Viviana Martinez-Bianchi, M.D.: Pasión por el cuidado de las personas

Wednesday, September 6, 2017

Viviana Martinez-Bianchi
Viviana Martinez-Bianchi

“Pasión por el cuidado de las personas” (passion for caring for people) was the title theme of the World Organization of Family Doctors (WONCA) Iberoamerican regional meeting in Peru two weeks ago. As explained on the meeting website the specialty of Family and Community Medicine is growing and gaining strategic spaces all over Ibero America (Spanish and Portuguese speaking countries). The presence of family doctors in primary health care teams is increasingly visible, as is their contribution to the good health of the people.   

The Sociedad Peruana de Medicina Familiar y Comunitaria, together with WONCA CIMF were hosts and organizers of of the meeting, it was attended by 1,400 people from 22 countries, with a scientific program that emphasized attention centered on the person, health inequities, quaternary prevention (actions taken to identify a patient at risk of over medicalization, to protect them from new medical invasion, and to suggest interventions which are ethically acceptable), communication in the clinical interview, shared decision-making, family and community approach, and innovation and new technologies in primary care. There was also an amazing display of art and culture, theatre presentations and dancing, as well as poetry and photography contests. The meeting was run “without industry fumes”- a concept of pride in this WONCA region, that does not accept pharmaceutical industry monetary support for their conferences.

The Duke Family Medicine Residency Program played a role as a host of a preconference workshop on leadership — co-facilitated with Shailendra Prasad, M.D., MPH, from the University of Minnesota — a workshop on surgical procedures for the primary care office setting, and a closing keynote on the leadership skills needed to strengthen family medicine in the world.

I have been traveling to Latin America for several years, having been invited to national academy meetings in Argentina, Chile, Costa Rica and Peru; and WONCA Iberoamericana Region high-level meetings called Cumbres in Asunción, Paraguay; Quito, Ecuador; and San José, Costa Rica; and WONCA regional congresses in La Habana, Cuba; Montevideo, Uruguay; and the world meeting in Rio de Janeiro Brazil; where I have held different roles, and led workshops and lectures.

More than just conferences, these are opportunities to meet with a cohort of family medicine colleagues from all over Ibero America, with whom I walk the wonderful, and at-times difficult, path of teaching, learning, mentoring and strengthening family medicine. I find it is always exciting to learn how the specialty is practiced in a diversity of settings, and I contribute with my knowledge when I can, as much as my colleagues contribute to mine. The increasing global burden of chronic diseases and multi-morbidity, alongside a pressing need to ensure a strong primary care workforce in the face of communicable disease outbreaks, makes strengthening family medicine a priority in low, middle- and high-income countries alike.

This Congreso Wonca Iberoamericana-CIMF in Lima was exciting for me as the Duke Residency Program director, in that I co-led the workshops with Samuel Fam, DO, our chief resident. Thanks to the support of alumni of the residency program, our residents can now experience global meetings and rotations around the world. My hope is that some of our residents will follow in the steps of Duke Family Medicine Residency graduates Stephen J. Spann, M.D., MBA, and Marc Rivo, M.D., MPH, who have been avid participants of WONCA activities and strong advocates for the development of family medicine worldwide. 

Preparing to lead in times of change

The leadership workshop brought 250 people together for eight hours of training. Students and colleagues — young and old, seasoned public health sector medical leaders, residents and new physicians — excited to learn leadership skills or to see how we teach these skills attended the preconference. Throughout the different activities, it was always exciting, and humbling, to witness the resilience and passion of those working in conditions of significant duress, and to hear from those in countries where family medicine is not yet understood, or where it has low relevance to ministers of health or other bureaucrats convinced that primary care involves a series of simple visits.

Part of the workshop was to prepare to convey the complexity of the care we provide, and the depth and breadth of family medicine. Leading in times of change, advocacy, conflict negotiation, understanding paradox in decision making, and climbing the ladder of situational leadership where some of the topics covered. Dr. Fam led the session “Communicating Change: Having difficult conversations, and other tricks in the path of the leader.” It was beautiful to watch him use his newly acquired Spanish-language skills, obtained through studying and exposure attending the community medicine and language rotation in Cacha, Ecuador.    

On Friday, Dr. Fam and I facilitated a “procedural skill for the primary care office” workshop, using tomatoes for abscesses, and pigs feet that we treated with subcutaneous soft balls to simulate cysts. The workshop was attended by residents ready to learn new skills, and faculty eager to learn teaching techniques. Here at the Duke family medicine residency we are big proponents of simulation to gain dexterity and hand and finger “muscle memory” before going to work on a patient, and it is my hope that more residency programs worldwide can use simulation to enhance skills at all settings. Each attendee had the opportunity to take their new set of tools home, and we ended with a proposal to teach the skills to those at home in their country or region of origin.

Saturday, I was honored with the invitation to do a keynote on leadership which I titled “Family Medicine, leading in times of change.” To achieve universal health coverage equitably and sustainably health systems must be based on strong primary health care. To achieve strong primary health care a well-trained and motivated primary care workforce is fundamental. In times of change, family medicine needs to raise up as a specialty worldwide, be the answer to primary care needs in every corner of the world, and for that to become reality, we need to not only train as excellent clinicians, but to also work on our skills as leaders. Leaders to make systems change, to convince through data, to use proven quality improvement methods to implement change, and evidence to improve the health of individuals, families, communities and populations.

This is of special importance in times of political turmoil, war and refugee crisis, when budget cuts and short-sighted policies appear to take the biggest toll on vulnerable communities. I dedicated my presentation to our patients, the people we care for, and especially to those who in the words of Uruguayan writer Eduardo Galeano are the “nobodies” or the “nobodied” and forgotten of every society. One of our important roles as leaders is to make sure that every person has a family doctor and health care team that knows them by their name, so that no one is a “nobody” in our care.

The Nobodies

Fleas dream of buying themselves a dog, and nobodies dream of escaping poverty: that one magical day good luck will suddenly rain down on them–will rain down in buckets. But good luck doesn’t rain down yesterday, today, tomorrow, or ever. Good luck doesn’t even fall in a fine drizzle, no matter how hard the nobodies summon it, even if their left hand is tickling, or if they begin the new day with their right foot, or start the new year with a change of brooms.

The nobodies: nobody’s children, owners of nothing. The nobodies: the no ones, the nobodied, running like rabbits, dying through life, screwed every which way.

Who are not, but could be.

Who don’t speak languages, but dialects.

Who don’t have religions, but superstitions.

Who don’t create art, but handicrafts.

Who don’t have culture, but folklore.

Who are not human beings, but human resources.

Who do not have faces, but arms.

Who do not have names, but numbers.

Who do not appear in the history of the world, but in the police blotter of the local paper.

The nobodies, who are not worth the bullet that kills them.

I am thankful for the opportunities to learn from colleagues from around the world. If you are looking for an opportunity to learn or share a topic you are passionate about, consider attending the next WONCA regional meeting. I promise it will be an amazing experience.

Viviana Martinez-Bianchi is program director of the Duke Family Medicine Residency Program and a member of the Executive Council of WONCA. Email with questions.
Editor’s note: A member of the Duke Family Medicine Residency Program leadership team guest blogs every month. Blogs represent the opinion of the author, not the Duke Family Medicine Residency Program, the Department of Community and Family Medicine or Duke University.