Junior Doctors Network and Global Health

Masahiro ZAKOJI
Chair, Global Health Committee, Saku Central Hospital, Nagano, Japan (zakoji@gmail.com).

Background

On behalf of the Japan Medical Association- Junior Doctors Network (JMA-JDN), it is a great pleasure and honor for me to write a few words for inclusion in the JMAJ. The JDN was offi- cially acknowledged in 2010 as a body of young doctors worldwide at the World Medical Asso- ciation (WMA) General Assembly in Vancouver. Since then, the network has expanded steadily and, in 2012, there were participants from eleven countries including Korea, Taiwan, Germany, Thailand, Singapore, Brazil, the United States of America, Canada, Spain, Israel and Sudan, at the JDN meeting, which was held along with the WMA General Assembly in Bangkok.1 In 2013, JDN was founded in Japan and officially accepted by the JMA as its subsidiary organiza- tion for junior doctors in Japan.

Establishment of JMA-JDN

The establishment of JMA-JDN has long been awaited since the foundation of the JDN world- wide in 2010. Finally in late 2012, candidate members for the JDN were appointed by the JMA Executive Board and members of the JMA Global Health Committee. Since our network was expected to represent “junior” doctors, those from post-graduate years 1 to 5 were eligible for enrollment. As of May 2013, 21 young doctors, aged between 25 and 39, from various training fields throughout Japan, including family medi- cine, obstetrics and gynecology, pediatrics, infec- tious diseases, and public health, have accepted the invitation.

Our first meeting took place on May 23rd 2013 in Tokyo, in conjunction with the JMA 4th Global Health Committee meeting. Although the meeting was held on a weekday, twelve JDN members made their way to the meeting from all over Japan, from Okinawa in the South to Hokkaido in the North, and celebrated the first day of the network establishment.

As a member of the newly organized JMA- JDN, I was privileged to accompany the Presi- dent of JMA, Dr. Yoshitake YOKOKURA, and Executive Board Member, Dr. Masami ISHII, to attend the 194th WMA council session in Bali, Indonesia, in April 2013 (Fig. 1). The wel- come speech was presented by the Indonesian Health Minister Dr. Nafsiah Mboi, who was an alumni of the Takemi Program in Interna- tional Health at the Harvard School of Public Health, named after Dr. Taro TAKEMI, the former president of JMA.

One of the main topics of discussion was over the final draft of the revision of the Declaration of Helsinki. It was somehow surreal for me that I was sitting around the same table where phy- sicians, lawyers, and other stakeholders were revising that declaration, to which I had paid the utmost respect and careful attention two years ago when I conducted health research on Chikungunya fever prophylaxes among plan- tation workers in Thailand. The discussion was well executed in a democratic and fair manner in that any delegate member was granted the opportunity to comment whenever necessary regardless of his or her affiliations.

Fig. 1 Japanese delegates to the 194th WMA council session in Bali, Indonesia, in April 2013 Left to right: Author, Dr. Yokokura, Prof. Kuroyanagi, Ms. Imamura, Mr. Noto and Dr. Ishii.

Fig. 1 Japanese delegates to the 194th WMA council session in Bali, Indonesia, in April 2013
Left to right: Author, Dr. Yokokura, Prof. Kuroyanagi, Ms. Imamura, Mr. Noto and Dr. Ishii.

Goals and Missions of JDN and JMA-JDN

JMA-JDN basically shares the goals and missions of the JDN world: “to provide a forum for experience-sharing, policy discussion, project and resource development on issues of interest to junior doctors, including (but not limited to) global health, postgraduate training, safe work- ing conditions, and physician migration.”2,3 Our members from various fields are enthusiastic to raise each specific objective, such as providing assistance for young foreign doctors willing to study in Japan, developing a training program on end-of-life care for medical students, and cul- tivating a better understanding among young doctors on JMA. Among those, I am committed to tackling global health issues through projects at my working place, Saku Central Hospital.

Saku Central Hospital Global Health Committee

I work for Saku Central Hospital in Nagano, a mountainous rural region in Japan. The former director of the hospital, Dr. Toshikazu WAKA- TSUKI, the 1976 Ramon Magsaysay Award winner for Community Leadership, is well known for his enthusiasm for primary health care.4 In the aftermath of the World War II, he started a mobile clinic along with health promoting activities through entertainment, that is, a short drama, focusing on health related issues such as the importance of water sanitation (Fig. 2). It should be noted that drama intervention in health promotion was put into practice in Saku region 30 years before the Declaration of Alma-Ata was adopted in 1978. He then started to provide an all-village annual health check-up in Yachiho village in 1959, which became a model for the nationwide health check-up system.

Fig. 2 A short drama “People in white coats” (1945) written by Dr. Wakatsuki Villagers enjoyed watching doctors and nurses act after a mobile clinic session.

Fig. 2 A short drama “People in white coats” (1945) written by Dr. Wakatsuki
Villagers enjoyed watching doctors and nurses act after a mobile clinic session.

We have provided training programs for 870 foreign medical professionals and governmental officials from 74 countries in the last decade (Fig. 3). In 2013, I was appointed chief of the newly organised Global Health Committee, which will provide young doctors, nurses, other staff, and people in the community, with the opportunity to contribute to the betterment of global health.5 With our inter-professional net- work in and out of the hospital, we are upgrading the quality of our training program for foreign visitors to meet their individual goals. We also provide comprehensive assistance for foreign patients in the Saku community, regardless of their solvency or legal permission to stay in Japan. We have assisted a few foreign AIDS patients, who were illegal over stayers without health insurance, to fly back to their home coun- try and continue their treatment.

In order to expand and strengthen the global health network, we will host the Saku Global Health Seminar in August 2013, focusing on what should be introduced to the world from our experiences of primary health care in rural communities in Japan.

Fig. 3 Foreign trainees and visitors to Saku Central Hospital

Fig. 3 Foreign trainees and visitors to Saku Central Hospital

JMA-JDN: Where to from here

Members of JMA-JDN started to analyze our own network by the SWOT method, that is strengths, weaknesses, opportunities, and threats, and will set our goals and missions soon by means of strategic planning. Since our members are scattered around Japan and engaged in full- time practices as young professionals, most of our interactions are inevitably online: drafted documents shared on a cloud server, daily com- munications through mailing lists, and monthly meetings over video conference services. The next JMA-JDN meeting in person will be held in November 2013 along with the 30th Anniversary of the Takemi Program in Tokyo.

We are determined to delegate to the Gen- eral Assembly of the Confederation of Medical Associations in Asia and Oceania (CMAAO) in New Delhi in September 2013, and the WMA General Assembly in Fortaleza in October 2013. We will also try to organize a JDN meeting in conjunction with the WMA council session in Tokyo in April 2014 to strengthen the JDN, especially in Asia.

References

  1. JDN News 1. Issue 1-2013, 4 February 2013. http://www.wma. net/en/80junior_doctors/40news/JDN_News-letter_Issue-1- 2013.pdf.
  2. Walker X, Loh L, Hornung T. Junior doctors network. World Medical Journal. 2012;58(3):119–120.
  3. World Medical Association, JDN, About us. http://www.wma.net/en/80junior_doctors/10about_us/.
  4. Saku Central Hospital. http://www.sakuhp.or.jp/ja/english/index.html.
  5. Saku Global Health Committee. http://www.facebook.com/SakuGlobalHealth.
広告

世界の人々の健康に貢献したい

「世界の人々の健康に貢献したい」そんな気持ちで医療者を志した職員のみなさんを応援する仕組みが、佐久総合病院で使えるようになります。佐久病院の職員の身分のまま、青年海外協力隊などの国際協力活動に参加できる「現職参加制度」の採用が2月20日の管理者会議で承認されましたのでご報告致します。この制度を使って国際協力に参加する職員が名乗りを上げるのが楽しみです。

20140224第5号

PDFファイルはこちら

HIV難民という視座・単回調査の限界

■プロローグ HIV難民という視座

HIV に感染した結果、職と家庭とを失い、社会の片隅にあるホスピス寺でひっそりと暮らすタイの人々がいる。ある日突然それまでの生活の場から切り離され、山間の寺に追いやられる人々の生き様は、政治や宗教を理由に迫害され、住みかを失った難民を思い起こさせる。

日本にも同じような境遇におかれるタイの人々がいる。建設現場で安価な労働力を提供するタイの男性や、夜のネオン街で渦巻く欲望に応える女性は、日本で HIV に感染しても治療の機会を得られないことが多い。滞在資格を持たず、日本の社会保障の編み目からこぼれ落ちてしまった彼らは、そもそもパスポートすら持ち合わせず、帰国さえかなわないこともある。

タイ国内、国外を問わず、両者に共通するのは、HIV 感染が原因となり、それまでと同様の生活が送れなくなってしまった、という点である。単に HIV に感染した難民という意味合いではなく、より広い(そして大雑把な)括りとして、ここで新たに HIV 難民を試みに定義したい。「HIV難民とは、HIV 感染を理由として、それまでと同様の生活を送れなくなった社会的弱者をいう。」

こうした HIV 難民がおかれる苦境を看過してよいのかという問いかけが私たちの問題意識であり、本稿に通底するまなざしである。第1章ではタイのホスピス寺で行ったボランティア活動を通して見知ったタイ国内の HIV 難民の境遇について紹介し、第2章では日本におけるタイ人 HIV 難民への支援の実際と課題とを、帰国支援した患者の追跡調査を通じてまとめた。

HAART — 30床強のなかで5人が30バーツ医療制度を利用して(2006/11から一部負担金も廃止)HAARTを受けていた。タイ政府が主導して生産するジェネリックのGPO-VIRはd4T(NRTI), 3TC(NRTI), NVP(NNRTI)の合剤で、一月一人1000バーツ(3000円)を割ったという。日本で同様のレジメンを処方すると、15万円強になる。

HAART — エイズホスピスのパバナプ寺では、2007年の訪問時、30床強のなかで5人が30バーツ医療制度を利用して(2006/11から一部負担金も廃止)HAARTを受けていた。タイ政府が主導して生産するジェネリックのGPO-VIRはd4T(NRTI), 3TC(NRTI), NVP(NNRTI)の合剤で、一月一人1000バーツ(3000円)を割ったという。日本で同様のレジメンを処方すると、15万円強になる。

■エピローグ 単回調査の限界

私たちの調査は、現地に事務所がある組織が行うものではないため、基本的には一度きりのものである。P氏の現状は放置できないものだったので、できることなら私たちもP氏と共に連れだって郡役場まで出向き、住民登録申請をし、病院で30バーツ制度に申請して受診するところまで手伝いたいという考えが浮かんだ。交通費くらいならば私たちの身銭を切っても、さして懐が痛むものではない。

しかし、現地の制度に対して十分な理解があるわけでもなく、もちろん言葉の壁は高く、しかも継続的な支援ができる立場にもない無責任な調査者である私たちには、実際の所、「30バーツ制度に申請しましょう、病院を受診しましょう」とP氏に頼み込むのが精一杯だった。

継続的なフォローアップが必要なゆえんはここにある。単発の調査では、患者本人に直接支援の手をさしのべることは難しい。帰国支援の一部として、帰国後の治療サービスへのアクセスをきちんと支援する仕組みを作らなくてはならない、そう切実に思った。

その後11月になって、とある全国紙の記者がP氏の元を訪ね、そのときの様子をメールで知らせてくれた。P氏は未だなお治療を始めておらず、私たちが訪れたときとは別人のようにやつれ、見当識も怪しく、病状の進行を伺わせたという。自体は急速に悪い方向へ向かっているようだった。

筆者は2007年2月に再度タイを訪れる機会があった。かねてから気にかかっていたP氏を訪ねて、半年ぶりに再び懐かしい道をたどった。高速道路沿いの商店も、P氏宅へ続く脇道の角にある食堂も、半年前となに一つかわらぬ佇まいで、私の不安は薄められる思いだった。

しかし、現実は生やさしいノスタルジーで揺らぐものではない。予想していないわけではなかったものの、笑顔のP氏の遺影が壁に掛けられているのを目の当たりにするのは、大変つらい経験だった。彼は結局、治療を受けない選択をしたか、受けようにも受けられなかったのか、いずれにしても未加療のまま2007年1月3日に他界したのだった。44歳の若さだった。

P氏の日本滞在中のアルバムをめくりながら、A姉さんとふたり泣いた。アルバムの中の彼は、凍てつく信州の冬、慣れない雪かきをした後、仲間たちと鍋を囲んでキリンラガーを片手にご機嫌な笑顔を向けているのだった。

P氏の冥福を祈ると同時に、彼の死が無駄に終わらず、今後の帰国支援の充実に活かされるよう強く願います。

タイ・ラオスとの国境の町ノンカイにて
平成19年2月 座光寺正裕

PDFでの報告書全文はこち
http://tropical.umin.ac.jp/report/06thai.pdf