 Okay. So hello everyone. We are very glad to see you, participants from all over the world in this event where we aim to show the variety of our family medicine doctor skills and their leadership in different work environments. Our event will be moderated by myself, your host, Dr. Adiyaski. I'm a family medicine resident in KMC, which is King Abdulaziz Medical City in Saudi Arabia, following for the National Guard Health Affairs. I'm the co-founder of Let's Talk Medicine.com. Also, I'm the Saudi representative for the Wonka Young Doctors Movement, Arrazi Chapter. Also, my co-host for today is Dr. Tania Penna. She's a board member for the College of Family Medicine in Nuevo, Lyon, in Mexico. Also, she has a master's degree in education also where she is a board member of a Miley-Wainakai Young Doctor Movement. Excuse me, I think. Dr. Jasmine, if you can wait for the control, one minute. Okay. So for today, each presenter will have 10 minutes for their topic and then at the end we will have a section for questions. So please keep your questions with the doctor name that you want to ask until the end. We'll follow us through today's webinar, Dr. Francesco Molina as our voice in Spanish. Also, with Dr. Chloe Chan, she will translate for us in Chinese. So I think the floor is for Dr. Tania. Okay. Thank you Adele. So we will go over these topics. We're going to make a little introduction about each presenter. And I would like to start up with Dr. Loh Quiff and Jasmine. She's a family medicine specialist in Ministry of Health in Malaysia. She's a strong advocate of mental health with active involvement in promotion of mental health care. Also, she's a team leader in domiciliary service with continuous effort to promote and improve domiciliary care. And she's also a woman's health advocate as a speaker of pap smear and mammogram campaigns. So thank you, Dr. Loh for Jasmine for being here. So Dr. Jasmine, I will give you the control. You can just click on the screen or by the arrows. Right. Good day to all. I'm Dr. Loh Quiff from Malaysia. So today I'll be talking about family medicine as a pillar of the health system. So this is the outline of my presentation. So I'll be talking about this, the healthcare delivery in Malaysia, the definition and domains of family medicine, the impact and the drivers of success of this family medicine. So first of all, the delivery, healthcare delivery in Malaysia. So Malaysia is located in Southeast Asia. So it has a population of 30 million with a female to male ratio of one to one. So healthcare delivery system in Malaysia is mainly under the Ministry of Health of Malaysia and generally has an efficient and widespread system of healthcare operating under a two tier system consisting of both government best in the public healthcare system. So our healthcare delivery system encompasses curative rehabilitative, promotive and regulatory concerns. So this diagram shows the provisions and care. So in Malaysia, the medical healthcare services are provided a public facility which comprises of the three level primary care, secondary care and tertiary level through a wide level of health clinics and hospitals. So primary care is the pillar of this healthcare system in Malaysia by being the trust of the Malaysian healthcare system and supported by the secondary and tertiary care. So my next slide shows this primary care as a hub of coordination. So what does it mean when I say that primary healthcare is the pillar of the healthcare system in Malaysia? This graph shows us how primary care access a hub of coordination and networking within the community served and with outside partners and the services provided by the primary care doctors. So we can see that primary care team actually provide continuous comprehensive and patient centered care. And then this is a hub of coordination and does not only care for acute and chronic diseases but also it provides networks within the community and provides a referral point to tertiary specialized care in Malaysia. So examples of referrals are to the non-governmental organizations such as the alcoholic anonymous and woman shelters. We also provide training support to the academy institutions and the training centers and also tertiary referrals, specialized care referrals, diagnostic services and specialized prevention services. So next as we can see the assess and reverse across sectors are pretty chaotic between the primary healthcare and secondary and tertiary healthcare and public versus private healthcare. So some argue that this is actually good for the patient's choice but it does not do any good in terms of continuity of care which is very much required in chronic disease care. So this is where primary care step in as a as its role as a gatekeeper and also foundation of the healthcare system. So it acts as this interconnecting dot that we can see the dots here. It acts as an interconnecting dot between the public healthcare system and as a referral point to the secondary and tertiary care and across other agencies and private sectors as well. So primary care steps in as a gatekeeper. So this will reduce the inappropriate referrals and unnecessary costs to the patients as well. So next I would like to introduce the healthcare facility that we have in Malaysia. So primary healthcare facilities are provided through 1,060 health clinics in Malaysia, 1,791 community clinics and 239 mobile health teams as well as more than 580 dental clinics as of 2020. So family doctor concept is one of the initiatives which was initiated by the Ministry of Health Malaysia as a way forward to strengthen primary healthcare in Malaysia. So with an aim of one family one family doctor. So this is a positive step to address the rising burden of disease and ensure that a wet population can be covered by the primary healthcare facility. So I would like to give the definition of this European definition 2011 of the general practice. So general practice of family medicine is an academy of scientific discipline with its own educational content, research, evidence-based and also clinical activity and it's a clinical specialty oriented to primary care. So this is the wonka definition 1991 family medicine provides comprehensive care and it's a general list who accepts everyone from womb to tomb and just not limit by age, sex or gender or diagnosis. And we also provide contextual care in which we provide care for the patient in view of their in context of the family and the family in the context of the community irrespective of the rest, religion, culture and social class. And we are also clinically competent. We provide comprehensive and continuity of care and we are professional. So next I'll show you this is the wonka for military as produced by the Swiss College of Primary Care revised in 2011. So this wonka tree emphasizes the holistic principle of family medicine in caring for the patient. So it outlines schematically the competencies which every family medicine specialist should have, which is primary care management, holistic modelling, comprehensive approach, specific problem solving skill, community orientation, person-centered care in which we are elaborating in the next slide. Once I mentioned just now the six core competencies and it's broken down into 12 characteristics. So first of all family medicine primary care doctors are the first point of contact within the health care facility. So we work by making efficient use of the health care resources through coordinating care, working with other professionals in the primary care setting and we develop a patient center orientated to the individual, the family and also the community within the community. And we promote patient empowerment and we have a unique consultation process which establishes relationship over time and provides effective communication between doctors and the patient. And we are responsible for the provision of longitudinal continuity of care as determined by the needs of the patient. And we provide this, we have a specific decision making process determined by the prevalence of disease specifically in the community and we manage both simultaneously the acute and chronic management and then we manage these illnesses which represents in undifferentiated ways. So we also promote health and well-being and have a specific responsibility within the community by providing physical, psychological, social, cultural and existential dimensions. So I'd like to quote Sir William Osler. The good physician treats the disease but the great physician treats the patient who has the disease. So definition of primary care is a setting within a healthcare system usually within the patients on community which the first contact with the healthcare professional occur. So this is the Wonka definition, European definition of general practice 2022. So in order to provide the best healthcare outcome and cost efficient care through the quality family medicine, one of the main thrusts of the WHO framework documents that the task is to define that which of the true unique activity of the family doctor, the true clinical generalist. We should try. Jasmine, two minutes, two minutes left. Representative care and health education on self-care. So next I'd like to touch a bit about our declaration of Alma Ata whereby this this is the declaration which is the first to underline the importance of primary health care and put health equity on the national international agenda. So the next is declaration of Astana. So which is one of the essential step towards universal healthcare system. So I'd like to talk about primary health care system and what it does. This is primary health care. It provides promotive preventative treatment, curative rehabilitative and palliative care for all. Basically, it provides well, the center of the primary health care is health and well-being for all. And it's in both in multi-sectoral policy and actions, empowerment of people, and also provides essential public care. So this is the sustainable development goal by WHO in 2030. So I'd like to emphasize on this point number three, which is good health and well-being. So good health and well-being, there are nine targets. So SDG 3.8, which is to achieve universal health coverage, leaving no one behind. It ensures that everyone everywhere can access essential quality health without facing financial hardship. And it highlights the power of primary health care to advance the protection and promotion of health. So universal health care is a human-right approach to health. And this can be achieved by being having a person-centered and integrated care with availability, accessibility, acceptability and quality health care, through primary care health. So this is my last slide. So the success of the primary health care will be driven by knowledge and capacity building, human resources, technology, financing, empowering individuals and communities, and aligns the coldest support to national policies. So to end my presentation, I'd like to emphasize that primary care is the pillar and heart of the health care system. That is the end of my presentation today. Thank you. Thank you very much, Dr. Jasmine. That was a great talk for us. Moving for family doctor in different areas, as in a spice road, it will be with Dr. Zainab Mohamed from Pakistan. Dr. Zainab, working as a faculty in one of the public sector universities of Karachi, she will be discussing the webinar about practicing family medicine in different areas, like an urban and rural setup. Dr. Zainab, Dr. Zainab. Yes. Thank you so much for the introduction. Am I audible? Is it clear? Yes, we can hear you. Yes, I will give you the control. You can just click and it will change. Okay. Okay. So should I start now? Yes, Ms. Okay. So thank you so much, Adil for the introduction and the topic for today's presentation and the talk of my family physicians working in different areas. And today I'll be elaborating more on how family medicine practices in rural and urban areas of Pakistan. Also, in order to know, so as we move forward with the slides, in order to know about the complete picture of family medicine in Pakistan, one must know what are the healthcare system and how the healthcare functions are part of the world. So let's begin. Okay. So the roadmap for today's presentation would be that we'll go over the brief overview of healthcare system in Pakistan. The urban and rural health scenarios also discuss how family physician can contribute to both urban and rural setups and what are the what are the way forward? Okay. So this is a brief slide on the population of Pakistan, which is living in urban as well as rural areas. So Pakistan having a population of approximately 180 million, we have almost 61% or a vast number or a big chunk of our population residing in rural areas as compared to only 39% of the population residing in urban centers. So this is a huge, these are huge numbers which family medicine or family physicians or GPs have to cater in order to achieve them. Okay. So this is a healthcare pyramid on the healthcare system organization that how family or how healthcare system functions in Pakistan. So the primary healthcare basically comprises of basic health units, rural health centers and dispensaries. And this we have for our primary care setup. For secondary care, we have tertiary care hospitals and district health quarters. And then we have these tertiary care facilities. So this is the healthcare pyramid that should be and ideally should be followed. However, the system of and this part of the world is not as organized as it's depicted in the picture. So there are a lot of loopholes and there are a lot of issues and there's lack of integration. There's a lack of horizontal as well as vertical integration between all these systems. So when a patient arrives in a primary care on a secondary care, so there is lack of follow-up and there is lack of, there is a reference system. However, there's lack of integration and the patient does not get referred back to the GP or the family position that he or she first came from. So this is the basic healthcare system of Pakistan. So moving on. Okay, so this, the next slide shows the percentage distribution of health consultations in private as well as public dispensaries, rural versus urban. So as it's shown in the chart or that I've as it's shown in the chart. So we have, so we have approximately 75 to 80% of the population which goes, which depends on the private or the private hospital hospitals, our patient clinic as well as dispensaries for their treatment. And only 20 to 25% of these population are dependent upon the public hospitals and public hospital dispensaries. So yeah, so, so 80% approximately 70 to 80% of this population goes to, has to bear the financial cost of it, has to pay from the pocket in order to get treated. So this is, this is a major issue. Next is the human resource. I just, I wanted to give a brief human resource and the lack of, human resource and lack of physicians per 1000 population at present. So we have approximately 0.82 physician per 1000 population. And there is a lack of or a deficit of one physician per 1000 population at the moment. And the available workforce at the moment is 1.45 per 1000 population. Similarly, if it's if we there's a next diagram, the right one, if we see the urban role distribution of human resources for health in Pakistan. So we have approximately 14.5% of physicians which are working in the urban setups and only approximately 3.6% of the physicians are working in the rural setups. Similarly goes for nurses and midwife 7.6% in the urban population and only 2.9% of the rural setup. So this lack of healthcare resources, this lack of human resources basically in the rural population also has a lot of disadvantages. catering and a lot of unmet needs of these rural health rural population of the country. Okay, so how is primary care delivered? How is primary care services delivered in Pakistan? So there is a huge as a large network of primary care service in different hospitals here. There are community health worker and community health programs and lady health programs, approximately one lack of lady health workers who are integrated and who are primarily working on the WHO based millennial development goals and they try to they try to they are basically working on the eight goals provided by WHO in uplifting the rural and the urban health population in the rural and the urban slums and they provide household services in in managing in managing poverty in providing cleanliness in educating the patients and empowering women and basically cleanliness. Along with that we along with these community based programs there are 11 vertical health programs which provide technical and financial support. Private sector also only comprises of 35% of all physician and 17% of the hospital beds in the country. So primary health primary healthcare is however then mostly rely on the general practitioner which are doing individual practices. There are maternity homes, there are polyclinics and laboratories. Okay, so when we talk about primary health services provided by general practitioners and all these services we have family physicians which are also working in the community. We have public and private hospitals which have departments including a family medicine which have family physicians working in these setups and there are public hospitals which have opened up clinics in the community to in order to cater the population of in order to provide the cost effective upon a person centered care in the community. However the key challenges still include a non-standardized care irrational use of medicine and missed opportunities to provide preventive care. So when we talk about these key challenges we talk about these untrained GPs and untrained general practitioners who are providing primary care services in the community and in in these clinics. Okay, so this is a slight idea of where we live in rural versus urban setups. According to World Bank there are 70 70% of the South Asian population still residing in rural areas and rely on agricultural needs and everything for their livelihood. Poverty is a big issue which which eventually leads to unmet health needs of rural population as well as urban population and eventually leading to increased rates of chronic diseases perinatal mortality infant mortality and malnutrition as part of the world. There are also decreased physician and nurses there is increased transportation barriers if we talk about physicians and nurses and health workers working in rural setups. So these are okay so these are big barriers for physicians as well as health working who want to practice in rural setup. Also these transportation barriers also have a huge impact on the patients who who we refer if in rural setups. So there's a low doctor patient ratio of poor access to healthcare which make it difficult to achieve health goals in rural setups. So the pictures I have kept here is the rural is the rural is a rural clinic and the rural health setup where I had worked for a couple of months in order to provide healthcare to the rural population. So there is so in the northern areas of Pakistan there is public-private partnership by AHAN Development Network and it works in coordination which there are multiple primary and secondary care hospitals which provide this is an 18 bedded hospital which provide primary and secondary care services. There are a lot of orthopedic care patients there are obstetric care patients with the the population over there rely on antenatal care services ultrasound services and orthopedic care so all these primary and secondary and urgent care services are provided in these hospitals because once you refer the patient the patient does not reach right away there is a long distance that the patient has to travel so one has to stabilize the patient before they refer. So number one knowledge, number two competency and number three you know having an idea as to how to practice in such areas is a difficult task. And GPJ is trained to do that. So this is an urban health center we practice these are and provide free of cost. There's one in Chanesar, these are part of our community centers in Karachi where we provide primary care services. There's a picture with undergraduate students and with these are the postgraduate trainees who we train try to help the TB controlled program try to try to generate camps and create camps so that we can empower and we can treat the and the screening of these general of the local community population and provide care. I think we are running out of time. Okay so I'll just okay if you want to mention something please. Okay I'll just end my slide with what needs to be done more and in order to do more on family medicine in Pakistan you need to shift the focus from tertiary care to primary care they need to improve standards of primary care incorporate family medicine and undergraduate curriculum and there is a lot has to be done in order to provide integration between various components of primary care. Thank you so much. Thank you Dr. Zainab for your great presentation. Now up next I have the great honor to introduce you to Dr. Brando Javier Cantu-Losano who is going to tell us about family doctor as the leader of the health team. He's from Buaynacay in Latin America. He's a family doctor from the Universidad de Monterrey National Coordinator for Anthropology in Ameyali, Buaynacay, member of the Colegio de Medicina Familiar del Estado de Nuevo León. He's Chief of Medical Services in the Mexican Social Security Institute. So Dr. Brando go ahead with your presentation please. Thank you so much. Dr. Adel can you help me with changing of the slides? You have the control you can change Dr. Brando from you just click. Not working? I believe it changed. Yes. Okay I will change. Okay can you put the first slide please. Thank you. Yes. Thank you so much Buaynacay and I'll receive for the opportunity of being a speaker here with you today. I am from Mexico and as an overview Mexico is considered a country in development. Our population has grown exponentially since the 1960s. The distribution of our population as you can see in the picture has been changing from the 1950s to the 2020s. We have 79 percent of the population on urban areas and only 21 percent on the rural areas. This distribution is because people are migrating looking for better paid jobs, better health opportunities, and better education. Mexico is one of the founding members of the United Nations since 1946 and as a member Mexico had the obligation to follow the Universal Declaration of Human Rights and to achieve the sustainable development goal. This being said every Mexican has the right of access to a good quality of health. Can you change the slide please? Mexico's health system. The universal access to health for every Mexican is given by the public health system. Any employee of a business has the right to demand the employers to pay a small fee to the social security institutions for them to give health coverage for the worker and their whole family. There is a variety of public health institutions giving service to either workers or and military personnel. The Instituto Mexicano del Seguro Social IMSS is the biggest social security institution in Latin America and currently gives health services to more than 60 million Mexicans with and without social security accounting for almost half of the country's population. For population without social security we have private medicine and the secretary of health gives coverage for with specific programs for prevention and treatment. Next slide please. In Mexico the family doctors regularly work in family medicine units which range from less than 10 to more than 30 consultancies each with a population above the 4,000 users. The family medicine units are composed of a variety of health professionals from family doctors, nurses, psychologists, impressionists, dentists, medical residents, and administrative and maintenance workers. This is a logo we designed on a symposium we organized on 2017 during my years of medical research. The intention of this logo is a family doctor helping in the construction of a family. But we are not alone. Around the family doctor we have our team of health professionals. As family physicians we are the leaders of this health team. We are the ones to identify the specifics on a patient's situation to give them counseling to promote prevention and to give care when needed. Part of this is knowing the limits of oneself and knowing the strengths and capabilities of the health team around us. It is proven that the more health professionals that work together on a patient the best the outcome can be. Next one please. There is an enormous amount of information on the subject of leadership. In the big picture it can be separated into two major aspects, the individual characteristics and the teamwork. Depending on the author you can find several traits and characteristics leaders regularly have or have to develop. Integrity is a big deal. In order to make team function properly you have to prove yourself to the team first. One of the things that helps team building is trust and you need to be trusted. One of the best ways to learn this is to lead by example. A good leader has to get his or her hands dirty. That means you have to work. Our words and actions have to be based on an ethical and they have to be congruent. What we think, what we say and what we do has to be the same. Needless to say doing the right thing that means righteousness has a very positive impact on people and especially in team building. As family doctors we have the obligation of keeping our knowledge and abilities current so the leader has to embrace a culture of education where we can develop our skills and we can motivate others to do the same thing in their area of expertise. One of the strongholds of the team is knowing trust and capabilities. You should not be doing all that work by yourself. But you can ask and you should ask for help or inter consultation with your team members who are also health professionals so we can expect a better outcome in the patient's health. We are we're using a superhero team here so you can check out what leaders have the individual traits. Next slide please. A good leader has to be committed to a mission. The collective goal is more important than the individual goals. Having a statement based on ethics, moral and the necessity of helping to the development of humanity speaks good of a leader and motivates your crew. In order for this to happen proper communication channels need to be established. A good review of the theory of communication is recommended for maintaining a good work environment. As I said before trust is essential. Getting to know your teammates is a conscious labor you have to do. Establishing bonds and sharing experiences along with your actions will build trust. Being constant, being on time, leaving on time, looking forward to self-development will help yourself and others to build discipline. By trying to be better you will motivate others to try to be better themselves. Next one please. A team has to have a mission. Part of the task of the leader is to educate the members of the common goal we share and to make sure that they accept this goal. It is of more relevance to remind them the importance of them being a part of this team and what they can addition to it with their knowledge and expertise. Being in a team means supporting people. Being in there for them and ensuring health. This will build trust among each other. A team is also a safety. Before health professionals we are humans so we sometimes can feel tired, sad or disappointed. Whenever that happens we can reach out for our team members and they will have our back either for emotional support or with the distribution of your enterprise. When a person is a part of a team we build strength. We are stronger. There are many things we cannot do on our own but with the proper persons we can go very far. Next slide please. Being a part of a team is recognizing that each other has a different wisdom and skill set. Sharing each other's knowledge for improving everyone else's is why we need to encourage contribution and sharing experiences. As individuals working on a field dealing with death and major health problems it is normal that from time to time we lose self-esteem. The leader has to detect whenever this happens and remind our teammates of the individual work each one has and to strengthen their capability for resilience. Defining main issues to be solved exploring possible solutions between all can help us determine the commitment we have as a team and it can help us distribute the errands among the crew. By working together the health outcome should be easily reached. Next one. This is my favorite quote. As a conclusion I would have to say that becoming a good leader can be achieved by keep on trying to become to be the best version of yourselves that you can be. Thank you so much for the opportunity. If you can put that next slide. This is my team. We are the YDM from all around Mexico working on the commission of anthropology. We are proud members of Family Alley Wainakei YDM and like them we have more than 50 members of our movement each trying to improve improve and strengthen our specialty as all as the YDM who are here today. Thank you so much. Thank you so much Dr. Brando. I think any uninteresting take with superhero theme I think we deserve it. We deserve to be proud as superheroes and thank you for bonding this. So moving to the second speaker with Dr. Maria Jotik Ivanovich. She is a family medicine specialist soon to complete her master degree in nutrition. Also she is a council member of the Vasco di Gama movement where she is staying in Bosnia and Herzegovina. I'm sorry I didn't say that right. Dr. Marina Yanny please take the stand. Thank you Wainakei and Alawa for the invitation and letting me participate in this great event. As you said my name is Marina Jotik Ivanovich and I come from Bosnia and Herzegovina. So I'm going to present you the role of family doctor in patient education. Let me just see okay. Bosnia and Herzegovina is the country that is stated in Balkanian Peninsula in Europe surrounded with Croatia, Serbia and Montenegro. As you can see we have two colors in this map the yellow and the green one. So you can guess we are also divided inside in two entities, administrative parts Republic of Serbska and Federation of Bosnia and Herzegovina. So I live and work in Republic of Serbska. You can see here this is a city named Doboy and situated in northeastern part of the country. I will not talk very much about healthcare system in Bosnia and Herzegovina because it is too complicated. I'm just going to mention about the healthcare system in Republic of Serbska where I live and work. We are divided in primary healthcare, secondary healthcare and tertiary healthcare and all these funds are through national healthcare fund. This is the healthcare center where I work. It is a public healthcare center in my town and these are my colleagues. They are currently 23 doctors working in department of family medicine and as you can see most of us are women and most of us are family medicine specialists. So many of us work in urban setting and few of us work in rural areas in villages that are surrounding our city. The second photo is showing us making a house for the world family of the day that we have celebrated. So today I'm going to talk about the role of family medicine in patient education according to American Academy of Family Physicians. This is a process of influencing on patient behavior and producing the change in knowledge, attitudes and skills necessary to maintain or improve health. As you can see the world itself doctor that comes from a Latin origin. That means to teach. So basically we are also the teachers for our patients. We do not only educate individuals, we also should educate families as well as communities. Even though patient education is responsibility of all physicians, being a family physician gives us a unique situation, a unique role to take a leadership role in patient education. Because as you all mentioned we are the place of first contact with our patients and his contact with healthcare system. So we coordinate him and guide him to sometimes very difficult situations and to the healthcare system of our country. What are the basic skills that we need to have and as to be patient educator. First of all we have to identify patient's educational needs. We have to gather information about patients daily activity, about his knowledge on the subject that we are going to teach him, what are his beliefs and what is his level of understanding. And then we have to tailor the education to the patient's educational level and cultural background. We have to inform the patient of findings clearly and consistently. And also we have to discuss treatment plan in terms of specific behavior, encourage questions and improve appropriate answers. The communication that we have with the patient and this education role is not only in one way. We also need to have the patient participating as we also do. And we also have to utilize appropriate written, audiovisual and computer-based materials. But during this process we can find some barriers to patient learning. A physical condition of the patient can be a barrier, financial consideration, support system, misconception about disease and treatment, low literacy, cultural and ethnic background, lack of motivation, environment, negative past experiences and denial of personal responsibility are the barriers that we can find. And what is very important is that we select a topic that we are going to teach and educate our patients, our families or communities. So I'm going to present you in short what my health care center has done in the past two years. And we have been working on the topic of breast cancer and trying to raise awareness of this disease among women in our community. What was the aim? Well, the aim of these workshops was to increase the attention and support for the awareness, early detection and treatment of the disease. But the major focus was on the breast self-examination and preventive mammography. So as you all know, breast cancer is a leading cause of death among women and according to GLOBACAN for the last year around 2.3 million new cases were established among women and around 600,000 deaths from breast cancer occurred in 2020. And this is a major problem in low and middle income countries. So we have to think of ways how to lower these numbers. First of all, these are the photos from our workshops. We have made also this frame to encourage women to get involved in the breast cancer awareness and to be there and to be also our voice in the community. We have performed three workshops during the October month. These are the photos from 2019 where we still did not have pandemics so we could gather really and around 50 women per workshop were presented there. The ages were from 18 years and above. We wanted to do so because we wanted for the young ones to be our voice and if they found when they go home they will ask their mother, sister or grandmother, did they do and perform breast self-examination when they come to the mammography so they can live the future better. Okay, so this is the walk that we organized in our central park in October 2019. This was the walk for the support of the women who were sick. Many of them lost their battles so we supported the ones that we lost and their families and also we wanted to share that together they're stronger and we can do much better things and improve and build let's say a better future for all of us. Unfortunately in 2020 we could not organize any workshops. We could not organize any gathering like we did in 2019 but we organized a small gathering in our park again where we distributed reflexes with breast self-examination and also we distributed masks. As you can see they have the signs of a pink ribbon and somehow we wanted to connect that preventive activities are important in communicable disease but also in non-communicable disease as in the breast cancer. Also I want to say that here we had the support of our local authorities and as with their support we were able to get a mobile mammogram for the patients, for the women living in rural remote areas so hopefully when this pandemic is over or things get better we will be able to use it more currently. Also I want to share with you that being there for patients is also important to adjust ourselves in the present so we have to include also social media in their education. So we have our official Facebook and Instagram page where we post on activities and where our doctors working in our health center can do presentations or small advices for the patients regarding many diseases and we are very happy and we are followed by many people in our community but also we get credit from doctors and our colleagues outside our city. Dr. Marina I think we are done. Okay I just want to say like Randall that we need to be the change that we wish to see in the world. Thank you. Thank you. Thank you Dr. Marina. So up next I have the honor to present Dr. Margaret Azimba. She is from the U.S. Family Medicine Doctor in Loma Linda, California and is affiliated with Loma Linda University Medical Center. She received her medical degree from University of Auckland Faculty of Medicine and Health Sciences. So Dr. Margaret. Thank you very much for that kind introduction and it is a real privilege to be amongst all of you as the panelists and also I'm looking forward to the question and answer part to really hear who is out there and who is listening to this because I think it's a really good topic you know as family medicine physicians we are speaking from all over the world and I want to say good morning and good afternoon and good evening to you all wherever you are. I'm here in the United States on the West Coast and but I'm from New Zealand grew up in New Zealand and I think that our identity as we have spoken about previously is really dynamic and diverse and so building on the previous topics you know thinking of the family medicine within the healthcare system and how important we are as part of the pyramid of healthcare and then also thinking about the diversity and how we need to approach health in a different way whether it's urban or whether it's rural and the importance of leadership and whatever role we do and as you have seen from my previous panelists as well there are often many roles that the family physician takes. I also loved about dokeere or dosteere that the family medicine is really the teacher and so I build on that a little bit in that I'm looking at the family medicine physician as an administrator and as an administrator I think there are a lot of different roles and as unique as family medicine is and as unique as the panelists are I can only speak to my own journey and it will be wonderful to hear other ideas and other thoughts of the family medicine as an administrator. I myself am going to be talking about really the World Lifestyle Medicine Council which is a non-profit organization and that's my space of administration. It comes from a point that here in the United States it shows that almost 80% so 79% of all family physicians experience burnout and I think that as we are dynamic and as we are diverse it also means that with all of these hats each cause whether it's breast cancer or whether it's looking at screening whatever it is when it is something that is a really good cause there is no limit to how much we can put in it and as family physicians we have a really unique skill set because all through medical school and registrar or residency training we are designed to look at a problem and solve it to meet with somebody and I like the quote as well to really to look at the whole person and then to see them as a whole person and help them on their healthcare journey to really help them diagnose and then treat from that and then we are also designed to be leaders and I love this question from Mal that as to what are the main contributors to burnout and I think that there are many many different answers to that but I think that is a combination of systemic factors that just to answer that question so systemic factors that mean that there is no limit to how much we can do and that's a perfect recipe for burnout even if it's something we're passionate about then also the system of sometimes not having the resources and it depends on what context that you work at but that futility that there is more that you can do than you have the facility and the resources to do and then we expect high standards of ourselves and as I say we wear many hats so you know I'm a family medicine clinician also an educator so here in Lauderdale I teach the medical students in the residence I'm a mother of four children and a wife it's our wedding anniversary today and at the same time I'm a daughter so looking after the older generation I know that a lot of people can speak to that as well and we're rich people so I'm from New Zealand but my mother is from the Netherlands in Europe and my father is from Africa so I think that all the people on the call you know any one of these things can burn us out that combined with the passion and then what is administration it's leading it's the process or activity of running an organization so you could be a chief medical officer in your own practice you could be in an administrator as in the social security so it was lovely to hear from Brenda for myself it's in a nonprofit organization and so that's just on the side as well I want to talk a little bit about the world life style medicine council because it came from this idea um oh and there's another question I just want to answer do you think family physician will fare better as compared to other specialist administrators that's a very good question and I think that it depends on how we look at it and how we fortify ourselves I think we have the potential to be the best administrators of any specialist because of our problem-solving because of our broad knowledge and because of our heart we're family physicians because we really care about the patients and I like that the idea that we're superheroes but we're also really in the trenches with patients and that combination of knowing um knowing our audience knowing our patients and really caring can make us phenomenal administrators so back to the global band of um disease you're welcome that's lovely pink blue um non-communicable diseases have overtaken infectious diseases as there's a biggest killers worldwide this was actually back in 2017 already that Margaret Chan the WHO the world health organization director general realized this and spoke about it publicly and that's so that's great fits in with the sustainable development goals and with so many of the other things that we're looking at oh thank you um now we have also that there not only are oh it's frozen thank you for the happy anniversary that somebody has just put my passion and the reason I came to be an administrator was from this non-communicable disease concept and public health concept to what needs to come into family medicine so very briefly I'm from New Zealand I did orthopedic surgery I came to the United States to marry my husband um and then I did public health and global health um and so I spent six years retraining at Johns Hopkins University in Baltimore and I did my fellowships at the World Health Organization in Geneva and at the National Institute of Health here in the United States on that journey really thinking realized that so much of disease is preventable and as family medicine physicians we have this unique opportunity because we have a relationship with the patient and we have this world health perspective and yet we have this clinical time where we can be with the patient so we can change this so the intersection of family medicine and non-communicable disease lifestyle medicine is it and that's what I got passionate about and that's why we started this non-profit the um it was called the lifestyle medicine global alliance and has now become the world council of lifestyle medicine looking at obesity which is a growing problem and unfortunately thank you it's growing in the places um that the low and middle income countries is growing the most so 71 percent of the global non-communicable disease burden is in low and middle income countries and there's a double burden because there's still infectious disease and covid has really highlighted this and that there's under nutrition and there's malnutrition and if you have non-communicable disease underlying it then the disease then infectious disease is much much higher burden there's this information note um just from the world health organization really on covid and the impact of non-communicable disease so there's this global what we call a syndemic and the Lancet um back in 2019 looked talked about the syndemic of obesity under nutrition and climate change so some of it is contextual as well that planetary health we can't talk about our own health without talking about the health of um oh thank you ma'am for being interested in lifestyle medicine and we can't talk about that without talking about the health of our own planet because as a living ecosystem we are part of that as well so most of these we can talk about in more detail later but what i do want to do medicine global alliance and we have now places from North America from South America from this is talking about the global syndemic from Africa from Australasia all through the Pacific and Asia so it's great here we have people from Malaysia and our translators from Hong Kong thank you for that as well and um also from Europe so many family physicians and other specialties who are passionate about this lifestyle medicine course um the Middle East cannot be forgotten it's thanks to you that this is all organized and um really a huge burden of um non-communicable disease in many of those places internationally as family medicine physicians we can be the um oh yeah PG2 we can be the uh the the catalyst in this conversation and in the lifestyle medicine global alliance we started from just three of us now it has become family physician and other physicians in their own countries in over 40 countries they have come together and each sister organization can be with can join with the globalization um and the global alliance or the world uh it's part actually of the the lifestyle medicine world council so second doctor Margaret lovely final words this is my last slide is that you can become certified and i'd love to answer many many questions more um especially as the details if you want to hear about the details of the administration so thank you i look forward to your questions thank you doctor marquette that yeah anyone's an informative presentation with a new perspective uh and subspecialty for family medicine which we lack in in maybe in several countries but lifestyle medicine looks yeah any shining with your efforts on it thank you okay so now moving to dr kuami one minute okay so uh dr kuami are you with us okay yeah so the role of family medicine yeah and their community by dr nana kuami iasi boating uh dr kuami is a family physician and the lecturer in komasi gana uh whereas he the current chair of the afri one uh renaissance young doctor movement of wonka in the african region uh dr kuami the stand is yours please yeah thank you very much adel and thanks to the global ydm for this opportunity and um kudos to harish in particular the co of wonka who has put together a lot of this platform for adel and team kudos right so um this afternoon i'm going to talk to us about the role of family doctors in the community um i bring you greetings from afri one renaissance adel i'm not able to control this life it's not it's not moving right so i bring you greetings from afri one renaissance that's the young doctor's movement of wonka africa okay so um for this session the objective is to highlight our role in the community as family physicians i'm going to celebrate some of the fantastic work being done by some young family physicians across the globe and then we're going to discuss some of the challenges all of us are facing as family doctors in the community and look at how we can suggest possible solutions to these challenges so we all aspire to be five star doctors that's what our training as family doctors teach us um but both wonka and then world health organization have five key points so we are going we are supposed to be care providers decision makers communicators managers or team members but cardinal within this definition is the fact that we are all community leaders meaning both wonka and the world health organization recognize the key role we as family doctors have in the communities as community leaders right so when we talk about family doctors in the community i look at it in several ways so first of all when you look at the community we're looking at has been situated within the community of family doctors and then within that space we also have a bigger community of other doctors or other specialists then there's a bigger community of family doctors within the healthcare system where we work and then we also have the geographical space and then the global space where we operate so as family doctors we represent a community within a community and within all these community communities we share with them unique social culture characteristics and interest and some of us where we find ourselves operating and we've gained a lot of respect among the community members they trust us they believe that we are the best people to be able to provide them with the right kind of healthcare and this one puts a lot of expectations so they have expectations of us that we all struggle or try to to meet so i share with you one experience of a very good friend of mine by name Dr. Vikesh Sharma who is a family doctor in London UK he has the practice of um going into the communities to engage West African population so where he practices he realized that quite a number of the patients who come to his practice either are from West Africa or majority of them were Portuguese speaking citizens so what he did was that he paid the visits to the the churches to engage with the West African community and how this has helped him is to equip him to be able to understand the peculiar needs of this population once again when it came to health education he realized that most of the materials that were being used for health education were in English but some of the people in the originating from the Portuguese speaking communities could not understand English so he engaged the local government to design education materials so that he'd be able to educate that through these initiatives one he was able to increase his patient population from West Africa and number two increase patient population from Portuguese speaking communities and with that as well he gained the trust and then established good rapport and relationship with these patients then i want to share with you another very vibrant and versatile young family doctor from Nigeria Dr Benji so Benji has an NGO which is non-profit and what they do is that they embark on campaigns and advocacy campaigns in the communities they do anti-rip advocacy and then during the COVID-19 pandemic they provided COVID-19 relief support for people within the community and i'm proud to say that Benji has led a group that has conducted free seduces for more than 3,500 people free of charge in Nigeria and he's won several awards and he's a two-stop young family doctor in Nigeria so there's one thing that we can also celebrate first next slide then i celebrate others all over the world you see Sanka from Spice Roots, second blood pressure or Melvina in Sierra Leone, conducting free BP screening and then Marita Douglas in Kenya doing home visits and a young doctor also in Kenya conducting evacuation for a patient and these are all rules that family doctors are playing in the community all over the world next slide so with this rule come with responsibilities and challenges one major responsibility we all face and i'm sure you all agree with me is high demands and expectations from our patients i know family doctors who in their practice patients will never leave a practice without seeing that particular doctor or they will make sure that that particular doctor that attends to them when they are not well or they are families and this puts a lot of demands and expectations on us and then number two in the midst of that in primary care settings a lot of governments do not put channel resources a lot of funds into primary care settings and so in spite of the demands on us we still do not have enough to be able to meet their patient's demands and then also because of the increasing expectations as Margaret presented a number of family doctors burned out from commitments to our patients their families their communities and all that but there are solutions to this one is visibility how can we be visible so one thing i celebrate one car for is the world family doctor day on 19th may because it gives us an opportunity to be able to trumpet what we do as family doctors and when we put it on social media on twitter on facebook and all that people get to know what we do and that also will push politicians and leaders to be able to look at family medicine as a very important specialty or a very important discipline within this healthcare delivery system we also do not have enough family doctors so all across the world we need to increase training of family doctors so that we can play this role technology is very important so at our primary care facilities in some african countries most african countries actually do not have electronic medical record system these systems are important because then it will help us to be able to have an idea of where our patients are coming from like doctor because someone who was able to know that a large percentage of his patients were from the west african population we're able to look at their generate data and be able to present it to opinion leaders on how they can support primary healthcare so employing technology will also help us a great deal in terms of our role in the community next slide okay two minutes to come gramy yes go ahead next slide so i went on facebook and i found this very beautiful picture from a giant of family medicine that's john win jones and dr john win jones has i've been following him on facebook and what he does is that he works through the community and takes beautiful pictures and what i've learned from this is the fact that there is not a family doctor who is only involved in patient care or going into the community and then providing healthcare but he's also into the beauty of the community so just going in there can also be therapeutic for us to be able to prevent burnout and be able to overcome all the stress that we face and from our work and then you also see this young man actually that's myself playing tennis and i showed this slide also to let this picture to also tell you that we all need to also get involved in the community not just in terms of providing healthcare but joints sporting clubs join james in the community be part of the community and by so doing we'll be engaging them and also getting healthy whilst we also overcome stress and overcome and also prevent burnout so these are slides that i thought i should share next slide right this is my last slide and um it's quite personal to me and i'm sure some of you might share in this as well so this one shows a picture of a typical funeral setting in Ghana and i'm sure in some african countries as well so in in in Ghana in some african countries funerals um when you report to a funeral as a guest usually you may go around and then there is an announcer who announced that okay so there is dr kwame a prominent family doctor in the community and he is here to pay his respects but part of it could also be that that person that you are attending the funeral may have been declined that you are seen in your clinic so one difficulty i always experience is whether to attend the funeral of my patient or not because if i show up and it's announced to the gathering that is the doctor who was taking care of the disease or the patient who is who has died one difficulty i always experience is whether it's an appreciation of my efforts to keep the person alive or that i feel in the effort to keep him alive i am so the next time you're also confronted with the an invitation to attend the client's funeral you may feel the same dilemma i have to go or not to go the decision is yours thank you very much for your attention thank you doctor so we are going to have our last topic for today before uh questions um i'm going to introduce dr salam hasa who is uh going to tell us about family doctor in conflict area um dr salam is a fourth year resident in the palestine board of family medicine from palestine gas so welcome dr salam thank you um okay i have the control okay thank you so um as you know thank thank you first for this nice introduction uh as you know family doctor can work in a wide spectrum of different environments but what about working in a conflict area how things look like and what are the type of the challenges that are related to the working as a family doctor in environment where there is a conflict in my presentation i'm going to answer those questions but i feel it is important to tell you a little about the conflict that we had in that we have in palestine as you see this is palestine in a green color where people palestinian people were living so peacefully but then and during the last 73 years the israeli occupation occupied parts of the palestine and then it continued to build colonial settlements that lead to more and more shrinkage of the land so we are now left with a small green area the white one is occupied palestine by israel by israeli occupation and the green one is west bank this one is west bank and gaza which of them is palestinian territory now i'm living in gaza so let me zoom in zoom in um yeah so i'm living here along with other two millions palestinian population but this area is the most populated densely populated area in the world and we are under blockade since 2007 by israeli occupation and this mean it is extremely difficult to travel outside gaza it's extremely difficult to get things from out into gaza and because of this we are lacking the access into clean water and to sanitation we have bad sanitation we have a state of poverty unemployment and we really have electricity for three to four hours per day and so it is not strange that the u.m. report in 2012 tell that my place gaza will not be livable by 2020 and um i can't imagine after those facts you may now imagine that the palestinian family doctors are in very clinic crying in the corners which is which is not the state actually we are very aware of our challenges in in in gaza and we are trying to find solutions for these these challenges we are trying to overcome them with the minimum resources that we have so uh okay so i'm going to to talk about the most important challenges that we have as a family doctors in gaza and first of all first of all it is a challenge of establishment of family medicine speciality this is actually one of our most important challenges was and because next please dr agel yeah and because as you see here in the bus people was able to go outside gaza to take their speciality then to come back into gaza but this is not possible after the blockade in 2007 by the israeli occupation and so a leader and the family doctor idea was okay we have the minimum resources but then we have to use them to establish our own family medicine speciality next please and we actually succeeded this now we are having 40 residents in family medicine board palestinian family board and also a 30 graduated family doctor so we managed to solve this first challenge next please the second challenge is about the the shortage of basic medication and the the shortage of basic medications is about 45 percent so imagine that you are in your clinic your hypertensive patient come to your clinic asking for his anti-hypertensive medication you know that this patient don't have the money to uh to buy his medication and neither you have this medication so this big challenge is solved by being as a family doctor in gaza to be aware of the non-governmental organizations that can offer this medication for free for the citizens of gaza like unaroa united nation clinics that can help the refugees to provide them with medication next please the next challenge is the adoration so the briefest facts are really difficult but this one is the most difficult because from time to time we have azraeli aggression on gaza i myself i'm a survivor of four wars two thousand eight twelve fourteen and twenty one and if you look to the human coast it's not easy to process all of this next please the problem of the problem with family doctors with us as a family doctors in gaza is the continuity of care during the aggression it's so important that to know that the the the patients need their family doctors the most during this time but during this time we are not able to access our patients and if if you mentioned that the aggression is simple actually and unfortunately it's not it's as you see from this picture israeli airstrikes are hitting some building in gaza and we lived like this for 11 days started in in in the last 10th of may in 2000 and the 21 and as you see in 2014 it is 51 days so the continuity of the care is not easy next please we try to solve this problem to use our minimum resources with the electricity and internet and to have to immediately program to reach our patients but it wasn't easy but we are trying our best at least to solve the problem partially next please and then if the challenge is with each aggression we know we will have waves of more psychological disorders acute stress disorders if you breathe more systematic stress disorders and other non-communicable diseases which were controlled they are now not controlled because the patients have no access to the clinic so um uh to solve this this challenge actually the family doctor in gaza have to be aware of this of this and to to give more focus for our patients after each aggression at least for three months to to try to bring things back to normal again next please uh the least the challenge is about the the lack of possibilities for training and international connections it's really unusual to have my voice in this panel this day thanks for as the young doctor's movement and wonk and wonk and wonk and for my friend Desan to help me to to to to hear a voice from gaza and we try to solve this problem from time to time for example in 2018 we have dr abu murahil he's a family doctor from uk he um by chance he was visiting gaza so we we grabbed this chance and asked him to come to our lecture to explain as for uh family medicine in uk and to have some of his experiences please the last challenge is really the most important one as a family doctor we have a responsibility not only to advocate and support our patients but also to support and advocate our whole healthcare system um we are in gaza as a family doctor we don't have billions of dollars to to refresh our healthcare system but we can reach by our voices to mainstream media like time magazine and fight magazine next please and also to talk with leaders all around the world about the situation in order to encourage the people and to enhance them with their administration to book to put a pressure on the israeli occupation to end the siege to end the blockade to end uh this burden of not having the right to put proper health and proper life in gaza next please and as you see this is beautiful two kids from gaza this is a few weeks ago during the israeli aggression their neighborhoods well was damaged by the israeli air strike those kids are not crying they are happy and joyful smiling because they managed to rescue their pet it was a fish so they they really find a way to find a celebration moment and to focus on that small light in the middle of the darkness actually the family doctor has to do the same in a conflict area he had to search for hope to search for that light and to work on it even each time he lost the control of the high participation and have waves of psychological problems it's okay they don't have to be part of the problem he has to be part of the solution and to focus on that light in order to help himself and his people and for sure he has to have a problem solving the scales thank you so much thank you very much dr salam for shedding light on this humanitarian suffering i think and we didn't have this point of view before that only our clinic to stay on open for all of our patients is a blessing by itself now yeah now we are moving to award from our young doctor movement chairs we have dr gabi and dr gabriell now and dr anas muhtaseb dr gabi as a family medicine consultant from argentina where she is the chair of winakai young doctor movement and representative of the cimf executive committee and dr anas muhtaseb is a family medicine specialist and and also has a master in health economics and he is the chair of the arrazi young doctor movement so dr gabi the floor is yours well thanks adel for your kind presentation just a few words first of all i want to give a special thanks to all of you for attending today to this wonka ydm global webinar and as i'm very grateful today i also want to thanks dr harry sligidakis from wonka for helping us once again and to my partner anas and alrazi movement and winakai movement for accepting this challenging idea of working together in the planification of this webinar about identity of family doctors so i'm i'm very proud to say that i believe that this wonderful experience is a big step given forward to strengthen ties and look distance and make distance sorry look shorter among family doctors all over the world so thank you very much once again and thank you adel and anas that's your turn now yes thank you very much gabi thank you adel tania and everybody can you hear me yes doctor we can hear the fans so so first of all i would like to thank you all for attendance and for participating thank to all panelists have us and special thanks to adel and tania for organizing this great job i would like specifically thank gabi and ydm leads for this nice idea to bring all family doctors worldwide together in one village actually this is maybe the first time to feel the feeling of small village of connecting family doctors from all over the world so thank you very much it was a great chance for networking friendship and more collaboration i hope that this webinar will continue for the next years with more success thank you all bye bye thank you all for our great chairperson for making us happy and easy to do this presentation to collect all of the panelists from all over the world i think for now we will move for a question and answers we have three questions or four in the chat section no one put it in the question and answer section so we will have a first question for doctor margaret they asked you to come on if lifestyle medicine can stand on its own as a specialty what do you think in a few words please yes so thank you for that question and the answer is yes so it is actually um already gaining certification as an independent specialty in um the united states but i don't think that that should detract from the fact that lifestyle medicine should be the first approach for everybody in any specialty so just like i think like family medicine um every good doctor has a little bit of their family medicine in them you know any cardiologist can actually still really speak to the patient like a family medicine person can so lifestyle medicine can be throughout but yes it can be its own specialty and you can become board certified and board certified in lifestyle as well as family medicine okay thank you doctor margaret for this i would leave the floor open for the next question which is the how to convince more medical students and more people into family medicine as it's lacking the private sector or the higher payroll compared to other specialities i don't know if anyone want to answer this from an experience or something i think i'm talking a lot of people have um insights that i just wanted to say that money is not what makes has ever made anybody happy um and i think that if you look at the fulfillment that can come from family medicine that is incredibly important the diversity the relationships the um leadership and i know that um dr kwame had something to say as well dr kwame please it might get finished i wanted to finish what you are saying okay uh yeah any from uh i would i would add on this uh from the country point of view we have here in saudi arabia we are shifting our whole uh economy health care system based on primary and prevention so as some of you may heard about the saudi vision in 2030 it is a national wide effort to guide medical students and more people into primary care and family medicine uh and uh and specifically uh so that will be any more uh encouraging for medical students to join in family medicine uh i think uh we are done for the questions thank you everyone uh we will leave it with kartania to end the session for today uh and then it was a pleasure to be with you thank you adel thank you all for participating let's keep encouraging family medicine and spreading the world about what family doctors can achieve for the health care system and population worldwide so thank you all and have a nice day