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Q u a r t e r l y
from the Association of Former WHO Staff Tel :+4122 791 3103 and 31 92
Office 4141, WHO, CH- 1211 Geneva, Switzerland E-mail: [email protected] Website: http://who.int/formerstaff/en/
Informed opinion and active co-operation on the part of the public are of the utmost impor tance in the improvement of the health of the people (WHO, Basic Documents, 47th Edition, 2009)
INTERNATIONAL YEAR OF FORESTS●2011
Forests for people
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The year 2011 has been declared by the UN as the International Year of Forests. The goal is to raise awareness of the importance of forests for life. Logo of the International Year of forests on UNO ← building in New York
The forest, a precious and diversified environment.
In view of the importance of deforestation in the world, the UN has declared 2011 as the International Year of Forests. On this occasion, awareness- raising campaigns will be organized around this theme for the general public. Forests provide us with wood, work, areas of nature, protection against natu- ral dangers, drinking water and places for relaxation. The forest is linked to CO2 and attenuates global warming. In addition, forests provide shelter for many animal and plant species, some of which are rare. 300 million people live in forests. ( www.un.org/forests/ )
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CONTENTS EDITORIAL Pages Following the elections, responsibilities have been Photos Forests 2 distributed within the new Executive Committee Editorial opposite Message from President; (see page 4). Functions and responsibilities 4 The Joint Committee of the Headquarters and Our health 5, 6 Regional Surveillance Committees which met in Health Insurance 7 2008, set up a Working Group to review a re- News from WHO 8, 9 form of the Staff Health Insurance (governance, Point of view 10 financing and long-term care). A story from WWII 11 Our Committee, which is represented on this Recent events 12, 13 Working Group, has given its position on the pro- In memoriam 14, 15 Book review 16, 17 posals of the SHI Secretariat (see page 7). On the lighter side ------Readers’ Corner, 18, 19, 20, 21 New members 22 Serious events – an earthquake followed by a Joining AFSM tsunami then a nuclear catastrophe, whose conse-
------quences for the future remain unknown – have occurred in Japan: we cannot remain indifferent Editorial Team to this tragedy. Editing & layout: David Cohen Editorial Board : We are sure that our readers will want to par- Yves Beigbeder, Sue Block Tyrrell, ticipate personally in the international aid efforts Maria Dweggah, Samy Kossovsky, to support Japan at this difficult time. Jean-Paul Menu, Dev Ray, Michel Thuriaux, Rosemary Villars. Our attention is also focused on the historic Translation, articles: all the changes occurring in North Africa and the Middle editorial board. ------East. We assure our former colleagues, their We pay special tribute families and the people in these countries of our to the Printing, Distribution, solidarity and we extend our heartfelt wishes for and Mailing Services . DC ------peace, justice and prosperity. The opinions expressed in this magazine are Important contacts: those of the authors AFSM: see on page 1 and not necessarily Health Insurance (SHI): + 41 (0)22 791 18 18; in ca se of those of the absence, please leave a message; someone will call back. Or email to: [email protected] Editorial Board . Pensions: +41 (0) 22 928 88 00 ; ------email : [email protected] for Geneva Send your contributions to: or [email protected] for New York David Cohen: AFSM office manned on Tuesday and Wednesday [email protected] from 9.30 to 12.30. Otherwise: please leave a message; someone will call back.
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Message from the President
ear Readers, Things are happening in our health Carol. Although urged by the Committee to insurance. reconsider their decision, they confirmed it D to the AFSM during their respective terms of In this Quarterly News you will find an office. article on “Health insurance: what’s new?” (page 7) as well as a letter from Marjory Dam, Even though the Committee disagrees with the with our comments, in the Reader’s cor- facts expressed in Marjory’s letter, we do not ner. Some of you have received from another wish to enter into a controversy which will be source a petition signed by Marjory Dam, pointless and counterproductive for everyone. Carole Modis and Ken Langford. We reassure you of our full commitment to continue to work with the Administration and The letter from Marjory follows her non re- retirees to secure the best possible govern- election by the AFSM Executive Committee as ance of the SHI Fund. Our priority is and will the alternate representative on the Headquar- remain focused on protecting your interests to ters Staff Health Insurance Surveillance Com- the best of our ability and we will keep you in- mittee and her subsequent resignation from the formed objectively on the new developments. Executive Committee, together with that of Carole Modis. You will find below the details of For this reason and more than ever, dialogue our representatives elected for the current between us is important. Please do not hesi- biennium. tate to give us your views. We regret the resignations of Marjory 1 and With best wishes. Jean-Paul Menu, Président ------1. Due to this resignation, Maria Dweggah was declared elected. We warmly welcome her.
2010-2012 Committee: Functions and responsibilities
President : Jean-Paul Menu Vice-Presidents: Sue Block Tyrrell, Dev Ray Treasurer: Anne Yamada BUREAU Assistant Treasurer: Bunty Muller Administrator a. i.: Roberto Masironi }
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Func tions and re spon sibilities Responsibles
AAFI/AFICS President (ex officio), replaced by a member of the Bureau when unavailable Staff Health Insurance David Cohen ([email protected] ), Ann van Hulle ([email protected] ) Pensions Ann Van Hulle ([email protected] ), Bunty Muller ([email protected] ) Relations with Regions Ann Van Hulle ([email protected] ), Rajindar Pal Relations with former staff Roberto Masironi ([email protected] ), Yves Beigbeder ([email protected] ), Roger Fontana Quarterly News: Editor in chief, David Cohen ([email protected] ) submission of articles, photos and obituaries AFSM telephone for information : 00 41 22 791 3103/3192 or email [email protected]
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Our health
Ischaemic stroke 1: a new treatment technique A new technique to remove blood clots from the brain, designed in the University Hospital of Geneva (HUG), is improving the prognosis of ischaemic strokes. trokes can occur in two The clot which is trapped by the forms: haemorrhagic , when stent is then removed together with an artery bursts (in 30% of the stent” explains Dr Mendes Perei- cases)S and ischaemic , when an ra. This method, developed at the artery is blocked (in 70% of cases). HUG, is used today in hospitals around the world. An ischaemic stroke is painless but destructive: the brain tissues are no More rapid treatment longer irrigated, there is a lack of oxygen, and each minute, 12 million About 800 patients with ischaemic neurons die asphyxiated. With the stroke present each year at the classic treatment used until very HUG. Unfortunately, only 10% of recently, the death rate from them are able to benefit from treat- ischaemic stroke, all ages included, ment. For the rest, it is too late. reached about 50%. They have been deprived of oxygen for too long and the lesions are At the end of 2008, Dr Vitor Mendes irreversible. Pereira from the Geneva Cantonal In the case of an attack of ischaemic Hospital, had the idea of using a 1. Introduction of the stent using a catheter; stroke, it is therefore imperative to it goes through the clot stent 2 to remove the clot blocking act rapidly (read the box). With the 2. The catheter is removed and the stent is the artery. The results have been used to trap the clot classic methods (intravenous throm- spectacular. “With this technique, bosis = disaggregation of the blood 3. The stent is removed with the clot . the clot is removed completely in clot by injection of a product), you results up to eight hours after a about 92% of patients treated. It is had to be operated on at maximum cerebral attack” emphasizes Dr the key to our success. When the within four and a half Mendes Pereira. In addition, we Ischaemic stroke has the dangerous particularity of being pai n- hours after the attack have found a net improvement in the less. Nine times out of ten, patients are hospitalized when the and the results were results. In fact, 64% of patients lesions are already irreversible. In order to act without delay, it treated have regained complete is vital to recognize the symptoms, such as partial paralysis of not effective for large the arm or the face, with difficulty in articulating even simple clots. autonomy after a stroke. This level phrases. In such cases, call the emergency services imme- was only between 25-35% of cases diately. Rapid care can save lives and avoid hemiplegia (para- More effective treat- using the previous methods. lysis on one side). ment Multicentric international study Act FAST : Facial weakness – can the person smile? has their The effectiveness of mouth or eye drooped? the new method has A multicentric international study Arm weakness – can they raise both arms? started in 2010 to enlarge the scien- Speech problems – can they speak normally and understand almost doubled the you? length of time available tific base of clinical data. Piloted by Time to call the emergency services for treatment. “We are Dr Pereira, it is being carried out . getting good over two years in some twenty hos- stent is used, the vessel is partially pital centres in Europe, Canada and open and circulation is instantly Australia. restored. David Cohen, based on an article by André Koller in the magazine Pulsations of the Cantonal Hospital, January 2011
------1 Also referred to as ischaemic cerebral vascular accident (CVA) 1 A mechanism like a spring, normally used to keep open a blood vessel. It is not a question of leaving the stent in place, it is only used to trap the blood clot and remove it. In fact, the insertion of a stent into a fragile vessel in the brain would be risky for those over 70 years of age. ( The Lancet , Stents may double the risk of stroke or dying in older patients compared to surgery, September 09, 2010).
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d Our health (Cont )
A health problem which is real enough but makes other laugh…. But you say – you mean Daltonism (colour blindness ). What is the problem ? n case you have forgotten (or never knew), when you drive a car anywhere in the world, 8% of the male drivers ahead of or behind you suffer from a visual perception disability and are there- Ifore likely to be a danger to you. That is about 32.6 million people in Western Europe, the USA and Japan . Games on line can present a present in 2 genes Xd/ Xd to problem for a daltonian be- appear. cause the games often use As far as driving a car is con- shades of red and green. cerned, the tricolour lights at Daltonism may hinder chil- crossroads can only be dis- dren in their studies and affect tinguished by their position their self esteem. At nursery and their luminosity. Green According to the WHO or primary school other chil- and red rear lights of cars International Classification of dren laugh at them when they often make it difficult to de- Functioning, Disability and colour grass red or a tiled roof termine whether a car is ap- Health (ICF 2001) these green. proaching or retreating... people suffer from a colour When cooking, a daltonian vision deficiency which pre- In Geneva a few years ago, may have difficulty in seeing vents them from distinguish- the municipal authorities be- whether meat is rare or lightly ing and matching colours gan to renovate traffic lights. cooked, whether “green” to- (achromatopsia or dyschro- I accompanied one of the matoes are ripe and whether matopsia). officials responsible and a sauce is tomato or choco- showed him the green lights They are at a disadvantage in late. which appeared orange to me numerous areas of life. To In fact this colour vision defi- and those which seemed blu- start with, more than 150 pro- ciency most often leads to ish which now are the only fessions are closed to them – confusion between red and ones in use. I am still inca- pilots, drivers and mechanics green. Known as Daltonism pable of understanding the in the Navy, the Air Force, the since the 18 th century – it colours of the morning Army and the Merchant Navy; takes its name from the Eng- weather charts or of respond- air controllers in civil aviation, lish physician who was af- ing when a repairman asks drivers and mechanics of rail- fected (diagnosis established me over the phone whether ways and other public trans- by Dr Thomas Young in its the small light on my televi- port – (buses, trains, under- most common form – defi- sion is green or red. ground). ciency in red and green), the During my medical studies I To these must be added pub- anomaly is hereditary. carefully camouflaged my lic security professions: po- Daltonians make up 8% of the disability in order to obtain an lice, customs officers, fire male and 0.5% of the female average score in histology fighters. population. For a woman to and pathology. I hid it even Pharmacists, electricians and be daltonian, her two parents more carefully during the tests electronic engineers, profes- must carry an abnormal to obtain a driving licence 60 sions related to textiles, print- gene X. The woman may years ago. ing, painting, photography, then bear the daltonian gene Reader, do not fear: I no lighting (theatre, cinema, tele- (without being aware of it) and longer have a car and am vision) as well as sorting transmit it to her descendants. driven around. foodstuffs are also problem- In fact, the mutated gene is Dr J-J Guilbert atic. recessive and must be
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Health Insurance: what’s new ?
The new AFSM Executive Committee recently elected its representatives to the Headquar- ters Staff Health Insurance (SHI) Surveillance Committee. n line with the Statutes, the term of of- AFSM EC took into consideration the re- fice of the member (David Cohen) and cent Audit Report on Staff Health Insur- the alternate member (Ann Van Hulle- ance which identified a number of weak- IColbert) is two years. Both David and Ann nesses in the current governance of SHI. have had many years’ experience in health The AFSM EC has recommended amend- insurance matters: David, in his capacity ments to the proposed new governance as a doctor in the Joint Medical Service for structure in order to ensure that the rights some 20 years, used to give advice to SHI, of former staff are not compromised. Is- and later he participated for several years sues such as parity in representation on in the Headquarters Staff Health Insurance the new committees have been stressed by Surveillance Committee, either as the AFSM. AFSM member or the alternate member. We are very conscious of the importance of Everyone knows Ann Van Hulle who is a adequate and appropriate insurance cov- newly elected member of the AFSM Execu- erage for long-term care (LTC). There tive Committee. Ann was elected as the have been improvements in LTC benefits AFSM alternate member on the Surveil- over the past decade but we feel that more lance Committee for the first time; she has is required. We shall be pursuing this mat- extensive experience in health insurance ter during the months to come. matters having managed that area for many years while working at WHO. All of these matters will be discussed at a Joint Meeting of SHI Surveillance Com- We are grateful for the opportunity to serve mittees and Staff Committees in October the AFSM members who participate in the this year. Recommendations arising from WHO Staff Health Insurance. It is a par- that Joint Meeting will subsequently be ticularly challenging task at this point in submitted to the Director-General for her time as the SHI Headquarters Surveillance concurrence. Committee (HSC) is currently reviewing proposals from the WHO Administration for The cost of health care continues to in- a significant reform of the existing govern- crease in most countries. We have a role ance structure of the SHI. The HSC has to play in working with the HQ Surveillance formed a Working Group which has been Committee to ensure the rational use of reviewing proposals as well as other as- SHI resources as well as efficiency in SHI pects of the SHI Fund, especially financial administration while defending the rights matters and long-term care. The SHI par- and expectations of retired staff. ticipants (active and retired staff) share a Lastly, we are aware that there have been seat on this Working Group. delays in reimbursement of claims from time to time over the last couple of years. The AFSM Executive Committee (EC) has The SHI Secretariat has assured us that recently conveyed its views/ recommenda- these delays have been overcome. We tions on the governance reform proposal to are monitoring the situation very carefully the SHI Secretariat and to the Working and will address the problem again with the 1. In formulating its views, the Group SHI Secretariat should it recur. Ann Van Hulle-Colbert, David Cohen
1. The President of the Staff Association at Headquarters confirmed that the Headquarters Associa- tion agreed with the position of the AFSM Committee.
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News from WHO
UN Secretary-General Ban Ki-moon visits WHO Mr Ban Ki-moon had meetings with the Director-General on Wednesday 26 January and took the opportunity to address the staff at the end of the afternoon. He expressed his pleasure in working with WHO, notably during the H1N1 pandemic and during the cholera outbreak in Haiti, and em- phasized the importance of WHO’s work in all the current eight UN strategic priority areas: • sustainable development – with the extra challenge of facing a global recession • climate change • empowerment of women • ensuring a safer and more secure world • advancing human rights • improving response to major humanitarian crises • disarmament and the non-proliferation of nuclear weapons • strengthening of UN reform. Mr Ban Ki-moon thanked the staff for their contributions and commitment, especially in facing the challenge of assuming an increased role whilst at the same time receiving less financial support. Mr Lahouari Belgharbi, President of the Staff Association spoke after the Secretary-General’s ad- dress, assuring him of the continuing commitment of the WHO staff. The last visit by Mr Ban Ki-moon to WHO was in 2009. Sue Block Tyrrell ------Executive Board Technical resolutions were passed on: • the eradication of dracunculiasis; • cholera – mechanism for control and prevention; • malaria; • child injury prevention; • health workforce strengthening; • strengthening national health emergency and disaster management capacities and resilience of health systems; • strengthening nursing and midwifery; • strengthening national policy dialogue to build more robust health policies, strategies and plans; • sustainable health financing structures and universal coverage; and • WHO’s role in the follow-up to the high-level plenary meeting of the 65 th session of the UN General Assembly on the review of the Millennium Development Goals. Other technical matters discussed include: • pandemic influenza preparedness – sharing of influenza viruses and access to vaccines and other benefits; • implementation of the International Health Regulations; • public health, innovation and intellectual property – Consultative Expert Working Group on Re- search and Development – Financing and Coordination; • health system strengthening; • global immunization vision and strategy; • draft WHO HIV/AIDS strategy 2011-2015; • substandard/spurious/falsely-labelled/falsified/counterfeit medical products; • smallpox eradication – destruction of variola virus stocks; • leprosy (Hansen disease);
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News from WHO (Cont d)
• prevention and control of noncommunicable diseases; • infant and child nutrition implementation plan; and • the UN Decade for Action for Road Safety – draft action plan. Progress reports were provided on many other technical matters. In addition, management, staffing, financial and programme and budget matters were discussed, notably the potential substantial gap between projected income and expenditure, and the future of financing for WHO. The report by the Director-General referred to this packed agenda and to the fact that the Organization is over-extended. Dr Chan stressed that WHO does not need to change its Constitution but needs to undergo some far-reaching reforms in line with its purpose and unique contribution. “The level of WHO engagement should not be governed by the size of a health problem. Instead, it should be governed by the extent to which WHO can have an impact on the problem. Others may be positioned to do a better job.” Measures have been and continue to be implemented to reduce overall costs, increase efficiency and limit further growth in staff numbers. Structural changes include the disestablishment of the HQ cluster for Partnerships, country focus and UN reform, the closure of the WHO offices at the World Bank and in Washington, D.C., the merging of departments at HQ and in regions, and the devolution of several regional centres back to the host gov- ernment. A more developed plan for the reform of WHO will be submitted by the Director-General to the World Health Assembly in May 2011. With regard to the election of the Director-General, the Board acknowledged that the successful candidate can come from any WHO region but that candidates appointed so far had only come from three of the six regions. The Board agreed to establish a working group, open to all Member States, to examine the process of nomination and appointment of the Director-General, with a view to enhancing fairness, transparency and equity among the Member States of the six WHO regions in this process. The Board documents can be found on the WHO web site – www.who.int Sue Block Tyrrell ------Highlights of the main public health events over the past few months are: • A new meningitis vaccine became available at the end of 2010, priced under US$0.50 per dose – it is hoped to rid the meningitis belt (stretching from Senegal in the west to Ethopia in the East) of the primary cause of epidemic me- ningitis. The development of the vaccine was coordinated by WHO and the Program for Appropriate Technology in Health known as PATH. • In December, WHO endorsed a new, rapid test for tuberculosis. It provides an accurate diagnosis in about 100 minutes compared to current tests which can take up to three months to have results. • In January, WHO announced a new test for diagnosing diabetes mellitus which does not require a patient to fast before a blood sample is taken. The disease affects 220 million people worldwide. • Also in January, a Hollywood film crew visited headquarters to shoot a short sequence for the film Contagion, about a deadly disease and an international team of doctors recruited to deal with the outbreak. • A newly published Global status report on alcohol and health analyses alcohol consumption in over 100 countries – the evidence allows countries to create policies to reduce the health impact of harmful alcohol drinking. • A new vaccine has been launched to protect children against pneumococcal disease which causes life-threatening illnesses such as pneumonia, meningitis and sepsis. • 8 March 2011 marked the 100 th celebration of International Women’s Day, with a focus on women’s access to science and technology. • In March trucks carrying WHO staff and medical supplies, funded by Italy and Norway, were sent to the Libyan Arab Republic. The material consisted of trauma kits, equipment and treatment for surgical patients for use in the health facilities in the eastern city of Benghazi. A shipment of six tons of medical supplies for 50 000 people over 3 months was sent to Tunisia, to cover treatment for people crossing the border. • Also in March, in response to the nuclear power plant crisis in Japan, WHO has been working with international scientific and technical partners to evaluate data and provide advice on health risks and about food and water safety. • World Health Day on 7 April focuses on antimicrobial resistance and highlights the importance of countries taking action today to protect the medicines of tomorrow. • The World report on disability will be launched in June. Further information and documentation can be found on the WHO web site – www.who.int Sue Block Tyrrell
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Point of view
World Health Report 2010 on :”Financing for universal health coverage” Is there progress from “ HEALTH FOR ALL ” of 1978? HO’s World Health Report (WHR) is clearly one of the most important publications on specific aspects of health progress globally. This is now the second time after 2000 that Primary Health Care is revisited in WHR: this time regarding important – mainly financial and economic – aspects to achieve an overall goal: Wuniversal health coverage. It is quite frightening to learn seemed achievable. Thirty to professional healthcare) from the DG that”... 20–40 per years later, we seem further and only “5 – 10% of people cent of all health spending is away from global equity, and are covered in sub-Saharan currently wasted...” She tells it looks like, solidarity is pro- Africa and southern Asia…”. us “...the report identifies con- gressively replaced by eco- “Closing the coverage gap for tinued reliance on direct pay- nomic and financial ‘system children under-five, particu- ments…as by far the greatest solutions’. This erosion is at larly for routine immuniza- obstacle to progress…” the centre of concern for a tions, would save more than growing number of health 16 million lives….” It would be We also learn that “any effec- professionals, like David interesting to know, what the tive strategy for health financ- Werner, member of the ‘Peo- comparative figures were in ing needs to be home ples Health Movement’, who the nineteen-eighties. grown…”, that “health sys- states in a comment to WHR tems are complex adaptive The report identifies three 2010:…..”The facts are in. systems”…, and that”...no one fundamental, interrelated WHO’s recommendations for in need of health care...should problems, which restrict ‘Uni- far-reaching policy changes risk financial ruin...” (Not versal Coverage’: are clear, if politically tooth- many years ago, WHO’s own 1. Availability of Resources less. As ever, the biggest ob- SHI reimbursed costs of long- 2. Overreliance on direct stacle is the short-sighted lasting chronic illness only payment at the time people resistance of the rich and regressively between 80 and need care, and powerful to what they selfishly 20 per cent over time, causing 3. Inefficient and inequitable condemn as socialized medi- substantial economic hard- use of resources. cine. What it comes down to ships for some pensioners). is that the Free Market Sys- A variety of well-known sys- This year WHR addresses tem is incompatible with tem solutions are offered in issues which concern all for- health for all – and in the the section “How do we fix mer WHO members: finan- c- long run with Health for this?” ing of increasing chronic dis- Anyone”. ‘Alma Ata’ and However, basic political is- eases and ageing population, ‘Health for All’ is mentioned sues, putting the individual the current economic down- only once in WHR 2010 in in the centre of decision- turn and rising health care the first sentence of the Ex- making are not addressed. costs. ecutive Summary (p. ix), re- In the section “A message of ferring to “….contributing to Many of us were working for hope” (p. xxi), we learn that quality of life ….and to global the Organization at the time of there is no “magic bullet”. peace and security”. This Alma Ata Health for All (the “Hope” in this context means makes one wonder, whether earlier version of Universal to conform to technocratic this was all WHO has learned Health Coverage ), and, at a solutions and expectations of from PHC. In the section time, when Primary Health the various health systems as “Where are we now?” (p. x), Care was relatively simple defined by current country we learn that …”more than and straight forward. Then, experiences and analyses. half of the world’s popula- the appeal was one for global Man is clearly no more in the tion lacks any type of for- solidarity in health matters, an centre of self-determination. mal social protection …”(and issue which for some visionar- That is the basic change in therefore guaranteed access ies like Halfdan Mahler, analysis, tone and style between 1978 and now.
What have we learned from the past experience? Joachim Kreysler
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A story from the Second World War..
...involving Brian Edwards and Samy Kossovsky When I arrived in WHO in April Completely ignorant of the fate re- Brian Edwards was the youngest of 1972, I soon had the opportunity to served for the men, their families the prisoners. Had he been two or meet Brian Edwards who has regret- met up on a train at a platform of the three months younger, he would tably recently passed away. “I knew Gare de l’Est (East Station of Paris), have stayed with his mother and a Kossovsky in Saint-Denis” … “It at about 8 a.m., guarded by armed would have passed the time of the was my father”, I replied. “Ah” German soldiers. They gave us occupation on the outside, as was added Brian, “you were the young nothing to eat or drink but allowed the case for me. lad (I was 14 years old in May 1944) some of the French people who We had the right to visit the prison- to whom I threw tins of food over the happened to be at the station to give ers for half an hour on Thursday wall in the courtyard of the us bread, water, pâté, sausages, mornings in an extremely noisy barracks”. whatever they could find, and to take visiting room. It was forbidden for messages for our close friends and any prisoner to give any message or Brian had been arrested on 5 De- relatives and to communicate with object whatsoever to their visitors. cember 1940 by the French police us. The fashion at the time was golfing on the orders of the Germans, as he trousers – surreptitiously my father was an English subject of Her Maj- Without any information we stayed passed me packets of “John Players esty the Queen in occupied France, at the platform until 8 p.m. that eve- and sons” which came out of the along with all the British subjects ning. Then the train began to move parcels from the British Red Cross found in the Paris region – men, eastwards to an unknown destina- or the St John’s Order and I hid women and children. tion. In the early hours we passed them in my trouser legs. As you can through Vesoul then finally stopped The same happened to my family: imagine, English cigarettes during at Besançon where many families my father, mother, my two brothers the German occupation were a real were interned in Fort Vauban which (aged 3 and a half and two years), treasure which allowed us to get overlooks the city. Those families and I were taken away at 6 a.m. by what we needed to improve our with members who were sick or had the police to the main police station meager rations. small children were transferred to in our district of Paris. My father, Saint-Jacques Hospital in the part While it was possible to hand over who had immigrated to France at the which had been transformed into a small packets of ten cigarettes, it end of the 1920s, declared himself German military hospital – including was another story to get tins of food born in Jerusalem, Palestine, which the mother and children of the which would have been much wel- was at that time under the jurisdic- Kossovsky family. comed at the family table. Hence tion of the Crown, and he had been came the idea to throw the tins from registered as such. He was there- During this time (as we learned a window on the third floor of the fore considered as a British subject much later), the men had been barracks over the wall on one side of by the occupying forces and the locked up in the Romainville fort in the courtyard, into the little grassy same applied to his family. In the the suburbs of Paris. After two and alley which ran alongside. A meet- basement of the main police station a half months the Germans thought ing was set for the afternoon and of this Paris district, families were it useless to keep and feed these when I appeared in the alley, Brian, separated – the men on one side, whole families who were obviously young and sturdy, threw the tins of with the women and children on the not a threat, so they sent the wives corned beef, golden syrup and other other. The whole empire was repre- and children back home. The men, food which I hurriedly stashed into a sented – the English and citizens of however, were in Drancy, in what bag and took home. We were able the colonies – white, black, Indians, was called the “sky-scraper”. When to repeat the operation on several even gypsies. My youngest brother these buildings at Drancy were occasions, but it became clear that was severely mentally handicapped, transformed into death chambers, the German sentries could notice us due to an infectious disease shortly especially for the Jews, the British and so we considered it best to stop. after his birth. A military German prisoners were housed in the large doctor, who was called in to evalu- Saint-Denis barracks, still in the There are of course many more ate the case, declared that this did Paris suburbs. It was called the tales to tell, but that will be for an- not prevent in the slightest either the “Lager (Camp) 111”. Each prisoner other time. detention of the whole family or its had to know his assigned number Samy Kossovsky displacement. (my father was number 78/111).
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Facts and events in Geneva
Coffee mornings in Nyon (10-12 noon)
QNT82 gave information on the monthly coffee next dates are Tuesday 19 mornings for former UN staff at the Sunset res- April, Wednesday 18 May, taurant opposite Nyon station. Below is a pho- Thursday 16 June, Tuesday 19 to of the group taken on 16 February where July and Wednesday 17 Au- three AFSM members were present – Angela gust. Blattler, Sue Block Tyrrell and Arie Groenen- Sue Block Tyrrell dijk. Do come and join us when you can. The
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Activities of Former Colleagues Break a leg! ot literally, no! This article is not about broken limbs but about that good luck wish prof- fered to all Thespians before appearing on stage. N Many of you who live in the Geneva area (and some colleagues fly over especially for per- formances) go to see the stage productions of the Geneva Amateur Operatic Society (GAOS) – web site www.gaos.ch and the Geneva English Drama Society (GEDS) - web site www.geds.ch . In the programme, you will often see that former WHO staff members are directing the GAOS shows, notably Kate Booth, Janet Clevenstine and Sue Lloyd, and others are helping with the cho- reography, the costumes and millinery, or are in the orchestra, backstage or front of house, notably Rosemary Wakeling, Valerie Buxton, Susan Bergomi and Nina Mattock. Kate, assisted by Janet, directed the most recent production of Cinderella in December 2010, and both ladies can also be found on stage as well as backstage and are members of various choral groups. The same goes for Sue, Valerie and Susan who have been very active members of GAOS for the past 30+ years. Valerie and Sue actually shared an office in the Congo in the mid-1960s, almost 50 years ago! At one stage, I had my office in HQ next to Sue’s and often heard her singing or dancing around the office! Rosemary is still very active in giving tap dancing classes (and has trained some former world champions) and Nina plays the flute or sings in musical groups. Jim Akre, Helena Mbele- Mbong, Michael Gurney, Michel Thuriaux and Philip Jenkins also sing in the GAOS Choral Group, as did Asha Singh Williams until she left Switzerland a few months ago. The original conductor of the Group was Roger Eggleston. The Group always welcomes new members if you would like to join! Former staff members Wendy Gray, Neil-Jon Morphy and Diane Simmance are active in GEDS, either on stage, backstage or directing. I am sure there are many other former WHO staff involved in GAOS and GEDS either now or in the past and I apologize for not citing all their names. Any anecdotes from such colleagues will be warmly welcomed. Many former staff are highly talented and pursue their passions. We look forward to hearing about your retirement activities …... Sue Block Tyrrell
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Facts and events (Cont d)
Volunteering to fill gaps in community development year, promising proposals are submitted to a At first glance, the 1% for Development Fund 1 general meeting of Fund members for discus- may seem superfluous: after all, why do WHO sion and approval. The Fund requires regular and other United Nations agencies exist? But reports on the use of its grants; where possi- the Fund was founded in Geneva in 1976 by ble, additional information is obtained through staff of the United Nations system out of frus- visits by Fund members or others on working tration at the failure of most countries to meet or vacation trips. stated targets for support of the developing world. Fund members were to contribute 1% of Independent 1% Funds now exist in Rome (at their salaries to community-development pro- the Food and Agriculture Organization), New jects, most of them too small for the pro- York (at United Nations headquarters) and Vi- grammes of large national and international enna (at the International Atomic Energy development agencies. Agency). Membership in the Geneva 1% Fund is now open to the entire community, and more The Fund has now disbursed about 7 million than 20% of its members are retired. Through Swiss francs to more than 700 projects in 75 the Fund, its members – in active service or countries, mostly in Africa, Asia and Latin retired, inside or outside the United Nations America. Because the Fund is administered by system – exercise technical expertise and ex- its members as volunteers, costs are minimal perience, idealism leavened by practicality, and and are covered by periodic sales of handi- trans-cultural solidarity. crafts from funded projects and by one-time donations. Members’ contributions thus go en- The Fund warmly invites additional participa- tirely to projects, many for improved community tion, whether through full or partial membership access to education, health care, clean water or contributions of money – one-off or periodic and sanitation. – in any amount. The finances are fundamen- tal, but members active in administering the Fund members evaluate proposals from com- Fund know that in sharing those resources munity members, nongovernmental organiza- they gain a great deal in fellowship with each tions or other Fund members, for projects that other and with the communities they assist. cost up to 20,000 Swiss francs each. Twice a Janet Clevenstine 2 1. http://www.onepercentfund.net or The 1% for Development Fund, c/o International Labour Office, Room 4-52, 4 Route des Moril- lons, CH-1211 Genève 22 2. Coordinator of the 1% Fund’s project evaluation and follow-up team ------The European sky for spring/early summer 2011 At this time of year the skies are much less brilliant than those of winter and autumn. The Milky Way is hugging the hori- zon and there are fewer stars to be seen. Find your way by looking for the familiar Plough (Big Dipper) almost overhead. Below it, in mid sky, is Leo, the Lion, with its curve of stars that really does resemble the mane of the Lion. Follow the curved handle of the Plough towards the horizon and you come to the bright yellowish star Arcturus, and beyond that, the white star Spica, in Virgo. Above and to the west of Spica is Saturn. Notice that Saturn, being a planet rather than a star, does not twinkle. Stars are point sources, so their light is easily distorted as it passes through our atmosphere, whereas the larger disc of a planet, though it still appears as a dot to the eye, is less strongly affected. Now is a good time to look at Saturn through any telescope you can get your hands on. A magnification of about 30 is all you need to show its famous rings. In dark skies, look for a scatter of faint stars about midway between Arcturus and Leo. This is a large cluster of stars in the constellation of Coma Berenices, Berenices’ Hair. Binoculars show the Coma star cluster really well, though it is not as well known as other clusters such as the Pleiades. If you want help with finding more constellations, go to the Society for Popular Astronomy website: http://www.popastro.com/youngstargazers/skyguide/ . Article kindly provided by the British Society for Popular Astronomy We are still hoping to get information on what can be seen in the Southern Hemisphere sky …..
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In memoriam
Peter OZORIO, Founder and Editor of AFSM's Quarterly News , died from a heart attack in Palo Alto, California, on New Year's Eve 2010. His career with The current QNT editorial committee ,fully his supports 50th this tribute to Peter and conveys its deep cond WHO began in 1958 Initially with only eight pages lencesJubilee to hisissue family." in 2002 had 24 pages . and he worked for 14 years at AMRO Rubrics such as "Lifestyles," "Anything in Washington D.C . but Retired ," "The Grand Art of Grand As Editor of the staff parenting, " Tom Strasser's "Health Cor- newspaper Vo z, he ner," and sorne 170 letters from readers kept attention fo- reflected the broad spectrum of AFSM cused on WHO's life. He was also on the editorial staff of murdered colleague UN Special and , while it existed, of Viviana Miccuci, one of Argentina's desa- WHO's Dialogue. parecidos. Of dual British and U.S. nationality , In 1972 he moved to the Liaison Office Peter was born in 1928 to parents of with the UN in New York, where his ef- Macao origin in international Shanghai, forts in WHO's programme for smallpox attended a British school there and eradication won him membership of the joined the English-language China Order of the Bifurcated Needle. In 1977 Press as a cub reporter . He worked in he moved with his family to WHO head- Tokyo, Seoul (with the UN Korean Re- quarters in Geneva, a move he called "a construction Agency) and London and, welcoming and transforming moment" in after immigrating to Canada, in To- his life . ronto. He received degrees in journal- As Information Officer in the Division of ism and political science from George Public Information (INF), he supported Washington University, Washington technical programmes and advocated D.C. health messages through such themes as In December he set aside some ap- "Cancer Is a Third World Problem Too," prehension about his own health and, and "Heart Diseases Are Developing in with his wife Mary Lou and daughter Developing Countries." He recommended Claire, enjoyed a cruise from Florida 31 May as "World No-Tobacco Day," now through the Panama Canal to San observed annually, and helped to en- Diego, California, to link up with son courage the cartoon character Lucky Edmund and family. But at Christmas Luke to exchange his cigarette for a he fell ill and died in Palo Alto . straw . He was also responsible for the Besides Mary Lou, Claire and Edmund, News Page of WHO's illustrated maga- he leaves his son T .J. (resident in Flor- zine World Health. ida) and four grand-daughters - Kim, Peter was always a champion of human Jessica, Katherine and Emily - "les girls" rights , and it was an open secret that he who featured on the Ozorio family engendered "Le Serpent enchaîné ," the Christmas cards. A large crowd of family tongue-in-cheek periodical of WHO 's and friends attended a Memorial Service Staff Association that exposed infringe- for Peter held on January 31 at the Cen- ments or bending of rules. On his retire- tre Jean XXIII in Petit Saconnex, ment in 1989 , he founded Quarterly Geneva. News for the retired staff of WHO. John Bland
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In memoriam (Cont d)
Vittorio Fattorusso passed away on January 4th 2011. cated to the global efforts of WHO Dr Vittorio Fatto- russo was a former and especially towards people he felt were in Director of the "greatest need". WHO Division of Dr. Fatorusso came to WHO from the Direc- Prophylactic, Thera- torship of CIOMS, bringing to the Organiza- Therapeutic and tion powerful knowledge and experience that Rehabilitative clearly contributed in leading the WHO to- Technologies. wards accomplishing its aims and objectives He was the editor of in highly controversial and conflict ridden Vademecun clinique: situations. du symptôme à l'or- Universal access to the basic and most needed donnance, a household name among medical technologies for health were at the top of his students and young physicians from the 1940s concerns and interests. Towards that end, he onwards. created the Unit of Drug Policies and Manage- Those, like me, who had the opportunity to ment , as well as other ways and means of pro- work with him, will always remember him as a moting the concept of Essential Drugs and knowledgeable, kind boss, full of understand- Vaccines. ing and, above all, a wise advisor. He was al- Because of his many thoughtful contributions to ways polite and gentlemanly, rare qualities public health and universal well being, he will these days. be remembered by this generation and public health professionals. I for one feel a profound vacuum over the Fernando Antezana loss of this great man who was so fully dedi------Guy Carrin (Guido) passed away on 28 March 2011:Guido was a wonderful person with whom I had dealings over the years. As a health economist, he had a keen interest in health insurance and was very active in that area in assisting countries. He participated in many of our SHI special studies and he was a real pleasure to work with. It is sad news and he must have been relatively young. Ann Van Hulle-Colbert ------Other deaths Margo Hermansen 4 March 2011 Erlinda Petersen, 21 February 2011 Josef Kierski May 2011 Kalyan Baghchi M.K. Q. Hashmi Joan (H.J.L) Robertson 25 March 2011
About Kathleen Duckworth Barker (see In memoriam QNT82,) Allow me to add a postscript to Fred Beer's "In memoriam" for Kathleen Duckworth Barker. He mentions the publication in 1955 of A Cure for Serpents , her translation from the original Italian of the memoirs of the Duke of Pirajno, which were highly praised at the time by such literary bigwigs as Cyril Connolly, Doris Lessing and Harold Nicholson, When, on behalf of our Association, I tele- phoned to wish her a happy hundredth birthday, she told me that her translation had been reissued in 1985 as a paperback (by ELAND, 53 Eland Road, London SW 11 5JX) and, 18 years later, was still selling and bringing her in a welcome trickle of royalties. I don't know whether, after another seven years, it is still in print, but in any case I can recommend it as an enthralling read, perhaps of particular interest to our members for what it tells us about colonial health care in what were not yet called the developing countries. Of course, those who can read Italian might prefer the original, if they can get their hands on a copy. John Fraser (ex TRA)
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Book review
Les invisibles by Yasmine Motarjemi, illustrated by Susan Litsios Illness due to contaminated food and drinking constitute a major public health problem. F ood and water can become contaminated at any stage of the food chain, including during storage and preparation before consumption. What better audience for promoting food safety awareness and proper food preparation hygiene than children who are forming life- long food habits with potential impact on their health. Les Invisibles is a delightful book about various microbial agents and the public in an entertaining manner. that can be the source of contamination of Her objective is to explain in simple read with foods. Finally, altogether they learn language the dangers of foodborne pleasure by the often very simple but important pathogens and major misconcep- older children, measures needed to take to protect tions in food safety. read aloud by themselves in the future. The story is full of suspense and parents to the The book’s author is Yasmine Mo- interest, beautifully illustrated with younger ones, tarjemi, of Iranian origins and with charming pictures by Susan Litsios, or used as Swedish and Swiss nationalities. an American artist and book illustra- teaching ma- She has a doctorate in food engi- tor who has had many solo and terial in schools or other educational neering from the University of Lund, international exhibitions of her art- settings. Sweden. Many of us knew Yasmine work. Her colourful, imaginative Les Invisibles tells the story of Sara, during the years she was working for pictures bring a wonderful story to a young girl who is home sick in the WHO Food Safety Programme, life and impart an important public bed. With the help of her cat in the area of the surveillance and health message to children and Rostam, she puts on her detective prevention of food borne diseases. adults alike. hat and discovers the invisible world She is the author of several WHO I gave the book a test drive with my of microbes and the danger they can books in food safety, including young granddaughter; she loved the pose to good health. She tracks Foodborne diseases: a focus on affectionate long-haired Maine coon down the source of the microbial health education (WHO 2000) pro- cat Rostam, exciting story, and the agent that has sickened her and moting the education of children in entertaining drawings of the mi- several of her classmates at school. food safety. crobes and other wonderful illustra- Through the investigation she learns She was inspired to write this book tions. We went off to wash our by reading reports of thousands of hands thoroughly before lunch, cases of foodborne illnesses in vari- vowing that all together we can ous countries of the world and the defeat the misery caused by the challenge to explain food safety to foodborne illnesses. Carole Modis So far Les Invisibles is only available in French; to order a copy, go to the web site at: www.elstir-editions.ch ; for additional information, you can contact Yasmine at [email protected] .
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Lost lives , the pandemic violence against children , Academic Press Lund, Sweden, 2011 . In December 2008 (QNT 74) I drew attention to a very moving book by Einar Helander on the sub- ject of "Children and violence". Einar has come out again with another very disturbing document on the same subject It is a scholarly textbook of 275 pages with over 800 bibliographic references. The 30 photos of victims are very painful and "Lost Lives" does not make pleasant leisure reading. However if you find the courage to read, for example, a chapter a week you may, like I was, be shocked to dis cover that " it is estimated that 50% of all now living persons were abused sexually, physically, and/ or emotionally before they were 18 years old" i.e. " global prevalence of victims estimated at 3,400 million ".
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Book review (Cont d))
The book includes a "short history of child abuse and neglect" and confronts the reader with the evidence of the global prevalence of the pandemic. It describes the combined sexual, physical or emotional abuse of children. It depicts both cases of children abused in residential institutions and the abuse derived from parental care. It quotes the Secretary-General of the United Nations (2005) about the " declining credibility and professionalism of the Human Rights Commission " undermining international law. The author denounces the "Causes and contributors to violent behaviour and its prevention". He takes us back to the behaviour of "Neanderthal hunter-gatherers" and is not very reassuring when stating that "the 20th century had the largest level of “democides” seen during the last 400 years : 7.9% of the world population (262 million) were murdered by paranoid country rulers ". Halfdan MAHLER asks in the Foreword "what is the future of a world where people find them- selves surrounded by oceans of contagious violence, immoral behaviour, lack of compassion, and unwillingless to change?»
On the lighter side
Communication in hospital... Good morning, is that the reception? I would like to talk to someone concerning a patient in your hospital. I would like to know how he is, whether he is get- ting better or worse. What is the name of the patient? His name is Joe Bloggs and he is in room 302. Just a moment please, I will pass you the nurse. After a long wait: Good morning, this is Frances the nurse on duty – how can I help you? I would like to know how the patient Joe Bloggs is in room 302. Just a moment please, I will try to find the doctor on duty. After a long wait: This is Dr Smith, the doctor on duty – how can I help? Good morning doctor, I would like to know how Mr Joe Bloggs is getting on – he has been with you for the past three weeks in room 302. Just a moment, let me check on the patient’s file. After another long wait: Hmmm, here it is. He has eaten well today, his blood pressure and pulse are stable, he is re- sponding well to the prescribed drugs and if all continues to go well, we should be taking off the heart monitor tomorrow. If everything goes well for the next 48 hours, his doctor will agree to his discharge between now and the weekend. Aaaah ! This is good news, I am thrilled. Thank you. By the way you talk, I imagine that you are someone very close to him, surely a member of the family? No doctor, I am Joe Bloggs and I am calling you from room 302. Everyone comes and goes in my room and no-one tells me anything. I just wanted to know how I was getting on! Many thanks!
------Or elsewhere… even when you speak the same language … Between what I think and what I mean, What I believe I say and what I do say, What you want to hear, What you do hear, what you understand, There are ten possibilities that we may have difficulty in communicating. But let’s try anyway.
Bernard Werber
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Readers’ Corner
RED: We received an open letter from Marjory Dam which explains her decision to resign from the AFSM Executive Committee. This letter contains numerous inaccuracies and errors. For example, it is stated that “ The Committee refused to recognize the problems of SHI governance and strongly rejected key elements of the reform". On the contrary, the Committee certainly recognized the weaknesses in the current governance but some felt that those weaknesses could be ad- dressed by improving the current structure rather than by dismantling it. The let- ter illustrates, as you will see, Marjory’s disappointment in not having been re-elected as a representative to the Staff Health Insurance and therefore not being able to continue to sit on the working group set up to study the reform of the health insurance. In fact, the election was totally democratic: 4 candidates presented themselves for 2 seats: the representative and the alternate. One of the candidates withdrew before the voting, and the members of the Committee elected two representatives, but not Marjory Dam. This is unfortunate, but it is the democratic rule. ------Here it is: « I should like to thank all those who supported me in the October 2010 election of the AFSM Executive Committee. However, I have resigned from the Executive Committee effective 8 February 2011. « My decision to resign is due to issues related to reform of governance of the WHO Staff Health Insurance. My position to support reform proposals presented by the WHO Ad- ministration conflicted with the views of the majority of the Executive Committee, who op- posed key elements of the reform. The Executive Committee, therefore, voted to remove me as one of the two representatives of retired staff members on the Headquarters Staff Health Insurance Surveillance Committee. In light of this vote of no confidence, I felt it would be impossible for me to continue as a member of the AFSM Executive Committee. The Headquarters Staff Health Insurance Surveillance Committee established a Working Group to review the insurance plan and to make proposals concerning inter alia its gov- ernance, which had become dysfunctional. At a meeting of the Working Group in October 2010, the WHO Administration presented workable proposals to reform the governance mechanisms. The majority of the members of the Working Group (myself included) viewed the reform proposals as positive. When I reported back to the AFSM Executive Committee, the Committee refused to recognize the problems of SHI’s governance and strongly rejected key elements of the reform. Subsequently, they voted to remove me from my functions as a member of the Working Group. However, at the meeting of the Working Group held at end-February 2011, the majority of its members agreed to the pro- posals, with some modification of details, so I guess you could say, “I was right!” Retiree representation through AFSM in health insurance matters is a practice, not a right. I believe these recent events call into question the competence of AFSM’s Executive Committee to continue to represent the interests of the retirees in health insurance mat- ters. The Administration’s reform proposals include a provision whereby retired staff members participating in the Insurance would elect their representatives, at large. I urge all retired staff members to express their support for this reform ». Marjory Dam Former Director, Governing Bodies Retired in 2007
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Readers’ Corner (Cont d)
"VWPs" or "VIPs”? Mr Ashok V. Desai, Consultant Editor of Businessworld, in a recent article, gifted us with a new acronym “VWP” - very similar to and rhyming with the familiar one: “VIP”. This was in the context of the statement made by 14 influential people from different fields writing to Prime Minister Man- mohan Singh to take immediate effective steps to check the all-pervading corruption in the country. Mr Desai justified why he called these 14 people “worthy” and not “important” as they took ‘respectable roads to acquire their riches’.
Going back to the acronym “VIP”, probably it started by referring to visiting foreign dignitaries or persons with high status in the country’s hierarchy like the President and Prime Minister. However, soon many more people having access to power centres, right from Ministers to Members of Par- liament or Legislative Assemblies – even lower down the line to District Boards - embellished themselves with the honorific ‘VIP” with all the accompaniments that are expected to arrive with it automatically – a revolving red light on their car, a preferential treatment on air- lines/railway reservations, jumping the long queues at temples etc. etc. Soon, because there were too many “VIPs” to be handled, another letter “V” (for very) was added to this acronym to refer to those who really were at the top. Hence, there was a scramble among “VIPs” to get elevated to “VVIPs”. Recent events have shown that, over a period time, thanks to the in- discretions (both in political and personal lives) and greed on the part of high and mighty in power to acquire unlimited wealth, even “VVIP” has become a “tainted” term not inspiring confidence and regard which otherwise they would have got because of the positions held by them.
So Mr Desai is to be thanked for bringing freshness by coining the term “VWP”. While anyone could become a “VIP” by being assigned to an important position, the “VWP” will have to prove himself or herself worthy of this honorific. Whether the 14 influential persons who are the first recipients of this title will justify such an honour by their envisaged campaign for divesting the country of the bane of corruption? Or whether future generations of political big-wigs will aspire to be called “VWPs” and not “VVIPs”? Only time will tell! Shiv K. Varma Dear M. Menu, My beloved mother passed away on June 8, 2010. I continue to receive notices, communications addressed to my mother - this should be discontinued. The only exception to this should be the Quarterly News of AFSM to which I had renewed the subscription for my mother in July 2010. I have immensely enjoyed my association with the WHO family for over half a century - by proxy through my parents. My father joined WHO in 1956 and was posted to the Sudan (Sennar in S. Sudan and his last posting in Khartoum as the WHO Rep), Egypt at Alexandria and Baghdad where too he was the WHO Rep. until his retirement and return to India in 1970. I will cherish memories of all the travels, throughout the Mid East especially, meeting wonderful people and making innumerable friends, the many holidays and living with my parents at all of their postings except Sennar through my young school and college years and beyond. Life has been an explo- sion of the mind, a learning experience like no other. My love and bonding with that part of the world is abiding and now I watch with trepidation, anxiety and excitement the sudden, sweep- ing and rapid changes that are taking place - almost like a forest fire - in every country that they were posted in. Even the geography of the Sudan is to be redefined. With the rest of the world I pray for peace and prosperity for all. I cope with my mum's loss one day at a time and miss her immensely. As for my dad, he was truly wonderful and after all these years the vacuum remains - my guru and mentor. I wish the AFSM and all your endeavours the best of luck in the wonderful work you do in inform- ing, entertaining and keeping the WHO flock, past, present and future bonded. With regards, Indrani Roychowdhury Chari Bangalore, India Association of Former WHO Staff Page 19
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Readers’ Corner (Cont d)
Response to the letter from Joan Bentley on health workers in the field for the magazine of the Association of Former WHO Staff Members (AFSM) (see QNT81 ). Ellen Rosskam, Ph.D., MPH, Interim Technical Officer, Global Health Workforce Alliance, World Health Organization
'Field worker' is a categorization that include a variety of cadres, such as community health workers, mid level providers, midwives, skilled birth attendants, traditional birth assistants, nurses, and doctors. Ms. Bentley asked whether health workers in the field still exist. They do. But also all too often they don't, particularly in remote and poor areas. The backdrop to this scenario is that worldwide there is an estimated shortage of 4.3 million midwives, nurses, and doctors, with the shortage most severe in 57 priority countries (WHO, 2006). We are in the year 2011 but still only some 40% of births in low-income countries are as- sisted by properly skilled birth attendants (Fauveau et al, 2008). Yet we know that teams of midwives and midwife assistants working in health care facilities could increase coverage of maternity care by up to an additional 40% by 2015 (Koblinsky et al, 2006). Policy mak- ers and development partners struggle to help find solutions to the unacceptably high rates of maternal and newborn mortality in many low and middle income countries. Unfortu- nately though, progress has been too slow for most of the 57 priority countries to meet Mil- lennium Development Goals 4 and 5. There are success stories however, where some countries struggling with but addressing the problem of access to skilled birth attendance in particular are making good progress towards achieving Millennium Development Goals 4 and 5. By introducing innovations in midwifery workforce management, countries such as Sri Lanka, Bangladesh, and Nigeria have been able to claim such achievements. The achievements of these countries show that addressing challenges in the 57 countries suffering from the most acute shortage of midwives, nurses, and doctors, calls for innovative thinking and innovative approaches, most urgently to reduce maternal and newborn mortality and morbidity. Attracting and re- taining health workers in remote areas is a particular challenge in the face of this crisis shortage of health workers. Strategic decisions are needed to address recruitment, reten- tion, and the motivation of midwives. Difficult as it may be, a number of low income coun- tries have demonstrated that meeting these challenges can be done, can be managed, and can be financed in resource-scarce settings. Recent groundbreaking global research on community health workers has provided us with a list of key messages critical to attracting and retaining health workers in the field. Key messages that have come from this research (Global Health Workforce Alliance, 2010) provide a roadmap of concrete actions needed to scale-up and keep health workers in the field. The key messages (included below) address 3 core issues: Planning, produc- tion, and deployment; Attraction and Retention; and Performance Management. Common to all 3 of these areas is the need for government support and political will. In- deed, today we have the evidence showing that where there is political will, there is a way. Key messages for integrating community health workers in national health workforce plans (Global Health Workforce Alliance, 2010)
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Readers’ Corner (Cont d)
Planning, Production and Deployment • Integrate Community Health Workers (CHWs) fully into national Human Resources for Health (HRH) plans and health systems, taking into account existing needs, expected social benefits, local values and preferences. • Involve key HRH stakeholders in the decision-making process, including relevant government bodies, civil society, private-not-for-profit and health professional groups. • Ensure effective and robust monitoring and evaluation throughout the policy and implementation process for the scale-up of CHWs. • Ensure that any scale-up of the CHW cadre in national health systems and/or in non governmental initiatives makes adequate provision of the additional costs and resources required for supporting the cadre (including training, supervision, equipment and sup- plies, transport). • Take into consideration the need for complementary strengthening of the existing health system to provide the enabling environment for implementation of CHW policies and planned interventions. Attraction and Retention • Prepare and engage the community from the start in planning, selecting, implementing, monitoring and supporting CHWs. • Ensure a regular and sustainable remuneration stipend and, if possible, complement it with other rewards, which may include financial and non-financial incentives. • Ensure a positive practice environment, including regular and continuous supportive supervision, health and safety issues, CHW’s information and communication needs, a clean environment, a manageable workload, and the availability of drugs/supplies/equipment. • Establish terms of reference for selection criteria, training duration, and scope of tasks that are clearly stated, publicized and respected by all stakeholders. • Provide an ongoing continuing education framework for CHWs and, where possible, support opportunities for career advancement, considering the needs of the individual as well as the organization. Performance Management • Governments should take overall responsibility for the quality assurance of CHWs as part of their stewardship role, even if CHWs are trained and managed by civil society or private-not-for-profit groups. • Performance management should be based on a minimum standardized set of skills that responds to community needs and appraisal of strategies, and is context-specific. • The management and supervision of CHWs should be integrated with that of other health workers, using a team approach, and should be developmental, systematic, planned and budgeted for accordingly, in order to achieve the desired service delivery and health outcomes. References The World Health Report 2006 - Working together for health, World Health Organization, Geneva, 2006. Fauveau, V., Sherratt, D.R., and de Bernis, L., Human resources for maternal health: multi-purpose or specialists? Hu- man Resources for Health , 6:21doi:10.1186/1478-4491-6-21, 2008. Koblinsky, M. et al, The Lancet , Vol. 368, 2006. Global Experience of Community Health Workers for Delivery of Health Related Millennium Development Goals: Sys- tematic Review, Country Case Studies, and Recommendations for Integration into National Health Systems, Global Association of Former WHO Staff Page 21
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Readers’ Corner (Cont d)
Health Workforce Alliance, Geneva, 2010 http://www.who.int/workforcealliance/knowledge/resources/chwreport/en/ Additional references Increasing Access to Health Workers in Remote and Rural Areas Through Improved Retention, Global Policy Recom- mendations, World Health Organization, Geneva, 2010. State of the World's Midwifery Report, UNFPA, June 2011 Mid level providers: http://www.who.int/workforcealliance/knowledge/resources/mlpreport2010/en/index.html
New members
We have pleasure in welcoming to the large AFSM family the fol- lowing new members and we congratulate them on their decision. New life members: Barbara FONTAINE ; Corinne EVERITT-PENHALE New annual members: Marc JABOULIN ; David BALDRY; Linda BALDRY ------The more we are, the stronger we are Dear Readers, In principle, you are all members of AFSM but many retirees, for one reason or another, have not joined the Association. Yet, the more we are, the more we can represent and better defend our common interests, espe- cially concerning health insurance. We kindly request you all, both annual and life members, to try to convince your friends and acquaintances to join AFSM. Below is the enrolment form which you can give to them. Many thanks in advance for your help. ------I am not yet a member and I want to join: as a life member (CHF 250); as an annual member (CHF 25 per year) Dues can be paid either in cash at the office or through a postal form (add 2 CHF for charges) for persons who live in Switzerland, or by bank transfer to the AFSM account number (+ bank charge, if any): IBAN: CH 4100279279-D310-2973-1 SWIFT: UBSWCHZH80A ------JOINING AFSM Name ………………………….. First Name Address:
Postal Code ……………………… City…………… Country ......
Phone ………. Fax ...... e-mail ……….
Date of Birth …………………… Nationality …………………………………………………………………
Date of separation from WHO ………………………………. Length of service with WHO
I should like to receive documentation in □ English □ French
Date ...... Signature
Association of Former WHO Staff Page 22