Correspondence

KB, WB, MK, and PT are founding members of the Global Health Alliance, a network of academic institutions to promote education in global health. WB, PT, WH, and RK were invited participants of an official “public dialogue” event between civil-society and the Federal Ministries of Health (BMG), Foreign Affairs (AA), and Development Cooperation (BMZ) before the formulation of the strategy. RK is an external consultant of the Gesellschaft für Internationale Zusammenarbeit (GIZ).

*Kayvan Bozorgmehr, Walter Bruchhausen, Wolfgang Hein, Michael Knipper, Rolf Korte, Peter Tinnemann, Oliver Razum [email protected] www.thelancet.com Vol 382 November 23, 2013

Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg 69115, Germany (KB); Institute of History, Theory and Ethics in Medicine, Aachen University, Aachen, Germany (WB); German Institute of Global and Area Studies (GIGA), Institute of Latin American Studies, Hamburg, Germany (WH); Institute of the History of Medicine, Faculty of Medicine, University Giessen, Giessen, Germany (MK); Institute of Hygiene and Environmental Health, Faculty of Medicine, University Giessen, Giessen, Germany (RK); Department of International Health Sciences, Institute for Social Medicine, Epidemiology and Health Economics, Charité-University Medical Centre, Berlin, Germany (PT); and Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany (OR) 1 2

3

4

5

Lancet. A new German Government: leadership for health? Lancet 2013; 382: 999. European Union Council. Council conclusions on the EU role in Global Health. https://www. consilium.europa.eu/uedocs/cms_Data/docs/ pressdata/EN/foraff/114352.pdf (accessed Nov 9, 2013). Karanikolos M, Mladovsky P, Cylus J, et al. Financial crisis, austerity, and health in Europe. Lancet 2013; 381: 1323–31. WHO Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. 2008. www.who.int/social_determinants/ final_report/ (accessed Nov 9, 2013). Rechel B, Mladovsky P, Devillé W, Rijks B, Petrova-Benedict R, McKee M. Migration and Health in the European Union. European Observatory on Health Systems and Policies Series. Maidenhead, Berkshire: McGraw-Hill, Open-University Press, 2011.

Appeal from Chinese doctors to end violence Within only 10 days in October, seven consecutive incidents of violence against medical personnel took place in Chinese hospitals, three doctors were killed and ten medical staff were injured.1 This recent wave of assaults on medical staff has led to widespread discussions on Chinese social media. Anger, fear, despair, and even hatred are common among doctors. Chinese doctors are under tremendous stress. The growing problem of violence in hospitals in China can certainly be attributed to the worsening of the doctor–patient relationship, but more importantly, it is probably due to the fact that China’s health-care system lacks regulations to protect

medical staff from intended violence.2 There is no comprehensive legislation in China to specifically address medical disputes and violence, with the exception of so-called guiding opinions without legal effects. On Oct 24, the Chinese Ministry of Health and the Ministry of Public Security announced new guidelines to provide better security at hospitals: the number of security guards in each hospital should be at least one per 20 patient beds or no less than 3% of medical staff.3 This announcement has provoked the ire of medical professionals and Internet users, stressing the government’s hypocrisy because it will not address the fundamental issue of protection of doctors and might even further intensify the doctor–patient conflicts.4 This deteriorated medical environment has led many to question what will be the future of doctors in China— this is a collective concern for the entire Chinese society.5 As doctors in China, we call for a zero-tolerance attitude toward violence in hospital. The Chinese Government should drive the momentum of health-care reform to bring fundamental relief in this tense situation. Legislation should be strengthened to tackle crimes hampering the safety of medical staff. Only with effective and prompt actions will we be able to rebuild confidence.

XiXinXing/Corbis

Health Coverage (UHC) based on the human rights to health approach and an unequivocal commitment to strengthening the leadership of WHO, by strengthening the core mandate of WHO for setting binding norms and standards for member countries. However, important gaps in policy and implementation aspects need to be addressed. We have identified the following gaps: intellectual property rights and access to medicines; 2 structural determinants such as trade, economic crises,3 and global inequity;4 serious limitations of the right to the highest attainable state of health for migrants, refugees, and asylum seekers in the European Union, including Germany;5 funding mechanisms for WHO; strategies to foster global health research and education; and an effective and transparent interministerial institutionalisation of German global health policies. Moreover, the stated aim of exporting the products of the strong German health-care industry for the benefit of global health ( appendix appendix)) w will divert scarce resources in low-income countries from urgently needed social interventions promoting equity to costly technologies of doubtful appropriateness. The new German Government should aim to fill the gaps outlined above and develop a concrete global health strategy, including a timescale and measurable goals. Only then can the intentions of the concept note be fulfilled.

We declare that we have no conflicts of interest.

Tian Yang, Han Zhang, Feng Shen, Jie-Wei Li, Meng-Chao Wu* [email protected] Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China 1

2 3

Reuters. Chinese doctor stabbed to death in latest hospital attack. Oct 25, 2013. http:// www.reuters.com/article/2013/10/25/uschina-health-idUSBRE99O08X20131025 (accessed Oct 30, 2013). The Lancet. Ending violence against doctors in China. Lancet 2012; 379: 1764. MacLeod C. China trying to stop patients from killing doctors. USA Today, Oct 24, 2013. http://www.usatoday.com/story/news/ world/2013/10/24/china-hospitalattacks/3178633 (accessed Oct 30, 2013).

1703

Correspondence

4

5

Ya W. Hospitals to beef up security. Global Times, Oct 24, 2013. http://www. globaltimes.cn/content/819897.shtml#.Um_ OK41jMn8 (accessed Oct 30, 2013). Jie L. New generations of Chinese doctors face crisis. Lancet 2012; 379: 1878.

Health-care access for migrants in France Owen Franken/Corbis

Health inequities are a major concern in Europe as recently emphasised by WHO’s European Health Report.1 The diversity of European health systems provides a “natural laboratory for health policies”.2,3 In France, PASS (Permanences d’Accès aux Soins de Santé) healthcare access departments are an important observatory. Created in 1998, PASS departments are mostly intrahospital structures providing primary care to vulnerable patients. In the PASS department of SaintLouis University Hospital in Paris, our experience with migrants from more than 90 countries led us to provide a global and integrative approach for very complex situations, analysing medical, psychological, social, cultural, and living conditions. Complex cases are submitted to a group including medical doctors (general practitioners and specialists), nurses, social workers, psychologists, and non-medical partners to share complementary skills and views, respect patients’ interests, and take into account health globally. The aim of these structures is to give the most appropriate solutions to each patient. However, as global and innovative as our approach can be, it is only a partial response. Indeed, many of our patients are vulnerable migrants who accumulate barriers such as comprehension difficulties, transportation, nutrition, and housing issues.4 It then makes any treatment much more hazardous. For these individuals, equality and access to wellbeing remains an illusion. Our approach is only a local response. Our service depends on national 1704

health policies, budget cuts amid crisis, geopolitics changes, and immigration policy—all depending on policymakers’ decisions in France and in other countries. More comprehensive international analyses and policies are needed to tackle health inequalities. We declare that we have no conflicts of interest.

Florence Tapié de Celeyran, Yannick Girardeau, Sylvie Khan, Frédéric Morinet, *Claire Georges-Tarragano [email protected] Health-care Access Department (PASS), Saint-Louis Hospital, 75 010 Paris, France (FTdC, YG, SK, CG-T); and Virology Department, Saint-Louis Hospital, Paris, France (FM) 1

2

3

4

WHO. The European Health Report 2012: charting the way to well-being. http://www. euro.who.int/__data/assets/pdf_ file/0003/184161/The-European-HealthReport-2012,-FULL-REPORT-w-cover.pdf (accessed Sept 19, 2013). Kleinert S, Horton R. Health in Europe – successes, failures, and new challenges. Lancet 2013; 381: 1073–74. Haut Conseil de la Santé Publique. La santé en France et en Europe : convergences et contrastes. 2012 (in French). http://www.hcsp.fr/docspdf/ avisrapports/hcspr20120301_santeFrance Europe.pdf (accessed Sept 19, 2013). Eurostat. The social situation in the European Union 2009. http://epp.eurostat.ec.europa.eu/ cache/ITY_OFFPUB/KE-AG-10-001/EN/KE-AG10-001-EN.PDF (accessed Sept 19, 2013).

Don’t steal the body He was an 11-month-old peaceful little baby with blue eyes and a disarming smile. His paediatrician father found him dead in his bed on a winter morning. The ambulance arrived. The doctor proposed to take him to the hospital. The parents refused. Instead, they kept him in their arms all day through. The body of this beloved son changed with time, becoming colder, stiffer, the colour of his eyes slowly disappearing. A few hours later came the moment when the parents finally felt the need to cut off from his decayed body. Modern societies sometimes lose contact with basic human instincts. When facing death, especially those unexpected, doctors often want to organise, lead, analyse, and reassure

the relatives in a safe and prepared environment. There are good reasons for this attitude to be the standard. However, there is also sometimes a need for time to understand the unforeseen. Sometimes, there is a need to face the sad and the painful. Sometimes, there is a need to fall down deep to recover. And always, there is a need to let people decide what they think the good is for them. There is obviously no miracle solution to face traumatic loss. Each of us needs to continuously find our own, when possible. These parents are just telling us that keeping their breastfed child has been constructive for their bereavement. It helped them to enter into their cruel new reality and, later on, move toward their renewed life. The process of going through a period of mourning includes looking back trying to understand what happened. Unprepared doctors might sometimes underestimate how difficult it is to simply face the reality and restart from there. In both hospital and community settings, taking away a body might happen under many circumstances and under the cover of relatively obvious or fairly hypocritical reasons. Questions such as the acceptable delay for necropsy and the postmortem samples that need to be taken immediately should be clarified and handled according to evidence-based priorities. Meanwhile, the next time you accompany the relatives of your deceased patient, these parents would be very grateful if you could sincerely ask yourself if you are not stealing the body in any way. I declare that I have no conflicts of interest.

Pierre R Smeesters [email protected] Université Libre de Bruxelles, Gosselies, Hainaut 6041, Belgium; and Murdoch Childrens Research Institute, Melbourne, Victoria 3052, Australia

www.thelancet.com Vol 382 November 23, 2013

Appeal from Chinese doctors to end violence.

Appeal from Chinese doctors to end violence. - PDF Download Free
245KB Sizes 0 Downloads 0 Views