2016 RM Enterprise: The Social Determinants of Health

To pick up where we left off “we can siesta when we’re dead”, at this point of the journey, sleeplessness makes everything hit or miss. Either you rise and immerse and participate radiantly through the RM and social events, or you inadequately “attend” to everything in a daze, a phenomenon some have not hesitated to qualify as the catatonic state. Haphazardly I must say, I’ve managed to rise up and hit most, if not all of my targets so far. Like an alignment of stars, we find ourselves well surrounded: all activities have been conducted by inspiring speakers and generated powerful insights, the “eureka” moments of Archimedes in the bathtub. Mostly, the participants show an enthusiasm of the most contagious kind. They are, it seems, constantly bathed in sheer exaltation, much like being high on life or on some strange Latin American drug. The people here may be invincible. Much like the notorious Gaulois, they have this magic potion which they sip all day, and which they refer to as Yerba Mate (or Tereré in Paraguay, which is served cold). Defying the laws of thermodynamics, this potion seems to harness more energy than the system could store in the first place. Yes, the abundance of energetic workshops and Yerba Mate keeps us moving forward, and at this moment I would probably be considered impaired, semi-autonomous at best, were it not for the magical support of this RM.

In the last thread, I mentioned the LEAD workshop had us build a project. Not only did the trainers equip us for good planning and realistic assessment, they also vouched to follow-up on us and make sure we would implement it. Judging from the personality of the trainer, and the obsessively perfect training he put us through (cheers to you Elias Ortega), I have not a single doubt that this project will come to life in the future; the alternative has not been presented to us as a possible option. Without further ado, here are the main lines of a project I have elaborated for Université de Sherbrooke’s medicine faculty, focusing on the Social Determinants of Health (SDH).

For those less familiar with SDH, they include the likes of economic inequities, social/cultural inclusion and exclusion, the conditions of birth, growth and living, access to education and the education system, access to health care, and so on.

First and foremost, I wish to point out an odd – and upsetting – contradiction that has stood out, from my perspective, in this RM, about SDH. On one hand, the Social Determinants of Health have been presented to us in this meeting as the most important health determinant that physicians should seek to address at the moment. Granted, this statement (coming from the opening ceremony) was highlighted by a speech from Sir – not Dr. or Prof, but Sir! – Michael Marmot, the last president of the WMA (World Medical Association) and also the world’s leading figure on SDH (alongside Richard Wilkinson I should say). And at a more “local” level, the SDH have also been identified by IFMSA Brazil’s clinical exchange committee (SCOPE) as the most important determinant of health abroad. So yes, on one hand, SDH seem a awfully serious matter in our time. However, on the other hand, the president of IFMSA has communicated to me, following the presentation of my project, that while SDH held a more central position within IFMSA in the past, they had more recently been losing ground amongst IFMSA activities and advocacy.

If this is not a cue to step in, then I don’t know what is.

So in a few words, the project, as “projected”, seeks to equip medical students with the skills necessary to improve their physicianship in clinical situations specifically patients from vulnerable populations (namely patients whose health are affected through SDH). The goal of the project will be to introduce the students to innovative patient-centered approaches structured around issues such as multiculturalism and xenophobia, institutional discrimination, collective trauma, poverty, substance abuse, and so on. To reach this goal, the aim of the project is to (a) offer a training that will lead to (b) the emergence of an SDH interest group that will help raise awareness and provide further training on campus.

So now, what kind of “innovative” patient-centered approach do I have in mind? Acknowledging that a patient’s need for care exceeds a disease’s pathophysiological / biomedical imprint, and that causes for suffering are beyond pain or other symptoms, this project is centered over the harnessing of three essential skills for a more holistic, therapeutic patient-centered approach: empathy (the ability to cue into another individual’s mental and affective states), narratology (the study of narratives, in this case the patient’s narrative), and cultural competency (the ability to engage with different cultural backgrounds in an open, productive and ethical way). To support this approach, the project would derive on already existing, very-much inspiring initiatives, such as Rita Charon’s Narrative Medicine program (currently taught at Columbia University, but also in France and found in McGill’s curriculum), Mary Gordon’s Roots of Empathy program (a Canadian initiative currently implemented in North American primary schools), and CineMed (a program of education through cinema currently implemented in Brazil, as was presented to me by a friend here at the RM; this cinema initiative would be adapted to facilitate cultural rapprochement through exposure to foreign cinema).

Narrative Medicine: http://www.narrativemedicine.org
Roots of Empathy: http://www.rootsofempathy.org
Cinemed: http://ifmsabrazil.org/educacao-medica/cinemed/

How would this be implemented? Ah, strategic planning: the part I must leave out, from sympathy, if only to avoid inducing unnecessary boredom. So I won’t get into depth with this technical information, but nonetheless, here’s my three step program: (1) preparatory work (surveying for student interest and potential, locating and reviewing the relevant literature, validating faculty support, assembling a workshop “toolkit”); (2) holding a capacity building workshop to transfer/spread the knowledge and skills aforementioned; (3) in collaboration with the trainees, launch a student interest group for SDH and patient-centered medicine at the start of the academic year 2016-2017.

Now, to conclude (the task I seem most obstinate to avoid), I want to emphasize that the project described above is a typical Regional Meeting result. As the president of IFMSA explained, these meetings are held for various social and organizational reasons, but they are nonetheless pure capacity building events (in comparison with Annual Meetings, focusing on the organization and policy statements). Through the LEAD workshop, IFMSA has empowered local and national officers, executive members and presidents; through this vertical transfer, it is thus expected that National Member Organizations will be better equipped – and also, motivated – to pursue IFMSA’s mission of paving the way for medical students to become global health leaders with high impact at a local level.

I’m running out of time. This blog was written in the span of three days ! And by now, as you realize, we are well into the actual Regional Meeting, and well beyond the Pre-RM. So I promise, for the next blog post, a real party mix for everyone !

El gato està sentado debajo de la mesa.