Dr Shafi Bhuiyan is pictured here with a team of ITMDs. Foreign-trained doctors are underutilized in Canada despite shortages of trained personnel.

By Shafi Bhuiyan and team of ITMDs
Toronto, Canada, Aug 20 2021 (IPS)

Canada is ranked number one out of 78 countries globally, with the highest marks in social purpose indicators, emphasizing human rights, social justice, and racial equity commitment, according to a recent U.S. News & World Report survey.

The country follows the Equity, Diversity, and Inclusion (EDI) principles, incorporating them into research and workplace environments, and it acknowledges challenges vulnerable populations face. Adopting these principles in every aspect of people’s lives makes Canada one of the most attractive places for numerous immigrants worldwide, with more than 13 000 internationally trained medical doctors (ITMDs) calling Canada home.

Canada’s health care is based on social equity fundamentals, having universal health coverage for essential medical services free of charge. Nevertheless, in 2019, about 4.6 million Canadians claimed that they do not have regular medical practitioners to seek advice or help.

In 2020, the highest record of 10.5 weeks waiting time from a family physician referral to specialist consultation was documented, with additional 12.1 weeks interval before treatment was initiated.

The COVID-19 pandemic aggravated these issues resulting in about 16 million healthcare services backlogs in Ontario alone. These will need up to almost two years to be resolved.

At the same time, Canada possesses significantly underutilized skilled healthcare professional resources trained abroad. According to the survey conducted among recent ITMDs graduates, 35% have passed the required licensing exams, including Medical Council of Canada Qualifying Examination Part I (MCCQE1), the National Assessment Collaboration Objective Structured Clinical Examination (NAC OSCE). This means they are eligible to enter the residency.

Very few will secure a residency position. The residency quotes retrieved from the Canadian Resident Matching Service (CaRMS) website showed that only 325 out of 3,365 (less than 10 %) spots were available for international medical graduates (IMGs) for the first iteration of the 2021 matching process.

Out of 1,358 IMGs participants, 948 (almost 70%) were unmatched this year partly due to a lack of transparency and understanding of the process rules.

Not to mention the cost associated with licensing examination, the CaRMS application process is a significant financial burden and even a barrier in many cases for the newcomers. According to Statistics Canada report, 47% of foreign-educated health professionals are either unemployed or employed in non-health-related positions that required only a high school diploma.

Nevertheless, internationally trained medical doctors play a significant role in fighting the COVID-19 pandemic, supporting the vaccination clinics, working as contact tracing managers and mental health advisors.

Another issue that needs an urgent solution is physician wellbeing. A recent study in Vancouver showed that the burnout rate reaches 68% among doctors, with 63% feeling emotionally exhausted and 39% depersonalized. Moreover, 21% of them had resigned or have thoughts about leaving their career.

On top of that, the aging population required complex care, along with a growing diverse population of Canada, underserved racialized, and newcomers’ communities need a considerate strategy to encompass community-based, culturally sensitive approaches to health care.

The ITMDs is a culturally diverse group with rich experience in different fields of medicine and research. Thus, foreign-educated health care professionals are fit perfectly to engage underprivileged communities, promote health and disease prevention, and manage multiple health priorities. Hence, the integration of internationally trained health care professionals could be a turning point to solve the current and prospective issues.

Moreover, 80% of Canadians stated that they feel comfortable being cared for by doctors who obtained mainly their training outside Canada, with 83% claimed that it should be more action to ensure fairness and opportunities for IMGs to practice medicine.

The question is: Why are internationally trained medical doctors still sidelined? The action is for the government to bring Equity, Diversity, and Inclusion (EDI) principles into the Canadian health care system.

Thus, a clear roadmap to integrate internationally trained healthcare professionals is necessary to address all existing challenges and strengthen Canada’s health care system. A move considered to be highly beneficial for all stakeholders (patients, physicians, ITMDs, government).

Collaboration is vital to move forward and make the ‘no one left behind ‘strategy a reality.

• The authors are from Asia, the Middle East, Africa, and South American countries.   
• The co-authors are: Drs Bhuiyan S, Krivova A, Orin M, Azam S., Shalaby Y, Tasnim N, Badran H, Al-Chetachi W, Radwan E, Tazrin T, Biswas M, Min K. S, Mehrotra M, Anuradha, Quintanilla E, Begum N, Adhikary I, Fatima N

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CLEAN-India is an environmental assessment, awareness, action, and advocacy programme that promotes behavioural change among young city dwellers in India. As part of the programme, a group of female students learns about the importance of clean water. Credit: Development Alternatives

By Prerna Sodhi
NEW DELHI, May 16 2015 (IPS)

“Swachh Bharat”, or Clean India, is a slogan that most Indians today associate with the country’s Prime Minister Narendra Modi and his first nation-wide campaign launched soon after taking office in 2014.

The call has definitely awakened popular consciousness on cleanliness but whether citizens follow it or not is another matter. In fact, it is commonplace to find people calling out “Swachh Bharat” as they toss garbage onto the street.

However, while the campaign may not have brought about the change it was aimed to usher in, a dialogue has started and it is a watershed moment for all those working in this area to capitalise on its momentum.The call for “Swachh Bharat”, or Clean India, has definitely awakened popular consciousness on cleanliness but whether citizens follow it or not is another matter

The idea of cleaning India up is not new, and neither is the term “Swachh Bharat” which has been used by many in the past and has now been “patented” by Modi. For decades, there has been concern with instilling an awareness of the need for cleanliness among citizens, many of whom even defecate in the open.

The current initiative by the government may address the issue of cleanliness at citizens’ level, but activists in the field of sustainable development argue that it should also cover issues related to water, energy and sewage disposal cleanliness.

Access to clean water is one of the main problems that the country faces. According to a report by UNICEF (the U.N. Children’s Agency) and the Food and Agriculture Organisation (FAO), every year around 37.7 million Indians are affected by waterborne diseases, 1.5 million children die of diarrhoea alone and 73 million working days are lost due to waterborne diseases.

The problem does not appear to lie in the lack of availability of water treatment methods, but rather in the unwillingness of people to adopt these methods.

“From the field, we observed that the lack of adoption of water purification techniques is not due to low awareness levels and it was not even illiteracy, as is often assumed,” said Kavneet Kaur, field manager for Development Alternatives (DA), a social enterprise set up in 1982 to tackle the serious impact of climate change on society and the environment.

“There was an evident lack of effort and prioritisation of safety among people to undertake one or more options consistently that made drinking water safe,” she added.

Most slum dwellers, for example, “opted for methods that did not cost their pocket a penny. Those who did have access to cheaper methods of treatment, like chlorination and solar water disinfection (SODIS), avoided adopting these methods because they were time consuming.”

For the last 30 years, DA, which works primarily in Bundelkhand in central India, has been addressing the behaviour change necessary for people to adopt water treatment methods.

According to Dr K. Vijaya Lakshmi, DA Vice President, out of the three interrelated components of water, sanitation and hygiene, “hygiene behaviour has been shown to have the biggest impact on community health.”

However, she notes, “despite its merit as the most cost effective public health intervention, ironically there was no global target to improve hygiene during the Millennium Development Goal (MDG) era. It has become evident that the MDG framework has fallen short of addressing quality, sustainability and equity issues.”

To date, DA has reached out to 50,000 households and 26 schools through intensive advocacy campaigns in urban villages, offering training on how to adopt safe water treatment methods such as SODIS, boiling, chlorination and sieving, despite meeting strong resistance from the local population.

For example, storing water in a PET (polyethylene terephthalate) bottle exposed to sunlight can kill up to 99 percent of the bacteria in the water, an “innovation” that uses nothing but natural ultraviolet (UV) light to provide safe drinking water for consumption. Water can also be purified by sieving boiled water.

Apart from advocating the adoption of these simple water purification methods, DA has also come up with innovations like the Jal-TARA Water Filter, which removes arsenic, pathogenic bacteria and excess iron from contaminated water, TARA Aqua+ (a sodium hypochlorite solution for purifying water), and TARA Aquacheck Vial, a device that tests for the presence of pathogenic bacteria.

Nevertheless, these innovations are not destined to go very far unless there is a major change in the mindset of the Indian people, and this extends to the “Swachh Bharat” campaign, not just in terms of clean water but also of a cleaner environment.

This idea has also been the driving force behind a youth-led social media campaign known as CLEAN-India ‘The City I Want’, launched by SA and now covering ten Indian cities – Mirzapur, Mohali, Vadodara, Alwar, Ambala, Bharatpur, Indore, Nashik, Mussoorie and Rishikesh.

CLEAN-India (where CLEAN stands for Community Led Environment Action Network) is an environmental assessment, awareness, action and advocacy programme that promotes behavioural change among young city dwellers. It has so far mobilised 28 NGOs, 300 schools, 800 teachers and over one million students.

The campaign is flanked by a number of other citizens’ groups such as resident welfare associations, parent forums, local business associations and clubs, which are actively participating in activities for environmental improvement.

“Going forward, it is crucial that civil society organisation practitioners interface with academic institutions in evidence gathering and inform policy-makers and investors in order to create enabling conditions where scalable innovation can flourish,” says Lakshmi.

Edited by Phil Harris   

Excerpt:

By Suleiman Al-Herbish
VIENNA, May 14 2015 (IPS)

When, in 2003, Professor Richard Smalley, winner of the Nobel Prize for Chemistry, listed the top 10 problems facing humanity for the next 50 years in order of priority, energy was at the top of his list, followed by water, then food.

Suleiman Al-Herbish, Director-General of the OPEC Fund for International Development (OFID)

Years later, this energy-water-food nexus is central to the work of the OPEC Fund for International Development (OFID) and a core element of our corporate plan.

It is hard to imagine a better life when you are in darkness and the ‘heart of darkness’ is the widespread lack of access to reliable and affordable sources of modern energy. This darkness continues to impede socio-economic development worldwide.

Nothing is worse than seeing such darkness in the 21^st century first hand. In Armenia, I visited the home of Ms Anahid, one of OFID’s many beneficiaries, whose house had recently been connected to a gas grid.

In her home, I saw a picture of her young son who had been tragically killed by a falling tree while collecting firewood. His young widowed wife sat in the corner and I had overwhelming mixed feelings: immense sadness for a life lost, yet relief that it would never happen again in that region.

It is a brutal moment when one realises the terrible human loss caused by energy poverty, and recognises how easily such tragedies can be avoided.

When one works in development, a single aim is in mind: putting people first. When we put people first, the facts are painful and implausible to ignore. The numbers are absolutely staggering: 18 percent of the world’s population still lives without electricity and 38 percent without clean cooking facilities.

If all of us think of these facts each time we switch on a light, use our phone or eat a meal, the darkness that 1.3 billion people live in becomes painful to imagine and hard to ignore.“It is hard to imagine a better life when you are in darkness and the ‘heart of darkness’ is the widespread lack of access to reliable and affordable sources of modern energy. This darkness continues to impede socio-economic development worldwide”

Despite the work of so many valuable institutions, organisations and pledges, people are often forgotten, and the political will never materialises. Yet, when the will is there, things do actually happen, and believe me, for the past ten years, I have personally seen them transpire.

In 2007, through the Riyadh Declaration, at the third summit of the Organisation of the Petroleum Exporting Countries (OPEC), member countries charged OFID with spearheading the fight against the greatest constraint to development – energy poverty – and long before it became a mainstream topic, OFID pioneered its fight against it.

OFID recognised that universal access to energy was a vital element to achieving the Millennium Development Goals (MDGs) and dubbed it the “Missing 9^th MDG”.

So, in September 2011, when U.N. Secretary-General Ban Ki-moon stated: “Energy is the golden thread that connects economic growth, social equity and environmental stability”, OFID roared.

And when Kandeh Yumkella, U.N. Under-Secretary-General and the Special Representative of the Secretary-General for Sustainable Energy for All, said that “the fact that so many lives continue to be blighted by the absence of electricity or other clean fuels for cooking and heating is without a doubt a shameful indictment of modern society,” OFID found an ally.

We knew that they represented many like-minded individuals who had the will to make our shared fight against energy poverty recognisable to the world.

We were exultant when, in 2012, with the launch of the U.N. Sustainable Energy for All (SE4ALL) initiative, energy access was finally established as a global priority. Energy poverty had finally reached the global agenda and our work throughout the years has been instrumental in attaining energy access.

OFID has been a leading partner in SE4ALL since its inception and instrumental in shaping the proposed Sustainable Development Goals (SDGs) with the eradication of energy poverty as SDG7.

Our commitment to this mission has been practical as well as communicative. Our strategy for poverty eradication has been action-based with a revolving endowment of one billion dollars pledged by our supreme body, the Ministerial Council, in our 2012 Declaration on Energy Poverty.

Over the past few years, OFID has transformed its commitments into actions in the field. This has led the share of energy projects in OFID’s total operations to reach 27 percent in the past three years, compared with around 20 percent since inception. These resources have been distributed among 85 countries for projects ranging from infrastructure and equipment provision to research and capacity building.

As the United Nations marks its 70^th anniversary, we reflect on the historical development of humanity and our unity as an international community to achieve a better world. It is an important time for us to recognize all the efforts in building improved lives and providing dignity to all.

As idealistic as I would like to be, I know there is much more to be done, and the fight is far from over.

What drives our motivation is OFID’s incredible will to continue. Where there’s a will, there is always a way.

I always said, and will continue to say: the day an institution like OFID closes its doors because of the lack of need from its partner countries to alleviate humanity’s countless problems is a day for us all to celebrate.

In the meantime, we will continue our efforts to power lives … one by one, until no single soul living on this planet is in darkness and no mother loses her son as Ms Anahid did.

Edited by Phil Harris

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“Poor and rural communities are disproportionately affected by the climate crisis. It is them – who did the least to create this problem – who are suffering the most from it”. Photo credit: UN Photo/Tim McKulka

By Dipti Bhatnagar and Susann Scherbarth
BRUSSELS/MAPUTO, Apr 1 2015 (IPS)

World governments expect to agree to a new global treaty to combat climate change in Paris in December. As the catastrophic impacts of climate change become more evident, so too escalates the urgency to act.

Mar. 31 should have marked a major milestone on the road to Paris, yet only a handful of countries acted on it. Unfortunately, the few plans that were announced before that date show that our leaders lack the ambition to do what it takes to tackle the climate crisis.

National plans for reduction of greenhouse gas emissions will most likely form the basis of the Paris agreement. These plans – known as Intended Nationally Determined Contributions (INDCs) – are meant to indicate a government’s self-stated commitment to solve the global climate crisis through domestic emission reductions as well as through support for the poorest and most vulnerable countries.“People on the frontline of climate impacts are burning while governments fiddle. People are paying and will pay for the devastation of climate change with their lives, livelihoods, wellbeing, communities and culture”

This architecture will result in an agreement that is weaker than each country being legally mandated to reduce emissions based on their fair share, determined through science and equity.

Yet, even with this architecture, the idea was that national governments would declare these plans by the end of March so that they could then be scrutinised.

Only six pledges had been received by the United Nations by the deadline – from the European Union, the United States, Norway, Mexico, Russia and Switzerland. These nations, with the notable exception of Mexico, are among the worst historical carbon emitters, yet these pledges do not reflect that immense historical responsibility and do not show any real willingness to address the scale of the climate crisis.

The commitments are well below what science and climate justice principles tell us is urgently needed to avoid hitting climate tipping points. The European Union announced target to cut emissions by ”at least 40 percent below 1990 levels by 2030” is merely re-hashed from last year’s announcement.

The United States has cobbled together a plan for a meagre reduction of 26 to 28 percent below 2005 levels, by 2025. If these insignificant pledges are an indication of what is to come, we are on track to a world which will be 4-6°C warmer on average. To put this into context, the climate impacts we are facing today are the consequence of a planet which is only 0.8°C warmer than it was.

So far, none of these countries’ announcements would contribute their ‘fair share’ according to science and equity. All parties are capable of much greater ambition, and it is high time to bring it to the table.

The deadlines that matter most are not set by governments, but by our planet and its natural boundaries, which have already been stretched considerably by the impacts of the climate crisis, for instance by the lethal and extreme weather events from Vanuatu to the Balkans to the Sahel.

Climate change is already happening now, bringing more floods, storms, droughts, rising seas and more devastating typhoons and hurricanes.

The mockery made of this latest Mar. 31 deadline is just another revelation of our governments’ inaction – under the influence of powerful polluting corporations – in the face of impending disaster.

People on the frontline of climate impacts are burning while governments fiddle. People are paying and will pay for the devastation of climate change with their lives, livelihoods, wellbeing, communities and culture.

Poor and rural communities are disproportionately affected by the climate crisis. It is them – who did the least to create this problem – who are suffering the most from it.

We need a just and drastic transformation of our societies, our energy and food systems, and our economies. Proven and workable alternatives exist and are already being implemented.

Key decisions about our energy systems are made regularly, and will of course be made long after the Paris summit. Take for instance U.S. President Barack Obama’s decision on the controversial Keystone XL pipeline, which would bring planet-wrecking tar sands oil from Canada to the Gulf of Mexico.

A decision is expected soon and a rejection of the pipeline project would send a strong signal that our long-term future is not founded on the exploitation and burning of more and more fossil fuels.

European Union governments announced their INDCs back in February with their new ‘Energy Union’ vision for meeting the region’s energy needs. The bloc has recognised the need to reduce energy consumption and help citizens take control of clean, local renewable sources. But these moves towards the good must not be negated with new investments in the bad – new gas pipelines are also on the menu.

Throughout 2015, Friends of the Earth International and others will be bringing more and more people together to fight against the power of the polluters and make sure politicians hear the voices of the voiceless and take real action.

In the run-up to Paris, and along the road beyond, we, together with thousands of others, will be promoting the wealth of real solutions and proven ideas that are already delivering transformation around the world.

We will be on the streets throughout 2015, in 2016, and as long as it takes to realise community-owned renewable energy solutions that benefit ordinary people, not multinational corporations.

The Paris deadline will come and go, like others before. But the energy transformation is under way and, whatever our governments will pledge or not pledge at the climate summit in Paris, the transformation will not be stopped.

Edited by Phil Harris

The views expressed in this article are those of the author and do not necessarily represent the views of, and should not be attributed to, IPS – Inter Press Service. 

* Dipti Bhatnagar is Climate Justice & Energy Co-coordinator for Friends of the Earth International, based in Maputo.

* Susann Scherbarth is Climate Justice & Energy Campaigner for Friends of the Earth Europe, based in Brussels.

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Children having a daily lunch meal at a kindergarten in a poor community in Salvador, Bahia. Brazil's National School Feeding Programme is an example of one of the far-reaching programmes implemented in line with the Millennium Development Goals (MDGs). Credit: Carolina Montenegro/WFP

By Daniel Balaban
BRASILIA, Jan 29 2015 (IPS)

With the current Millennium Development Goals (MDGs) expiring at the end of this year to be replaced by the Sustainable Development Goals (SDGs) which will set priorities for the next fifteen years, 2015 will be a crucial year for the future of global development.

As a country with an outstanding performance in reaching the MDGs, Brazil can play an important role in shaping and achieving the SDGs.

Extensive consultations with governments and civil society have been held in recent years, and consensus around many issues has been established and channelled into a series of documents that will now guide the final deliberations on the exact content of the SDGs. September 2015 has been set as deadline for their endorsement by U.N. member states.

Daniel Balaban, Director of WFP’s Centre of Excellence against Hunger. Credit: Carolina Montenegro/WFP

A Working Group has identified 17 goals encompassing issues such as poverty, hunger, education, climate change and access to justice. While some of these topics were already covered by the MDG framework, there is a new set of goals with emphasis on the preservation of natural resources and more sustainable living conditions, meant to reverse contemporary trends of overuse of resources and destruction of ecosystems.

As governments quickly move to adopt the SDGs, they must capitalise on what has been achieved with the MDGs to secure new targets that will go beyond the lowest common denominator.

Brazil has a compelling track record in achieving the current MDGs, and it can use its experience to influence the final negotiations of the SDGs towards ambitious targets.

The country has already reached four of the eight targets – eradication of extreme poverty and hunger, achieving universal primary education, promoting gender equality and combating HIV – and it is likely to achieve the remaining targets by the end of the MDG deadline.“As governments quickly move to adopt the SDGs, they must capitalise on what has been achieved with the MDGs to secure new targets that will go beyond the lowest common denominator”

Through a set of innovative and coordinated policies, Brazil has tackled these different areas and demonstrated that it is possible to radically decrease poverty and hunger within a decade, giving special attention to the most vulnerable groups.

The National School Feeding Programme, for example, is one of the far-reaching programmes implemented so far. In 2009, the existing policy was upgraded to recognise school feeding as a right, whereby all students of public schools are entitled to adequate and healthy meals, prepared by nutritionists and in accordance with local traditions.

At least 30 percent of the food used to prepare these meals must be procured from local producers, with incentives to the purchase of organic produce.

The programme also devotes additional resources to schools with students of traditional populations, often exposed to food insecurity.

Another feature of the policy is the participation of civil society through local school feeding councils, which oversee the implementation of the programme, as well as financial reports produced by municipalities.

Altogether, the programme tackles a wide range of issues, combining action to combat hunger, ensure adequate nutrition (including of the most vulnerable groups), support local farmers and involve civil society, in line with principles of inclusion, equity and sustainability, which are also guiding principles of the future SDGs.

It is a good example of how the incorporation of innovative features to existing policies can result in more inclusion and sustainability while optimising resources.

As it occupies a more prominent role on the world stage, Brazil has been active in promoting such policies in multilateral fora, in addition to investing in South-South cooperation to assist countries to achieve similar advances.

The WFP Centre of Excellence against Hunger is the result of such engagement. In the past three years, the Centre been supporting over 30 countries to learn from the Brazilian experience in combating hunger and poverty.

Brazil is now in a position to showcase tangible initiatives during the SDGs negotiations to prove that through strong political commitment it is possible to build programmes with impact on a range of areas.

Such multi-sectorial action and articulation will be required if countries around the globe are determined to tackle humanity’s most urgent needs related to hunger, adequate living standards for excluded populations, and development, while reversing the trend of climate change and unsustainable use of natural resources.

The world is at a crossroads for ensuring sustainability. If the right choices are not made now, future generations will pay the price. However daunting the task may be, this is the moment to do it.

Edited by Phil Harris   

The views expressed in this article are those of the author and do not necessarily represent the views of, and should not be attributed to, IPS – Inter Press Service. 

* Daniel Balaban, an economist, is the Director of World Food Programme’s (WFP) Centre of Excellence against Hunger. He has also led the Brazilian national school feeding programme as President of the National Fund for Education Development (FNDE), which feeds 47 million children in school each year. In 2003, he served as the Special Advisor to the Secretary of the Council of Economic and Social Development under the Presidency of the Federative Republic of Brazil.

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