Challenges facing the More Doctors program (Programa Mais Médicos) in vulnerable and peri-urban areas in Greater Brasilia, Brazil

Background A shortage of physicians, especially in vulnerable and peri-urban areas, is a global phenomenon that has serious implications for health systems, demanding policies to assure the provision and retention of health workers. The aim of this study was to analyze the strategies employed by the More Doctors Program (Programa Mais Médicos) to provide primary care physicians in vulnerable and peri-urban parts of Greater Brasilia. Methods The study used a qualitative approach based on the precepts of social constructivism. Forty-nine semi-structured interviews were conducted: 24 with physicians employed as part of the More Doctors program, five with program medical supervisors, seven with secondary care physicians, twelve with primary care coordinators, and one federal administrator. The interviews occurred between March and September 2019. The transcripts of the interviews were submitted to thematic content analysis. Results The partnership between the Ministry of Health and local authorities was essential for the provision of doctors—especially foreign doctors, most from Cuba, to assist vulnerable population groups previously without access to the health system. There was a notable presence of doctors with experience working with socioeconomically disadvantaged populations, which was important for gaining a better understanding of the effects of the endemic urban violence in the region. The incentives and other institutional support, such as enhanced salaries, training, and housing, transportation, and food allowances, were factors that helped provide a satisfactory working environment. However, the poor state of the infrastructure at some of the primary care units and limitations of the health service as a whole were factors that hampered the provision of comprehensive care, constituting a cause of dissatisfaction. Conclusions More Doctors introduced a range of novel strategies that helped ensure a supply of primary care doctors in vulnerable and peri-urban parts of Greater Brasilia. The inclusion of foreign doctors, most from Cuba, was crucial for the success of the health services provided for the local communities, who subsist in violent and socioeconomically deprived urban areas. However, it became clear that barriers from within the health service itself hampered the physicians’ capacity to provide a satisfactory service. As such, what is needed for primary care to be effective is not just the recruitment, training, and deployment of doctors, but also investment in the organization of the whole health system.

Medical service in Serbia before the First world war

Modern medicine in Serbia began to develop only after the liberation from the Turks in the Second Serbian Uprising of 1815. The first European-educated doctors came to Serbia in 1819, by order of Prince Milos. The military medical service, in charge of systematic treatment and care of wounded and sick Serbian soldiers, was founded in 1835. The first military doctors and chiefs of Serbian medicine were foreigners, Dr. Emerich Lindenmeier (1806-1884) and Dr. Carlo Belloni (1812-1878), who founded military hospitals in Belgrade, Ćuprija and Paraćin. During the Serbian-Turkish wars (1876-1878), Serbia had only 19 military doctors for about 130,000 soldiers, the divisions had only dressing stations for first aid, and there was also a medical ship for the evacuation of the wounded. Foreign doctors were succeeded by Serbian doctors educated in Vienna, Dr. Vladan Djordjevic (Chief of Medical Services 1877-1884), Dr. Mihajlo Mika Markovic (Chief of Medical Services 1886-1903) and Dr. Lazar Gencic (Chief of Medical Services 1909-1915). By 1885 (Serbian-Bulgarian war), the number of military doctors was increased to one doctor per 1,000 soldiers, and each division (5,000 soldiers) received a field hospital with 200 beds and a medical company with 5 doctors and 100 paramedics. Before the Balkan War (1912), 5 permanent military hospitals with surgical wards were opened, and the medical companies of the divisions had 4 doctors and 450 paramedics, and 4 field hospitals for 400 wounded. For the first time, ambulance trains were used for evacuation and treatment of the wounded. The hygienic-epidemiological service was neglected, and dysentery, typhoid fever and malaria were frequent: in 1913, over 5,000 Serbian soldiers died of cholera alone.

Features of psychosomatization of medical professionals with occupational deformations

Introduction. The stressful conditions of the occupational activity of medical workers lead to the appearance of symptoms of occupational deformations and psychosomatization in them. Purpose. The purpose of identifying the features of medical workers with occupational deformations was achieved by interviewing 6830 medical workers, including 816 cases with pronounced deformations of a professional plan, and establishing links between the components of occupational deformations and psychosomatization. Material and methods. There were used Maslach Burnout Inventory and its modification, Mental Burnout Definition Questionnaire, Questionnaire for Identifying Problems and Their Impact on Health, Psychosomatics of Our Lives, Giessen somatic complaint questionnaire. Mathematical and statistical processing included descriptive statistics, C. Pearson’s correlation criterion, and Cheddock’s table. Results. Medical workers with a high level of exhaustion of emotional and psychoemotional species have a higher average level with a tendency to a high level of deformations of the occupational occupational plan, a higher average level of reduction changes in personal and professional achievements and motivation professional species and an average level of depersonalization processes and estrangement of personal and professional nature dominates exhaustion emotional and psychoemotional species, which determines a high level of complaints about the activity of the cardiovascular system (heart complaints) and intensity of complaints, above average complaints about the activity of the digestive and respiratory systems, gastric complaints, the average level of complaints about the activity of the musculoskeletal system, complaints negative skin reactions, pain in various parts of the body. Discussion. The results of studies by domestic and foreign doctors and psychologists confirm the need for diagnostics, prevention, and correction of professional deformation and leveling of psychosomatic symptoms of medical workers in the context of health care reform. Conclusion. Psychosomatization of medical workers with professional deformations develops according to the coronary type, which gives reason to recommend to medical workers systematic diagnosis, prevention, and treatment of disorders of the cardiovascular system.

Aulus Cornelius Celsus – a famous Roman encyclopedist

The ancient Romans did not work as physicians, but they used the services of foreign doctors, mostly Greeks. During the times of the Roman Empire there emerged a class of well-educated patricians, who possessed knowledge in various field. Aulus Cornelius Celsus, the author of a voluminous work, was one of such patricians. Of the numerous volumes of his encyclopaedia only a fragment on medicine in extant. The piece which remains intact is a collection of medical knowledge of those times.

Treatment of mentally disturbed persons in medieval Serbia

The treatment of mental health patients in Serbia in the Middle ages was the same as in other European countries. Medicine of that time was based on science, the use of magic rituals and witchcraft was banned. Doctors from Serbia, Byzantium and the national doctors had been educated in Salerno and Montpellier, the most developed centers of medicine. They took the exam in front of the government Medical testimony. The development of medicine was followed in the Hodoloski code which was considered the oldest record of folk medicine and the Hilandar medical code which represented a collection of medieval scientific European medicine and Serbian medicine culture (XII-XV). The first Serbian hospital was established in Hilandar in 1199. The founder was Saint Sava who wrote the rules about the work of the hospital. Actually, it was the practice for all medical facilities that were opened later. We know about mental diseases and healing in Serbia from Lives of Saints in monasteries Zica (from 1207) and Decani (1327) and from the biography of Medieval ruler (king) Stephen of Decani. The illustrations of healing some patients with mental diseases were shown on frescoes and in the lives of saints. In Medieval Serbia, there were 49 foreign doctors working (15 in XIV, 30 in XV and 4 in XVI century) and until Turkish conquest Serbia took a very important place in Medieval Europe. Objective of this paper is to show where psychiatric patients were treated in Medieval Serbia, the way they were treated, who treated them, where the hospitals were and what kind of treatment wereapplied.

Relevanz sprachlicher Kompetenzen im Anästhesistenberuf in Deutschland

This article aims to show the importance of multilingualism in academic education on the example of video-recorded interview between a foreign anaesthetist and her patient. As follows from the analysis of the transcript, the anaesthetist’s limited knowledge of German impairs her competence to conduct the conversation appropriately. This perspective on the professional context of app. 55.000 foreign doctors currently working in Germany shows the (medical and legal) relevance of mastering the national language in academic professions – especially in cases in which the communication between experts and laymen occurs on a daily basis.

Upscaling the South African Health Sector through the Integration of Skilled Migrants

Considering the skills shortages in the South African health sector, this study explores the possibility of integrating foreign medical doctors into the under-staffed South African health sector. In achieving this aim, semi-structured interviews were conducted amongst 37 medical doctors, alongside three business entities who recruit skilled migrants. More so, textual analysis and review of audited documents in alignment with this papers theme are reviewed. The study emphasises that no assertive policies or stratagem have been enacted or devised by the South African government or non-governmental entities in integrating such foreign doctors. In furtherance to this, no comprehensive documentation of migrants’ competence has been considered at the port of entry by the Department of Home Affairs which, on its own, represents a missed opportunity. As an agendum to integrating foreign medical doctors regionally, nationally, or locally, the study advocates a comprehensive compilation of migrants’ skills, competence, and qualifications at the port of entries. Such useful data will not only be used for decisive policies but could also be used to integrate, relocate, or mix-match skilled migrants into the under-staffed South African health sector, or integrate them into regions across the globe where their services are needed.