 We're connecting to the cloud server and Oleg has already said that he likes our our Facebook streams, so there we go. We've got a vote of support from Oleg from Norway So I'm recording now and I'm going to Start the webinar now so You've got there's four minutes for the start So it's occur. It's over to you now. We're now live Yeah, we started short before, you know Good So we're live now You're late. So if you could Just detect my wife's just got to mute her her computer here. Could you just turn the Volume off. I've just got to go help. Oh, we've got some chat in the chat room. So Zaku we've got another three minutes. We've got a few people coming in Amanda. How Welcome Amanda. Yeah, welcome to drip thought Yeah, yeah, we're just all assembling at the moment. It's lovely to see people starting to come in We've got 26 participants. So We'll just wait for Those who are registered to be able to come in While we're doing that just to note we've got over 400 registrants for this so Hopefully a large number of those people be able to join us Hello, everyone greetings from Bangladesh and Very shortly we will start. Can you start rose? Zaku we've got 31 participants. I think you should leave it till shortly after Yeah, just to make sure we're not starting before those that want to join. Yeah Ken we've got Ian Cooper. I notice and Truth up from Bhutan. Welcome Welcome Professor Kanabala to Yeah, kind of Malaysia I think just and we have the Bruce just tell me and it's right time to start. I think we'll just wait for a few more participants to join us as a cool so We've got quite a few coming in at the moment. We've got quite a lot registered. So we'll Maybe if we just give them a minute or two to to just join us and then we can go from there Hello, so dear you're gonna join with us In Cooper's just noticed that the chat is set to go to the panelists only We can certainly You can choose the option set to panelists and attendees So please feel free to do that Bruce is Roger here. I'm hearing an echo Yeah, sorry, that was that was Facebook my apologies I was I had Facebook on that screen and me on this screen. So just so everyone knows is a Live feed on Facebook So If anyone is having trouble with the webinar themselves, you can go to rural Walker and and join in there so Bruce Okay, we've we've got about 46 participants. I think we should start going so I'll hand Yeah, whenever you're ready If everyone else could mute their microphones, that would be great Greetings from Bangladesh on behalf of 17th onca while rural health conference. It's now on stage all set for you. So I end over to Today's muster of the ceremony Please go ahead Getting from Bangladesh on behalf of 17 onca world world health conference 2020 Dhaka Bangladesh. I Would like to welcome you all from home and abroad. I would like to invite our community speaker Roger steter family chair onca working party on rural health topic on Training for rural practice 25 years onwards and upwards before our keynote speech Let's have a glimpse of On beautiful Bangladesh on the screen Let's we enjoy it Thank you Bangladesh has been marching towards success against all odds since the liberation of 1971 Our story is the story of relentless progress We have made several achievements in the health sector by reducing child mortality of five years and below five years and Improving maternal health Bangladesh has fulfilled the millennium development goals ahead of time However Bangladesh had to strive to cross a long road to come to this position For any kind of medical treatment villagers had to come to town With the dream to deliver healthcare at every doorstep of the masses in the remote areas of the country Honourable Prime Minister Sheikh Hasina Started the community clinic in 1998 under the health and population sector program so far over 50 million people have benefited with care from community clinics and this number is still growing With the contribution of land and active participation from the locals and with the technical support from the government 13 thousand four hundred and fifty community clinics now give service to almost Five lag 40,000 people daily its value is growing with time Overall management and promotion of the community clinic is catered by the local inhabitants The government provides a community health care provider a family welfare Assistant and a health assistant through six weeks theoretical and six weeks practical training Along with the necessary medicines Every day from 9 a.m. To 2 p.m. The following services are provided treatment of minor ailments common diseases and first aid screening of chronic and non communicable diseases integrated management of childhood illness expanded program on immunization nutritional education and micronutrient supplements health education and counseling reproductive health and family planning services There are also other programs for maternal and new NATO healthcare services Community clinic health care near home live healthy. Thank you all I Would like to invite our clinical Professor Roger stretcher founding chair onka Working party on the role health tropics on training for role practice 25 years onwards and upwards Well, thank you very much as a care and Thank you for that that introduction I'm just going to share my screen so you can See my slides So you should be able to see my slides now and as you heard my The topic for my Opening keynote address for the 17th world rural health conference is training for rural practice 25 years Onward and upward. I do want to start by saying this is an enormous Privilege and a great pleasure for me to be to be with you today And I want to congratulate Bruce Chater and all the the rural onka team and especially zekir and the team in in Bangladesh for bringing us all together in this way for the 17th one co world rural health conference I think it's fair to stay as as the covert 19 pandemic was we're starting to take hold And the the planned conference in April had to be postponed We weren't quite sure how it was going to happen, but a great effort by so many In Bangladesh and around the world has brought us together today for for the opening of this conference and I expect a really exciting next three days from Bangladesh and then a series of Seminars over the coming months all part of the 17th one co world rural health conference So welcome everyone a great opportunity for us to get together Virtually for this conference and I think we have much That's very exciting to talk about and to share so my part of the conference in this initial Keynote address is to to look backwards and then to look forward So it's actually 25 years ago this year that the Wonka World Council approved the first rural Wonka Policy the policy on training for rural practice what I'm going to do briefly is set the scene and then Talk about what we know now that we didn't know then 25 years ago In terms of rural health and rural practice the experience of implementing training for rural practice and also about recruitment and retention of the rural health workforce So I have no conflicts of interest to declare But I will tell you a little bit about myself My background is in Australia as a rural general practitioner family physician I was practicing about two hours east of Melbourne in the southeast part of Australia for nearly 20 years And during that time I also was appointed as the first professor of rural health in Australia and the head of the what became the Monash University School of Rural Health Which was a sort of Rural branch of the of the big city medical school of Monash University in Melbourne And then in 2002 the opportunity came to to go to Canada and to join others in establishing The northern Ontario school of medicine as a multi site rural based Medical school and I was there as the founding dean and CEO until last year And and now I'm actually speaking to you from New Zealand where I'm the professor of rural health at the University of Waikato And during that time and particularly between 1992 and 19 And sorry 2004. I was the inaugural chair of the Wonka Working Party on rural practice The working party on rural practice was formed following a get a gathering of rural practitioners attending The the 1992 Wonka World Conference in Vancouver. There are a whole lot of us there and we were really Seeing the need for a much greater Focus and a lot of work to do to improve rural health and rural practice. And so We got together over at a lunch break during that conference And that led to establishing the Wonka Working Party on rural practice Which has gone from strength to strength over the years With rural policies with the conferences like like this one Statements and collaboration with the World Health Organization This I think Photograph in a way sums up the working party. You'll see Well, you can see this this was actually at the conference that we held in in Nigeria in 2008 and and we were The group of us here were being installed as honorary chiefs So this is me you recognize me you recognize Bruce Chater the current chair of Rural Wonka and this is Ian Cooper who was at the time The chair of Rural Wonka from from South Africa So this is what I'm talking about the the Wonka policy on training for rural practice And you can see that it's been reprinted and redesigned Three times, but it was 1995 when when the policy was formally approved And so it's 25 years on that we're looking at what we know And we and where we're going really in with training for rural practice around the world This slide is the beginning of just drawing your attention to the key recommendations in the policy. So highlighting that there was Recognized a worldwide shortage of of rural doctors and the need really to have a specific Interventions that would actually improve training for rural practice and you can see The recommendations the first five of them there Particularly about recruiting students from from the rural background providing rural Undergraduate medical education training for rural practice after graduation Continue education professional development for rural practitioners academic roles for rural practitioners And for the rural for the medical schools themselves to take on a role a commitment to serve regions that a specific region including the the rural and right parts of the region and And connecting with the real the health needs of the population of that region So that's the notion of social accountability And it was actually in 1995 that that year that the world health organization provided the definition that that is still Really the guiding light for social accountability of medical schools and other health professional education institutions The the remaining recommendations were about the the importance of recognizing that rural practitioners and their families Need to to be part of the community and need to be supported And and for all of this to happen In each country there needs to be a national rural health strategy So they they are the nine key recommendations in the 1995 wonka policy on training for rural practice So what do we know now? well It was actually in 1996 that we held the first Wonka world rural health conference and that was in china and I think for those of us who were there there were over 300 participants from 30 countries It was something of surprise when we realized that although You know the countries we came from the geography the climate The developed and the and the less developed Countries there were so many obvious differences that there was a lot that we really have in common and in fact Access is the rural health issue and it's the same everywhere Even in countries where most of the people live in the rural areas the resources are concentrated in the cities there are always Transport and communication difficulties between one rural community in the next and also between the rural and the urban centers And there are there have never been and they're still not sufficient providers of health care the rural workforce everywhere around the world We now know and we're able to describe rural practitioners So when compared to their counterparts in the big cities rural practitioners may be described as extended generalists They provide a wider range of services. They carry a higher level of clinical responsibility in relative professional isolation And that's true whether we're talking about doctors like general practitioners or family physicians Pediatricians surgeons. It's also true about other members of the health team nurses nurse practitioners pharmacists physiotherapists rural practitioners are extended generalists and also rural practitioners Frequently live in the community that they serve and so they have the opportunity to influence the the health of the whole community at a community level And actually the best example that I know of this is the is the doctor in a small inland town in South Australia That was so effective in in presenting the message of the connection between red meat and cholesterol and heart disease That the butcher shop started selling fish We also know now from extensive research What are the key parameters of high quality health care rural health care? and The first and and really important point Is that the health services that are most successful most effective in addressing the health needs of people in rural and remote communities Are those health service delivery models that are designed in the rural communities by the rural communities for the rural communities Taking models from the big cities and somehow trying to modify them and transform them and make them fit into the rural setting Just doesn't work people living in rural communities prefer to be looked after Close to home and during my time as a rural practitioner in in Australia I twice had had people choose to go blind rather than travel two hours to the nearest eye specialist And speaking of specialists We now know that specialists are really important to high quality rural health care And their role is a supportive role recognizing that the doctors the nurses the other members of the health team in the rural communities They are the frontline providers of all health care And so the role of the the specialist is the true consultant role providing support collaboration assisting the local providers of care to provide so that That the people in the rural communities really have high quality health care close to home We now know that those key parameters that were outlined in the The policy on training for rural practice, which was aspirational in 1995. There was some research But quite limited research and lots of good ideas Now we know that the three factors most strongly associated with going into rural practice after education and training Are first of all a rural background that's having grown up in the rural setting The second factor is positive and I emphasize the word positive Clinical and educational experiences in the rural setting as part of undergraduate medical education And the third factor is targeted training for rural practice after graduation And they are the there's there's now abundant evidence right around the world that these that these three factors come together Contribute to successful recruitment into rural practice So we're going to change gears now and talk about Northern Ontario this this map that you can see is is on is the province of Ontario in Canada Um, these are the great lakes Excuse me And these are these are the great lakes and this is Hudson Bay and James Bay in this This vast area, which is largely black is northern Ontario north of the great lakes And and this is a population distribution map. So the black just shows that mostly is start sparsely populated It's almost Sorry over 800,000 Square kilometers and almost 800,000 population. There are five population centers with 50,000 or more and all the rest are 10,000 or less so vast vast geography with a harsh climate and long distances between small communities a resource based economy that's based on on on mining forestry and tourism And the health status of the people is worse than the general population in Ontario and In Canada. So that's the context in which the northern Ontario school of medicine Was established opened officially in 2005 expecting Accepting the first students in that year The school serves as the faculty of medicine of two universities Lakehead University in Thunder Bay, Laurentian University in Sudbury. They are 1000 kilometers apart And the school was established from the beginning with a social accountability mandate That's a commitment to improve the health of the people and the communities of northern Ontario. There's also a commitment to innovation Distributed community engaged learning is the distinctive model of medical education and health research that we developed in northern Ontario Distributed means there are actually over 90 sites where The the medical students and the and the trainees and the learners in other health disciplines May undertake part of their their clinical learning. Those sites are connected electronically Both in in in real time and asynchronously and we have an extensive Digital library service, which means if you have the access if you have the internet You have access to educational resources and information Pretty much the same as if you're in the big city like in a in a teaching hospital environment But the centerpiece of distributed community engaged learning is community Engagement that's the interdependent partnerships between the communities and the school of medicine and so the the communities and the school work together and And co-created the curriculum that we deliver in northern Ontario So here's the map again of northern Ontario gives you a visual of the over 90 sites And also with the color coding a sense of the different parts of the curriculum for the school for the undergraduate medical students For example in in their first year All students have four weeks Living and learning in indigenous communities that includes these communities that are very remote. You can only get there by airplane Except in in the winter when they cut ice roads to bring in heavy Heavy equipment and our students in northern Ontario school of medicine Awesome students have four weeks living and learning in these communities and this is a this is not a clinical experience This is a community experiences And the students are there to learn from the community about the history the tradition The culture the social and the health issues. So that's in first year the students have two times four week Experiences clinical experiences in remote and rural communities in second year And these are small communities and they're there to learn With and from the health team the doctors and the other members of the health team And then in third year the students leave the two larger centers of Thunder Bay, which is here and Sabri, which is there and they go to one of 15 communities in northern Ontario and they live in that community for the entire academic year and they're based in general practice family practice and essentially they see patients So you can say that the curriculum walks through the door like the first patient might be a child That's pediatrics. The next patient might be pregnant. That's obstetrics. The next patient might have the surgical problem This is the principal clinical year for the students. They're learning their core clinical medicine from the community family practice Perspective. This is a so-called longitudinal integrated clerkship Northern Ontario school of medicine. Nelson was the first medical school in the world Where all of the students undertake a longitudinal integrated clerkship, which we call a comprehensive community clerkship because of the active participation of the community you can see the rest of this slide that We have learners in other health disciplines nutrition, dietetics, physician assistants and in other health science Learners that are all part of the of the education and training programs of northern Ontario school of medicine So what are the outcomes? Well, first of all If you think back to those three factors, the first is recruiting students from a rural background in northern Ontario We aim to reflect the population distribution of northern Ontario in each class And we've been quite successful. These figures are from the first 10 years of intake from 2005 to 2015 It's very competitive over 2000 applications for 64 places And we've been successful in the sense that 92 of the students have grown up in northern Ontario The other 8 come from remote and rural parts of the rest of Canada So that's a very different class profile from the other medical schools In Canada, which are in big cities and most of the students come from the big cities In fact 40 percent of our students come from remote and rural communities, which more or less Reflects the demographics of northern Ontario 7 percent indigenous is lower than we're our target, which is 12 percent And in fact, uh, we as a result of of this research We tweet the ambitions process and and the intake is now closer to 12 percent of indigenous students each year And francophones people for whom french is the home language is the other population special interest and 22 percent is a good reflection of the population Before we leave this slide. I just want to highlight this other So gpa stands for grade point average and it's a number out of four this this reflects the academic standing of the applicants and You know, certainly in the big cities like in Toronto There was the assumption that we must have lowered the academic standards to allow in all of these dumb Northerners, but in fact 3.7 is about the same as the intake as the other medical students in in Canada So that's the admissions process. Let's now Share some of what we know from the students experience Clearly the emphasis on rural medicine and and generalism and we've we've done Research, which which really is focused on on our students and our graduates experience of generalism in rural Practice, but I think this last one, which I've highlighted Really sums it up You don't know it until you live it. I think that is the central theme and the and the real basis of the success of northern Ontario school of medicine So here's a quick snapshot of the success Looking first in the top half of the slide is the graduates from the undergraduate program the md program And you you can see that 62 of the graduates have chosen to become general practitioners family Physicians mostly training for rural practice That's almost double the national average for canada going into family practice 33% have chosen other general specialties like general medicine general surgery pediatrics And that leaves 5% have chosen subspecialties like dermatology radiation oncology neurology Now that 5% is important to us in northern Ontario for two reasons The first is that we need those subspecialists They have to go elsewhere for their training at the postgraduate level, but they are coming back And so serving northern Ontario But the other is that it shows that even though we have a very different curricular model and learning environment From the other medical schools Our graduates are very competitive if they choose to train in a subspecialty They're generally successful in matching to training in that subspecialty So that's that's looking at what happens to the graduates of of the undergraduate program in northern Ontario In canada the medical schools all only medical schools run postgraduate education Vocational training and so we can look at the at the graduates The red they're called residents the trainees are called residents in in north america and that almost 70 percent of the not some graduates of the residency training programs Are in northern Ontario and if you look at those who did the undergraduate and their postgraduate in northern Ontario 94 percent are practicing in northern Ontario including in the smaller remote rural communities So Now it's 15 years since the official opening of northern Ontario school of medicine and and not some's really made a difference in northern Ontario It's not just about more more doctors But but actually the whole health team that are responsive to the social the social cultural linguistic geographic diversity of northern Ontario and there are other benefits in terms of research and academic developments in economic development as well Okay, we're now going to shift gears So we've looked in broad what we know about rural health and rural practice from research in the last 25 years We've looked at the specific example of implementing the recommendations from the policy on training for rural practice in northern Ontario and now we're going to sort of Step back and look at the bigger picture of the recruitment and retention of rural practitioners and starting in 2008 2009 The World Health Organization convened a an expert panel John win jones and and Ian Cooper and I are amongst the members of this expert panel that developed this document launched actually by Ian Cooper in South Africa a global policy recommendations increasing Access to health workers in remote and rural areas through improved retention this was a really groundbreaking document at the time and a group the World Health Organization has recently reconvened a group to review Additional evidence accumulated in the last 10 years and to to update these global policy recommendations This slide actually is as you can see is a figure from that document And and it recognizes that there are many factors that contribute to to the the choice the decision to to practice in a rural community and they are many of them to do with personal and professional issues family issues and and the broader environment and it's important to to recognize all of those and address all of those issues The actual World Health Organization policy document Has recommendations under four headings and they're the first four dot points on this slide of recruitment and retention strategies the 10 years ago and now Still the strongest evidence is around education and training and really Very strong evidence of the of the benefits of of education and training for rural practice consistent with the Wonka policy on training for rural practice from 1995 other recommendations are about regulations and one sort of another Uh finance financial and other sort of recognition and reward and then of course the professed personal and professional aspects I would say in the last 10 years. It's become clear that there are these two other key categories of interventions that are important one is That the health service to help the delivery model itself is actually Is is actually sustainable and supportive of the rural practitioners and the other is the the really essential Contribution that the community makes that's active community participation or community engagement So i'm now going to share a Framework that was developed through a partnership around the Arctic Circle as you can see over seven years with five countries and focusing on Recruitment and retention of health and other public sector workers in remote rural communities in the far north of these Northern countries in europe and around the Arctic Circle and we developed through the recruits and retain making it work projects The remote rural workforce stability framework now this framework has three key tasks plan recruit and retain the first task is plan and It begins with actually Identifying what the health needs are of the population That's to be served as the basis then for designing the health delivery health service delivery model and only when you have that information can you identify well, what are the the knowledge and the skills the capabilities of The health workforce that you're looking to recruit and so planning is a really a critical First task in the process of planning recruiting and retaining the rural health workforce so recruiting One of the really important insights that we gained through this project and there were there were case studies in each of the five participating countries was the importance of information sharing This isn't just about the job for the for the potential recruit. It's about the whole community It's about living and being part of the community. It's about the family Rural practitioners generally relocating to to a rural setting There's a family and the family has to feel at home and want to be in the community with with the education and the employment and the and the and the social and recreational activities and once again, that's where The community participation community engagement is really central to successful recruitment So having recruited Retention it's so important and anywhere not just in in rural communities It's a supportive work environment. It's being part of a cohesive team that makes healthcare providers workers more generally Feel that they want to be part of this team and stay in this team and make their contribution To the services that they deliver It's important that they that they are supported to develop as a team with professional development at the local level with of course these days online education and training to keep up to date and funded travel for upskilling and for professional discipline specific Continuing education and professional development And a critical element a real contributor to success Is the active involvement in education and research education research academic involvement Is a real contributor to successful retention and of course it is about training the next generation of healthcare providers for this rural community and for other rural communities Across the region and the world Now for plan recruit and retain to be truly Effective there are these five conditions for success the first is to recognize That when you've seen one rural community, you've seen run rural community so those unique aspects that make each community special and and and the the the contextual Contributions the next therefore is to involve the people in those communities active community participation community engagement as I've mentioned Success requires dedicated investment real resources allocated. This is not Just to fit in with the existing budget, but actual targeted investment to to actually be successful in recruitment and retention of the rural health workforce And this is a continuous work in progress. It's not a one-off set of interventions. And then you're done It's it's really important to establish that annual cycle of activities at certain times of year certain activities It's the right time for them for example The graduation of a new cohort from from the education training institutions. That's a key point in that annual cycle And continuous quality improvement research and development this whole System is evidence-based and it's important to be testing the evidence and undertaking research and measuring And improving all the time continuous quality improvement. So those are the success factors this slide gives you a visual representation of the remote rural workforce stability framework and and with those those tasks so plan Recruit and retain each with their three components and then right in the center the bullseye are the five conditions for success Okay, so we've looked back to the the policy and the recommendations in 1995 and we've we've now reviewed what we know in terms of rural health and rural practice practical experience of implementing the recommendations in that policy And and also what we know about recruitment and retention the plan recruit retain framework. And here we are Right in the middle of the covet 19 pandemic I would say there were many Developments over the last 25 years that were not anticipated and and predicted When the policy was approved and certainly this pandemic was not one of them even a year ago. I would say that Most if not all of us really didn't see this coming So this pandemic has brought into sharp focus existing in in equities and and Uh disparities the fragility the lack of the limited resources that that rural communities and health services Had to the point of civic leaders in the rural communities telling people to stay in the cities So you can't escape the virus by coming to us Because we don't have the resources to look after our own people if they become ill let alone looking after outsiders um, we've also seen the phenomenon of people avoiding accessing any health services for fear of of Uh of the the virus and that of course then leads to other other health issues I would say some positive messages from the experience are the importance of self-sufficiency and resourcefulness and really providing the justification for renewed advocacy For investment of resources in health services in communities in rural and remote communities So that for the next crisis pandemic or whatever it is those communities and the and their services are well prepared to deal with With the issues at the local level and and and so therefore Not put extra pressure on on the uh higher level services that that are in the big cities and another observation that i've made anyway about the pandemic is that It's made the impossible possible So yes, there was telehealth and yes, you know odd groups like the wonka working party on rural practice rural wonka, you know been meeting Initially by audio teleconferencing now by video conferencing as as we are today But in the big cities that was seen as something. Well, I suppose it's possible. I wouldn't be you know it's it's kind of a bit Bit doubtful second class, but uh now telehealth is is normal and and in fact accepted as as a constructive contributor to health care everywhere. So that's an important part of Of what we've learned and what the world knows similarly You know this university i'm with now in new zealand for the whole year All of the course week has been developed online and and the academic staff didn't see that as possible Until they had to do it So lots of positives as well as some of the major challenges that go with the pandemic What we know now Just to summarize what i presented is rural medical education was a great idea back in 1995 and with the main focus on on the rural workforce Now we know that the rural setting is a great place to learn clinical medicine that that the There's an argument that all medical students and trainees should have some of the clinical learning in the rural setting because They learn so much and they learn so well We also know that a facilitated career pathway the rural generals pass late pathway actually works That was the idea in 1995 We now know that it really works starting in the high school even the primary school in the rural communities And encouraging the young people to see a future for themselves that might include health care and becoming doctors And so that motivates them to study you get the grades get into university get into medical school And you need a the selection process to support that and and all of the other components right through including Once in practice support transition to practice Not just continuing education professional development, but opportunities for graduate studies masters and phds So that the that the the doctors and the other rural practitioners They can pursue an academic career and and progression in their career with while staying in the rural setting and not having to move to the larger cities so We also know now that there are some real key Commonalities around the world we found with the recruit and retain making it work project That we in the small remote rural communities in five countries with different languages different cultures We had more in common with each other than we had with with the people in the big cities in in our own countries So across international borders. I've already highlighted education and training recruiting from the remote rural communities providing that training in the setting and supporting practice and active community participation That is absolutely the the Key to success or one of the critical factors in success is community engagement So in conclusion, I would say that 25 years on we're on a roll We have the evidence We are we have the momentum and now especially thanks to the the COVID-19 pandemic We have the opportunity to shape our own future. So looking to the next 25 years I can see that If we work hard if we keep going if we maintain and and increase the momentum That in 25 years all people living in in Remote and rural communities around the world will have access to high quality healthcare close to home That's the end of my keynote presentation. There are a Some references for those who would like to to follow up What I've presented in this slide also has my email address at the bottom for anyone who would like to make direct Contact with me and I'm sure that the organizers of the conference will make sure that you have access to my my PDF and my PowerPoint slides thank you very much everybody and Not sure who's speaking next is a cure or who's who's who do I hand over to Bruce over to Bruce I think thank you very much To make a comment go ahead Thank you very much professor roger stutter for your keynote speech Now I would like to call very much a dynamic person dr. Bruce stutter I will call dr. Bruce stutter Please welcome dr. Bruce stutter Thank you very much. I'm just going to share my screen and Hopefully that will all Come up properly So thanks very much roger for a an excellent introduction I'm associate professor brisk stutter chair of A rural wonka a rural academic and a rural family doctor providing comprehensive rural primary and secondary care To my town of of theater in australia You can just see bungalow dash there on the other side A bit further around the globe It's a great pleasure to set the scene for the next few days on behalf of a rural wonka council I wanted to to talk a little bit about the rural ethos This 17th world rural health conference hosted by our colleagues in bungalow dash exemplifies many of the aspects of Of rural medicine rural family medicine that we hold self-evident And that's a sense of community common goals and experience It's some collegiate goodwill and shared passion It's closeness and caring particularly to our community It's persistence rigor and scholarship But I think roger's shown that in large amount in his talk and youth in the future So I want to deal with all of these one by one First of all sense of community common goals and experience as roger said this year we marked 25 years since the official establishment of rural wonka The wonka working party on rural practice For those of you don't know wonka is the world organization of national colleges and academies of general practice and family medicine General practice and family medicine is a tradition Is a tradition of practice really based on generalism And although morphed remarkably in this day and age of mega cities and technology It has its roots in the country doctor and this was one of the classics of of looking at country doctors In 1992 a young country doctor roger strasser who you just saw who'd recently added academic to his imperative impressive repertoire Was that the vancouver conference with a few colleagues? Where's fab the founding CEO of wonka nithya nardu and robert hall And that small group They weren't elected representatives to family practice colleges or they weren't just academics. They were passionate rural doctors Who felt for their communities? Wes was encouraging them to form a working party and what a wonderful working party It's turned out to be At the next conference Three years later in hong kong a small group met and you might recognize a few of them uh the the the first is uh john win jones on the left then myself jim rourke nithya nardu john mcleod tom duelen across the back and then tarika's is mj raja kuma roger strasser the young roger strasser and and goo goo you on So they were pretty youthful faces back there and I would just emphasize that These were young people really in those days a lot of young people involved and I think that's the tradition that we want to keep going So this small team not only formed rural wonka, but within a year held the first National international rather rural medicine conference in shanghai in 1996 You can see the the latest view of the boond at that stage in shanghai At that conference we found out as roger said when you've seen one rural town You've seen one rural town, but the challenges faced by rural doctors were common Um, and we see this mutual understanding amongst rural doctors replicated so many times And no more than in the initiative of our bangladesh colleagues have come together To address these challenges in very practical ways I know I'd love to come and see it someday the brahman baria medical college With sakur and his colleagues The It's they've done an amazing job there So I'm very sorry that we can't we can't visit at this stage Like to talk also now about collegiate goodwill and passion Rural wonkers flourished over the years because of passion The members of rural wonker council are all working rural doctors students with a passion for rural academics Or administrators who have a mission for rural We are so pleased recently to include our nursing and midwifery colleagues All these council members are closely linked to their communities And the family practice and rural doctor organizations in their countries But they also have a passion to advocate for their local rural communities We've seen this passion replicated In south asia The south asia conference of south asia region of wonker has had a significant presence from bungladesh and We've been honored on wonker to have professor's neural uslam and and kanabalu as prominent examples A big thanks also to raman kuma who joins us tonight He's the regal president for for south asia and we very much appreciate his support We've also seen this in the passion With the formation of wasa Thanks to wasa for your support for this conference This conference itself is brought to you by primary care and rural health bungladesh And sakura and his team of young rural doctors have worked tirelessly to ensure that this event is a success Closeness and caring particularly In with communities and with the community of rural doctors is another characteristic of rural doctors Rural doctors have been challenged by covid and many of our doctors have been victims of it and this is a very sad Collage of some of the the the people who have been involved in in india But despite this terrible toll, it's wonderful to see especially the enthusiasm on the right of our young doctors To care for and support their colleagues and communities As rural doctors, we're close to our communities. We're also close As a family of rural doctors Persistence rigor and scholarship. I think Roger's shown in spades and I thank him From the depth of my heart As the first chair of of rural wonka We've addressed this as I said and roger said a number of ways over the last 25 years As roger mentioned, we've had this the establishment of a real body of academic knowledge and That's been very much a a work in progress, but I think it has Stood the test of time and proven to be evidence based It was our south asia colleagues from pakistan particularly tarik as is so you saw in that That very young photo who challenged us some years ago to address the needs of lower and middle income countries We took our common experience to spilled in our policies and Those policies being training for real general practice and real practice and real health And recently explored the literature in lower and middle income countries. Look at how these measures are And can be implemented Um in doing so we've developed a close relationship with wHO And developed with their support a checklist for rural pathways That's already been used in evaluating the future of rural health in kergestown so This very much is complimenting the want the wHO policies the work that roger's done And and a raft of other stuff that is being developed around the world The other tangible commitment that we have made to this is ensuring that we support conferences in lower middle income countries It's been a labor of love for our dedicated team Both in council and in bangladesh, and i'm sure you're in for a treat this weekend The final thing i'd like to talk about is youth and the future as I alluded before rural wonka was formed by young people 25 years ago Um, and we need the young students and young doctors of today to continue that tradition We need our rural seeds to glow to grow and flourish We need my arrow and herd generation As the future of rural medicine One of the things that struck me With this conference is that sakura has a very young team of passionate rural doctors and students We're very grateful for their enthusiasm the cute commitment of sakir and his colleagues in Primary care and rural health bangladesh to take up the challenge At first it was going to be face-to-face to now virtual of a world rural health conference So for today, I look forward to seeing On show these qualities of a sense of community common goals and experience collegiate goodwill and passion closeness and caring persistence Riga and scholarship and and as I said the youth and the future The conference is not the same We cannot see and enjoy the sights and sounds of rural Bangladesh in the same way That we would have with a face-to-face conference, but in fact this virtual conference Has allowed us to democratize the conference allowing young and old richer and poorer from all around the world to join us The conference is Not just today it's we've got not only this exciting program over the next three days But also in the next four months A series of recorded global leader Presentations in partnership with network towards unity for health Followed by case studies and webinars. So we'd want you Please To contribute case studies and come on to those webinars We're going to have the launch of another nine chapters of our rural medical education guidebook And then two special rural seeds rural cafes And finally a closing ceremony. So It is with great pleasure to be able to Join you at this conference. So I look forward to sharing the celebration over this weekend And seeing the presentations and discussions unfold over the next few months We have a very exciting time ahead So, thank you very much and a hand back to our colleagues Thank you very much Dr. Bruce Sutter for your nice words Downway medical college had been established by the year 2013 It was a dream project by a novel man He's a none other than dr. Avosa is sir I would like to welcome him and requesting to tell about his journey with primary care and rural health And before his speech, uh, we enjoy a small video about Dr. Avosa Good evening everybody who are participating in this operation I'm delighted to share with you 17th one the world rural health conference hosted by primary care and rural health Bangladesh is now happening with huge enthusiasm This is the first time in the history of Pwanka Rural that it joins forces with Bangladesh to organize its conference as an as an emphasis of the growing scope and expertise in Bangladesh The theme of the conference is achieving rural universal health coverage through community approach There are many sufferings and deprivation of basic health care of in Bangladesh as they do early disease and other health care facilities There are many barriers to health care access in rural areas such as distance and transportation poor stigma privacy issue and so on Distance and transportation is the most common barrier in all zones of rural population This can be a significant burden in time away from the workplace Poor health literacy is another barrier for accessing health care Health literacy impacts a patient's ability to understand health information and instructions from their health care providers Social stigma and privacy issues are more likely to act as barriers to health care access Rural residents have little concerns about seeking care for mental health Sexual health, pregnancy Anis or pregnancy overcome these barriers to provide primary health care to this rural population in Bangladesh Along with emergency and public health services Primary care is the most basic and the most vital services needed in rural communities It provides health promotion disease prevention health maintenance counseling patient education diagnosis and treatment of acute and chronic illness in a variety of health care settings Now we are giving special attention to primary health care in rural areas to control the spread of disease and reduce the growing rates of mortality I believe we can do it if we work together I am happy to announce that we already established rural health centers and rural health training centers which is generously supported by our professor Dr. Jaqeeb Rahman We have established Corona isolation unit with 100 beds separated both male and female in brahman bed medical college and we also established a PCR lab also We need to encourage young doctors and arrange training for rural health care professionals I would like to express my utmost sincere to thank Dr. Jaqeeb Rahman the progress chairman of this conference and this team and I also like to thank our principal professor beginner general Mohammad Shavikul Islam and other Personals of this institute Thank you all keep up the great work. Enjoy the conference And thank you all and good evening again Thank you very much. Dr. Abhusey sir for sharing your speech with us Now we enjoy Now we enjoy the journey of primary care and rural health Bangladesh by a small video