Sunday, November 30, 2008

Opening Day: Conference report.

I wasn’t sure that I would have much to report from the conference as a whole, and my wandering of the Havana streets from yesterday are documented in my “personal” blog, with some pictures. One of our speakers today, however, merits comment, and is somewhat relevant to the issues with which we are grappling in the quest for improved children’s mental health. So, I blog.
This conference is quite eclectic; people from 22 countries all focused on the theme of Health Equity, a concept which I both like and fine hard to “sell”. The opening was full of ceremony that reminded me of how hierarchical Communist nationalism can be: we stood for the playing of what I am guessing was the Cuban National Anthem, a vigorous melody with much Revolutionary zeal, and we greeted in Spanish by Dra. Ileana del Rosario Morales Suarez, Chair of the Scientific Commission that put the conference together, who spoke of the need for medical education based on the needs of the people. She then introduced the Honorary Conference Chair, the Vice-Minister of Public Health for Medical Education, Dr. Roberto Gonzalez, who put this in the context of the Cuban Health Care system, of which he was justifiably broad. My Spanish was good enough to follow these “in principle”, but not good enough to capture the flavor of what they said. Hers was more lyrical, his was more of a recitation of the accomplishments of the Revolution in medicine. I realized halfway through the Spanish portion of the program that simultaneous interpretation was available; tomorrow I will try to get an earpiece.
The final speaker was in English: Dr. Charles Boelan, a Flemish doctor from the WHO, who spoke of “Social Accountability: A Mark of Excellence for Health Profession Educational Institutions”. I really liked the way in which he framed the discussion of health equity in the context of the role of the medical school in civic society. Let me try to capture a few of the high points.
1) Medical schools are really good at creating doctors who are well grounded in the science and art of medicine. He spoke of medical schools in the Middle East and South Asia, who were proud (and justifiably so) at the academic achievements of their students. One marker used to measure success was the number of graduates who ended up in the US system, which he pointed out was draining the best minds out of a third world country that would benefit from their expertise. When offered praise on the quality of the medical education offered in their system, the Nepalese dean despaired of the schism between the folks in the medical school and the folks who needed help.
2) He then framed it as an issue of partnership, quoting Desmond Tutu “Successful partnerships are built on trust, shared values and a clearly articulate vision of outcomes”. He felt that, in medical schools, we are often not clear on when the “product” is meant to be (everyone knows it, so why should we articulate it?) and that we don’t spend time developing a shared vision with the key stakeholders in the process (health managers, health policy makers, health professionals and civic society)
3) He saw as having an obligation to two levels of service, an HUMANISTIC one that addressed the needs of our individual patients and a SYSTEMIC one,, in which medical schools needed o t see themselves as part of the social fabric.
4) He saw the challenges to this as intrinsic to medicine: we are not always engaged in the civic process, our systems tend to be closed and unwelcoming and the system is not engaged with us.

All of this left him with a concept of the socially accountable medical school, in which medical educators actively engage with civic society to create doctors to meet social needs. I do not do it justice, but it was quite engaging. How does this relate to our work in Children’s Mental Health?
For one, the Children’s Mental Health Initiative has begun the process of engaging the Social Services educational system in developing a better “product”, a clinician who can fully utilize this new system that we are building. We need to do similar things in Medical Education, training doctors to think of Mental Health as something other than a default diagnosis to be raised when physical disease has been excluded. The second is that we need to remain focused on the outcome that we want from the Rosie D case: Family Centered Collaborative Mental Health Care based on wraparound principles (not just improved access to psychotropic medications), and not get overwhelmed by the details of the process by which we will get there. Third, we need to see the Children’s Mental Health Campaign as central to the process of improving the quality of care in the Commonwealth, not as a vehicle to a specific legislative end, although, in order to keep the Campaign alive, we will need pay attention to the specific needs of our members and generate some ongoing legislative successes.

Anyway, I’m looking forward to Day 2 of the conference. We present on Day 3. More later.

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