce world hunger.
Genetically modified crops are crops that have, through the use of biotechnology, had their genome altered
in order to infer an advantage that can increase the survival or yield of the crop. GM crops have been
around for over 20 years, but for numerous reasons have not yet achieved wide spread use.
Presenting issue: The issue is whether or not GM crops can solve the problem of providing enough food
for the world’s population. The successful production of the crops and their accessibility, safety, and
environmental impact must all be considered to determine whether GM crops are a feasible solution to the
world hunger dilemma.
Analysis: With the advantages of higher yield, cheaper and hardier products, there is potential for GM
crops to have a great impact in reducing world hunger and poverty. However, there are numerous barriers
preventing GM crops from achieving such an impact. These include the initial cost of crop seeds due to
patenting issues, potential toxicity to humans, the threat of new viruses or pests, the danger of
pest/microbe resistance, as well as religious, cultural and ethical concerns relating to genetic modification.
Suggestions for the future: The major barrier that can potentially be overcome is the issue of access to
GM crop technology in developing countries. Research and development by publicly financed laboratories
could decrease local political resistance to the research and reduce access costs by eliminating
international patent costs. Addressing the restrictions associated with international patents would need to
be considered to allow affordable access to developing countries.
Role of the global doctor: Doctors will have an important role in supporting the use of GM crops and
monitoring associated health outcomes from the introduction of GM crops into the diets of the general
population.
Group IPS7: The Grameen bank experience - impact on gender equity and health
Victor Tang, John Tsai, Emma Hannan, Yvonne Chan, Muath Alduhishy, Alshuqaybi Hassan, Michael Chen, Kathryn
Noakes, Mahveesh Chowdhury, Trent Cullinan, Sally Saunders
Background: Bangladeshi women suffer from lower social status than their male counterparts. There are
many factors that perpetuate the gender inequality. This includes structural and social institutions like
religion and a patriarchal culture that discourage women from participating in education, health, and
employment. These social forces have also ensured that women are socially and economically reliant on
men. Although there are laws aimed at addressing these problems, there still exists the problem of how
effectively these laws are implemented. This gender disparity has led to gaps in gender equity and health
access, producing statistics of higher female child mortality, greater rates of malnourishment, and shorter
life spans.
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University of Queensland School of Medicine Global Health Conference
Presenting issue: The Grameen Bank was introduced to combat the gender disparity in Bangladesh.
Founded in 1976, the bank offers small collateral-free loans (“microcredit”) to groups of 5 women. The
bank’s primary goal is poverty alleviation. By doing so, the bank hopes this will have a positive flow-on
effect leading to female empowerment and greater social and economic independence. By extension,
women will have greater access to health care and nutrition, allowing them to bridge the health discrepancy.
Analysis: Using key goals of the UNMDG, we will examine the effectiveness and impact the Grameen
bank has had on female gender equity and health. Measurements in this analysis include maternal
mortality ratio, lifespan, and proportion of live births attended by skilled personnel.
Suggestions for the future: The bank has struggled to change the socio-cultural situation of Bangladesh
which is arguably at the root of the gender disparity. The bank should attempt for greater involvement of
authority figures such as politicians. They would help promote education and health of women and creating
awareness about how women, besides men, can also play a significant role in improving Bangladesh.
Your role as a global doctor: As future doctors, we can help by being more socially aware of the plight
faced by others overseas. This could be addressed in the curriculum by increasing our knowledge of
different cultures.
Group 31: Losing the antibiotic resistance battle – how can this be turned around?
Michael Bui, Madeleine Carney, Susan Dragone, Steven Gilandas, Jee Yong Jung, Jessica Kelley, Matthew Linger,
Ricky Nelles, Bridget Podbury, Nataliya Soboleva, Richard Tsen
Background: The spread of antibiotic resistance throughout the world is a major health problem
concerning the health field. Developing countries as well as developed countries are facing similar
problems and while there are some policies in place to improve the situation, the issue is far from being
solved.
Presenting Issue: The goal is to discuss what antibiotic resistance is, give some examples, show the
significance of the problem and how we should be addressing the issue
Analysis: In the start of the presentation, a case study will discuss what antibiotic resistance is and
demonstrate the global nature of the problem. A few examples of resistant organisms and their means of
acquiring resistance will be discussed. The significance of the issue will be addressed as well as reasons
for resistance. A comparison of Australia and other developed countries will be discussed followed by a
comparison of Australia and developing countries, mainly India. It will end with ways resistance is currently
being combatted (and how Australia is implementing those already) and lastly ways which could further
improve the situation, the main focus being on the ways of decreasing antibiotic resistance.
Suggestions for the Future: The ways in which to reduce resistance would be to implement prescription
guidelines, educate providers and the community, implement stewardships, regulate non-therapeutic use in
animals, improve/increase diagnostic tools to narrow spectrum used, improve hygiene, and audit usage.
Your Role as a Global Doctor: Actively take part in combatting antibiotic resistance. Make better usage of
diagnostic tools and only prescribe antibiotics when appropriate. Advocate for more research into producing
new antibiotics and research into improvements. This problem could be addressed early for doctors by
providing better education in antibiotic usage.
Group 16: Role of social media in health promotion
Samuel Cook, Lauren Edwards, Erin Gallagher, Stephen Haig, Gilbert Jin, Jonathan Lauder, Yun Le Linn, Kelly
Marais, Hanika Patel, Aaron Sia, Kiranya Tipirneni, Timothy Ziethen
Background: The internet, once characterised by a unidirectional flow of information towards the
consumer, has evolved into an interactive forum in which the consumer is now actively engaged. This
movement has been largely cultured by social media, which has seen a rapid increase in popularity over
recent years.
Presenting issue(s): Social media is now widely-used as a health resource, with approximately three
quarters of young people using the internet to seek health information. Various groups have taken
advantage of the popularity of social media sites to promote and discuss health-related topics.
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Analysis: Social media allows groups to generate and distribute health-related information on a large-scale
basis almost instantaneously. No longer is the consumer a passive recipient of this information; instead, the
content takes on a form with which the consumer can interact, critically analyse, share, promote, and
modify. By breaking down communication barriers which exist across other mediums, social media
presents an open dialogue between the public and their representative health officials. Despite its
advances, the use of social media for health promotion faces significant challenges. Differences in internet
access, culture and language mean that groups are not always targeted equally across online platforms,
and limited regulation of internet-based health messages can sometimes undermine their credibility and
purpose.
Suggestions for the future: In light of these challenges, it is important for internet-based health
campaigns to consider a multi-faceted approach which identifies the target audience and specifically tailors
itself to these recipients. Both the outreach and outcome of such campaigns should be carefully evaluated,
with each process involving all relevant stakeholders.
Your role as a global doctor: On an individual level, social media enables doctors to communicate with
one another and with the public. It is advisable that this be done only through mass education programs, as
communication with individual patients is discouraged due to its potential for abuse.
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Group 18: Generic medicines
Dipen Patel, Chee Han Ting, Brandon Steed, Anna Morgan, Anzela Selamat, Sweta Lal, Michael Tallack, Jihye Jung,
Ella Houston, Justin Kathage, Eric Sales, Sachin Kher
Pills with no Frills: The benefits and drawbacks of generic medicines
Background: Generic medicines have increasingly become a valuable way for improving equity of access
to pharmaceutical treatment of disease. As drugs reach the end of their patent, competing pharmaceutical
corporations are able to manufacture and sell them at cheaper, more competitive prices. These generic
medications have significant benefits – a reduced price means more people have the opportunity to
purchase potentially life-changing drugs, and they represent a more cost-effective option for governments.
Presenting issue(s): Generic medicines should increase accessibility and decrease inequality. However,
there are questions over both the safety and efficacy of generic medicines. Our presentation will thoroughly
investigate these issues.
Analysis: In Australia, the safety and therapeutic effectiveness of generic drugs equals that of branded
medications, with few exceptions. However, on a global scale, legislation and production standards are not
equal. This is especially problematic in impoverished countries where combating disease (as identified in
the UNMDGs) is dependent on effective drugs. Worldwide, there is potential for confusion amongst
consumers due to many different names for the same drug, with an associated risk of duplication or
reduced compliance. Furthermore, there is the potential for decreased efficacy and safety of cheaper
medications as production costs are lowered in attempt to compete in the market.
Suggestions for the future: Manufacturers are currently required to demonstrate bioequivalence before
marketing a new generic product in Australia. This must be more strictly enforced, expanded to include
therapeutic equivalents, and encouraged in other countries. Pharmacists and GPs should be properly
educated regarding the available generics and the evidence. Lastly, consumers should be informed of the
benefits of choosing a generic.
Your role as a global doctor: As future doctors, it is our role to be aware of the advantages and
disadvantages of prescribing generic medication, and to be mindful of manufacturing standards in other
countries and how this might affect their use. Low cost generics have the potential to significantly change
health standards in the developing world, a process that we can assist and advocate for.
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University of Queensland School of Medicine Global Health Conference
Group 23: Global travel and disease transmission
Stefany Almendinger, Min Chng, Fraser Donaldson, Jack Ju, Ping-Juei Liu, Minji Kim, Mark Phillipps, Jacqueline
Schott, Sarah Stanwood, John Vardanega
Global Travel and the Spread of Disease: Five Illustrative Examples
Background: Modern advances in travel have made it easier for disease to spread globally, as groups of
people move to places that would have previously been inaccessible. The prevention, when possible, of
travellers acquiring new disease, as well as the early detection and containment of incoming disease, is
essential to maintaining global health.
Presenting issue: We will be discussing the spread of Dengue and Malaria, Polio, HIV/AIDS, Tuberculosis
and influenza.
Analysis: We will be discussing the groups most likely to contract and spread these diseases upon travel,
as well as routes of transmission, impact on Australia when travellers return or arrive carrying these
diseases and our role as global physicians in this process.
Suggestions for the future: Regulation of antibiotic use, cooperation between multidisciplinary health
service providers, education and targeting populations at risk, increased availability of drugs to those who
need them and preventative measures when possible. Key players to involve would be multidisciplinary
health professionals, government agencies, advertisement agencies and travel agencies.
Your role as a global doctor: Our role would consist of educating our patients as best as possible, as well
as communicating effectively with other health professionals. We also need to detect and report early, so
effective measures for quarantine can be taken. On a larger scale, advisement to the government with
regards to targeted risk groups on behalf of health professionals would be ideal. Support needed for this
would be an open and flexible government, and a curriculum that includes information on educating
patients effectively.
Group 26: What is the role of health NGOs in development of sustainable
health care?
Patrick Bekhit, Alastair Bell, Simon Hoang, Mingming Jing, Kusali Janadari Kasturiarachchi, Eileena Li, Shannon
O'Beirne, Cristobal Javier Quitral Huidobro, Kathryn Suchow, Zheyi Teoh, Bartosz Wlodek
Background and Presenting Issue: The media traditionally portrays health NGOs such as MSF and the
Red Cross as organizations that only aids developing countries in the face on an acute conflict (For e.g.,
post-disaster medical relief following the 2008 tsunami). However, the role of NGOs in the realm of medical
humanitarianism stretches far beyond this and it is often more important for these organizations to leave
behind a sustainable form of health care. Irrespective of an NGOs' primary purpose, developing sustainable
and durable health services allows the local community to utilize them once these NGOs depart and
consequently prevents the health care needs of these areas from being abruptly halted. We explore several
different sustainable practices that medical NGOs can employ.
Analysis and Suggestions for the Future: Leaving a sustainable infrastructure of health care has
beneficial downstream effects that could aid in meeting many of the UNMDG targets such as decreasing
child mortality and improving maternal health. Methods in which this can be achieved includes providing
medical training to locals, educating the public on healthy practices and bringing medical equipments that
are reusable and easily repaired. The ultimate consequence of these actions is to empower a local
community so that they eventually are able to address their own health needs without the assistance of
foreign organizations.
Your role as a global doctor: As global doctors, a holistic understanding of which practices are
sustainable will help build NGOs that provide humanitarian work that is pragmatic and efficacious. NGOs
will not achieve lasting results without first providing local training, education and leaving behind a working
and durable infrastructure. These principles are applicable universally when ensuring sustainability and can
be translated in medical practice in every corner of the globe.
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Group 28: Fukushima and Chernobyl - looking back to look forwards
Alice Tinsa Yu, Linda Stewart, Priscilla Shum, Joseph Pummer, David Liu, Megan Kemp, Antony Ji, Smaranda Filip,
Erica Clarke, Kay Tai Choy, Glenden Aprile
Background: In 1986, an explosion at Chernobyl Nuclear Power Station in Ukraine released large
amounts of radioactive particles into the atmosphere. It is one of only two nuclear power accidents in
history that have classified at the highest rating on the International Nuclear Event Scale, the other being
the Fukushima-Daiichi event in 2011 which caused widespread release of radioactive particles into
groundwater.
Presenting issue(s): Uranium fission nuclear power is an attractive solution to the energy needs of
burgeoning populations all around the world and continues to be one of the most efficient methods for
generating electricity. However, the threat of individual radiation exposure events and the potential for
contaminants to spread beyond national borders from a single incident cannot be ignored.
Analysis: Radiation exposure events have wide ranging impacts on a community, from the direct and
individual health risks of exposure, through to the displacement of populations and the disruption and
destruction of natural ecosystems. In the spirit of UNMDG #7 (ensure environmental sustainability), the
ecological risks and impacts of nuclear power generation and its knock-on effects on community health
must be addressed.
Suggestions for the future: As demonstrated in both events, adequate protocols must be developed for
“worst case scenarios” in order to ensure the best possible outcome for the populations involved. These
must range from accident mitigation through high safety standards and operational protocols to the creation
of adequate capacity in the community to urgently respond to and provide relief once an accident occurs.
Your role as a global doctor: The role of doctors in the context of communities relying on nuclear power
is to identify health risks at a population and individual level and that includes advocacy on behalf of the
health of the community and also to address concerns of patients. Additional training that can be included
in the medical curriculum to this end can include promotion of general health advocacy in communities, a
rundown of how to produce results in a legal and political framework, and basic knowledge on radiation
exposure both chronic and acute.
Group 15: Investments in vaccine development and access by Global health initiatives
Frank Po-Chao Chiu, Ammara Doolabh, Jonathan Gayed, Aaron Hansen, Jinwen He, Evelyn Ye Ding Ma, Janarthan
Muraliharan, Gowri Ravichandran, Satvir Sahans, Tsz Tong, Vy Tran, Thomas Yeung
Background: In the past decade, investment into global initiatives has been crucial for successful
development and support of vaccination programs and initiatives worldwide. Despite these achievements,
several limitations in vaccine access, development and distribution exists across developing nations.
Presenting Issues: As vaccine development, distribution and delivery is inextricably linked, provision of
vaccine coverage and access is limited by the increasing complexity and cost of developing new vaccines.
This issue is compounded by the hesitancy of manufacturers to develop vaccines against poverty-related
diseases due to the belief of financial loss.
Currently, public-private health alliances have partnered to improve vaccine access. The GAVI Alliance is
one example that provides financial resources to eligible countries for operational costs of managing
immunization campaigns and vaccine purchasing.
One key factor to successfully establishing vaccine access is the ‘technological transfer’ to developing
countries. It ensures vaccine access for a local population where global distribution is severely limited (e.g.
pandemic influenza vaccine which has poor vaccine coverage). However the largest barrier to technological
transfer is the lack of research and development, which will require a higher level of political commitment
from developing nations.
Analysis: The United Nations’ Millennium Development goals aim to reduce child mortality, combat
HIV/AIDS, malaria and other diseases through global partnerships for development of vaccines in
industrialized countries, and to improve vaccine accessibility in developing countries.
Future suggestions: With increased subsidy, the focus can be shifted towards maintenance of vaccine
affordability for developing countries while simultaneously forming greater incentives needed to encourage
private sector investment in developed nations. Additionally, improving the health infrastructure and
technology transfer to developing countries could result in increased output and decreased costs, with the
ultimate goal of self-sustainability.
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University of Queensland School of Medicine Global Health Conference
Role as a global doctor: Physicians play a key role in vaccine initiatives through education and
encouragement for patients to receive current vaccinations. Their roles can go beyond the bedside to
include: participation in clinical research and vaccine development, petitions to governments for funding,
and advocating programs provided by global initiatives.
Group 6: TB in PNG and Australia
Taha Othman, Sonia Volante, Brett Travers, Stefan Saric, Liora Berger, Emily Shao, Andrew Han, Dan Mammel,
Annabelle Wellham, Kris Ulyate, Tristan Barnes, Natasha Harney
Tuberculosis in Australia and Papua New Guinea: A Shared Future
Background: One third of the world’s population has latent TB and is at risk of developing an active
infection. Treatment involves prolonged drug regimes, which are often not fully completed, particularly in
developing countries. This substandard care is the greatest risk factor for the development of multi-drug
resistant (MDR) TB and extensively drug resistant (XDR) TB. Disproportionately high rates of all forms of
TB are seen in Papua New Guinea (PNG), Australia’s closest neighbour.
Presenting issue(s): In 2010, Australia had a TB incidence of 4.7 per 100,000, 3.5% of which were MDRTB. In contrast, PNG has one of the highest rates of TB in the world: in 2007 the incidence was 430 per
100,000, 6% of which were MDR-TB.
Many people in PNG are dying of a treatable infection, highlighting an obvious inequality. We must consider
the potential spread of MDR-TB and XDR-TB into Australia, with its economic and social implications.
Analysis: Controlling TB in PNG is directly related to indicators 6.9 and 6.10 of United Nations Millennium
Development Goal 6 - to halve world TB prevalence by 2015. As one of PNG’s closest neighbours,
Australia should support PNG in its fight against TB for humanitarian reasons, and to prevent the spread of
MDR-TB and XDR-TB into Australia.
Suggestions for the future: PNG, Australia and the World Health Organisation have implemented a
number of initiatives to combat TB. However, additional resources are urgently needed to interrupt the
transmission and spread of MDR-TB and XDR-TB. Future initiatives include education regarding
compliance, new methods for early detection, and a more effective TB vaccine.
Your role as a global doctor: Our role as future doctors will be to diagnose and effectively treat TB.
Additionally, we will be involved in educating and assisting medical personnel in PNG – a skill that should
be included in our medical curriculum. Finally, as the next generation of researchers in the field, we will
seek to develop more effective TB therapies and vaccinations.
Group 36: D8 Promoting a healthy lifestyle: what does it mean for urban
developments in Southeast Queensland
Andrew Argyropoulos, Jay Hyung Choi, Tripti Gupta, Esmond Hii, Ellinor Johnston, Yu-Na Kim, Norman Lee, Pamela
Martin, James Matthews, Raymond Ng, Ilynn Zaoh
Highway to Health: Urban Development Initiatives and Health Promotion in South-East Queensland
Background: A major goal of Southeast Queensland’s Regional Planning Projects is to “make
Queenslanders Australia’s healthiest people.” Poor health in Queensland is driven by chronic diseases with
modifiable risk factors. Queensland’s risk factor priorities include reducing obesity rates, smoking rates,
alcohol consumption and unsafe sun exposure by 2020.
Presenting issue(s): The population of South-East Queensland is expected to double by 2040, sparking a
wave of urban development. Research suggests that urban environments can impact on chronic disease
rates, and can aid or impede health through water and air quality, noise, temperature, access to green
spaces, and opportunities to exercise and to interact socially. Further urban development best take such
challenges into account.
Analysis: We reviewed Australian government documents to identify evidence-based urban development
strategies that address Queensland’s health priorities. As a developed country, success in these areas can
provide a template for urban design that promotes equality between genders (MDG 3), ensures excellent
maternal health (MDG 5), and incorporates environmental sustainability (MDG 7).
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Suggestions for the future: We found many initiatives that could aid Queensland’s health promotion
efforts. Increased shade in public spaces and schools can decrease sun exposure. Green spaces and safe
bike paths can encourage exercise. Ensuring a walking distance of no more than 1000m to public transport
and 600m to shops can decrease car dependence. Smoke-free public spaces can reduce smoking rates.
These strategies would be funded by all levels of government and coordinated by local government.
Your role as a global doctor: As doctors, we should increase awareness among the general public of the
various initiatives and infrastructure that are in place to promote a healthy lifestyle, and encourage them to
take advantage of these measures. Before we can make these recommendations, we need to be familiar
with the initiatives. As students, it would be helpful if the medical curriculum provided a brief summary of
evidence-based, health-promoting urban developments.
Group 24: Is the “War on Drugs” winnable? Is it a law and order or a health problem?
Shannon Theune, Rachael Weir, Kason Leung, Nicholas Teo, Joshua Mauro, Matthew Eustace, Emily Zametkin,
Shanika Wijayanayaka, Sally Harrison, Thomas Beesley, Zachary Drew
Background: Studies have shown no correlation between the restrictiveness of drug laws and the
incidence of drug taking. Current laws are inconsistent in regards to the severity of restriction relative to the
harm of the drug.
Current drug laws have a number of costs, including financial (imprisonment and prevention - $40 billion
per annum in the US) and environmental (secret dumping of toxic by-products), and often drive violent
crime, political corruption and sex work.
A prominent case study in Portugal showed that decriminalisation was associated with decreased rates of
addiction, lower costs and fewer drug related deaths, with minimal changes in drug-use prevalence.
Presenting issue(s): The war on drugs is not winnable the way it is being fought today. There is evidence
that decriminalisation of drugs can be effective in improving health outcomes.
Analysis: Based on the evidence from Portugal and other countries, there is reason to suggest that lessrestrictive drug laws may decrease rates of addiction, reduce financial costs, decrease stigmatisation and
allow for developments into the management of addiction - as seen with smoking. Reducing the market
value of drugs through decriminalisation will decrease the need for unsafe drugs and methods of use.
Illicit drug trafficking and use threaten progress on UNMDGs by perpetuating the cycle of poverty,
destabilizing social and economic structures, and increasing the transmission of infectious diseases such
as HIV and hepatitis.
Suggestions for the future: Redistribution of finances currently used for prevention and punishment to
education and treatment for addiction, prioritising health outcomes.
Your role as a global doctor: By combining decriminalisation with improved awareness and treatment of
addiction, better health outcomes can be achieved globally. Health professionals who understand the
complexities of drug abuse will be better prepared to treat the diseases associated with abuse, such as
hepatitis C and depression. Addiction medicine should be incorporated in medical school curriculums to
prepare future doctors to face the challenges of addiction worldwide.
Group IPS5: Measles control in South Africa
Chris Bong , Alex Bowden, Pinar Cingil, Nick Duong, Brook Gulhane, Julian Harris, Luke Jorgensen, Brenton
McCormack, Angela Ng, Kyle Severinsen, Mariam Rizk
Catch-up, Keep-up, Follow-up: Maintaining Measles Control in South Africa
Background: Despite the availability of safe and cost-effective vaccines, measles is a highly contagious
infection that still places within the top four childhood killers worldwide. Previous efforts have shown that
comprehensive immunization strategies can work, on the provision that, organisational, political and
financial funding are also present.
Since 1999, measles has been reduced across South Africa by 60%, due to nationwide catch-up
immunization programs, improved laboratories, and public involvement. However, recent resurgences has
reignited interest in measles eradication.
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University of Queensland School of Medicine Global Health Conference
Presenting Issues: Maintenance is the core issue encountered. Sustaining routine coverage rates of at
least 80% (required for herd immunity) and continued “follow-up” campaigns are paramount. In most cases,
those infected have either not been vaccinated or missed the booster. Vaccine refusals were based on
religious grounds, inadequate education, sporadic vaccine shortages and imported-immigration outbreaks.
Analysis: In 2001, a major initiative was launched between sub-Saharan Africa and WHO, UNICEF, and
Red Cross organisations. Since 2006, 213 million children have been immunized, saving an estimated 1.2
million lives. Ambitious goals to further reduce deaths by 90% in comparison to 2000 levels were set.
The 2009-2011 measles re-emergence was both evidence of the benefits of the program and the
consequences of failed coverage. In relation to the UNMDGs, whilst it is unlikely that measles will be
completely eradicated by 2015, interventions targeting vulnerable populations have proved significant for
public health.
Suggestions for the Future: Local demand for future vaccinations need to be increased. Communitybased mobilisation involving the training of primary caretakers, mothers and church leaders about
surveillance and immunisation importance would extend the reach of the program.
Your Role as a Global Doctor: Our role is to set the right example in developed countries first, though
appropriate vaccinations schedules and behaviours. More direct involvement has impacts on self-driven
improvement and may be counter-productive. However, support in other forms such as funding, research
for low-cost tools and vaccine delivery training is encouraged.
Group 21: DSM V – are we over medicalising mental health?
Lu Zhao, Lindsay Luce, Sunmi Yang, Viral Patel, Sarah Robertson, Nathanael Bain, Nadine Abou Eisha, Lauren
Shelton, Jaxon Taylor, William Fairbairn, Christopher Jackson
The DSM-5 and Over-Medicalisation
Background: The Diagnostic & Statistical Manual (DSM) of Mental Disorders outlines the standard criteria
for diagnosing mental health disorders as followed by health professionals. The diagnostic threshold of
psychiatric conditions has been lowered with each subsequent DSM, leading to increasing medicalisation
of previously normal behaviors such as bereavement or forgetfulness. As a consequence, a major concern
of the DSM-5 is over-medicalisation, which is the unnecessary diagnosis and medical treatment of
conditions.
Presenting issues: The new DSM-5 guidelines will likely result in increasing numbers of unnecessary
psychiatric diagnoses with the addition of new conditions and lowered diagnostic threshold for existing
conditions. This over-medicalisation and subsequent treatment of psychiatric conditions results in
substantially increased social and economic burdens to individuals, families, and the healthcare system as
a whole.
Analysis: The changes in DSM-5 attempt to increase early identification and treatment of psychiatric
disorders, however these benefits are shadowed by the potential of harm due to misdiagnosis. Improper
usage of healthcare resources diverts allocation of resources away from individuals who require assistance.
Limiting harm due to improper psychiatric diagnoses and proper healthcare resource allocations contributes
to achieving many of the United Nations Millennium Development Goals (UNMDG) including eradication of
diseases, improving maternal health and achieving primary education.
Suggestions for the future: The DSM is a useful guideline to diagnosis of psychiatric conditions, however
medical professionals should be conscious of financial and social burdens that can arise with overmedicalisation. Additionally, further research into the benefits of diagnosis and treatment of psychiatric
conditions with respect to the potential burdens of misdiagnosis should be explored.
Our role as global doctors: Reducing misdiagnosis and over-medicalisation of psychiatric conditions
contributes to global achievement of UNMDGs. Global doctors should be wary of the allocation of medical
resources to ensure maximum access and treatment to the population which requires it.
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This publication was made possible with the support of
UQ UNMDG Project
University of Queensland Medical Society
and its sponsors

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