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Samar AhmedSamar Ahmed, M.Sc., M.D., J.M.H.P.E.
Director, ASU-MENA-FAIMER Regional Institute
FAIMER Institute 2011 Fellow
Director, Quality Assurance Unit
Ain Shams University Faculty of Medicine
Cairo, Egypt

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Dinesh BadyalDinesh Badyal, M.B.B.S., M.D., Dip. Clinical Research
Director, CMCL-FAIMER Regional Institute
CMCL-FAIMER Regional Institute 2007 Fellow
FAIMER Institute 2009 Fellow
Professor and Head
Department of Pharmacology
Christian Medical College
Ludhiana, India

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Ciraj Ali MohammedCiraj Ali Mohammed, M.Sc., Ph.D.
Director, MAHE-FAIMER International Institute for Leadership in Interprofessional Education
CMCL-FAIMER Regional Institute 2008 Fellow
FAIMER Institute 2010 Fellow
IFME 2013 Fellow
Professor of Microbiology and Deputy Director,
Manipal Centre for Professional and Personal Development
Manipal Academy of Higher Education
Manipal, India

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Sudha RamalingamSudha Ramalingam, M.D., P.G. Dip. (Bioethics)
Co-Director, PSG-FAIMER Regional Institute
PSG-FAIMER Regional Institute 2010 Fellow
Professor, Department of Community Medicine
Registrar Research
PSG Institute of Medical Sciences and Research
Coimbatore, India

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COVID-19: Reflections from the FAIMER Community

Fellows and faculty from the FAIMER Institute and Regional Institutes share their experiences during the global COVID-19 (Coronavirus) pandemic.

Mitra AminiMitra Amini, M.D., M.P.H., M.S.
FAIMER Institute 2019 Fellow
Professor of Clinical Education Research Center
Shiraz University of Medical Sciences
Shiraz, Iran

There are many cases of COVID-19 infection and a high number of deaths all over the world. I am a Medical Doctor, and this affects me professionally. There are reported deaths among healthcare staff across the globe.

Medical schools’ missions have changed to e-learning courses. We are working hard to improve our lessons in an offline and online format. Our last-year medical students are working at hospitals. We are thinking of designing online teaching and learning opportunities for medical students in the clinical wards.
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I also tried to write some manuscripts about this pandemic. I sent a letter about the lessons learned during the COVID-19 pandemic to Medical Teacher journal, a Really Good Stuff about mentoring our students to medical education journals, and a rapid review of social isolation to the Iranian Journal of Medical Sciences. I am writing a review of all the different social aspects of this pandemic all over the world.

I am a professor and work at a medical school and also an outpatient clinic. My husband is an associate professor and an infectious disease specialist and visits COVID-19-infected patients in the hospital every day. My daughter is a medical student and works at a hospital. We treat all medical students like our children. We have tried to be the best role models as a dual-career academic medicine couple and a three-physician family in this hard situation. We decided to help our medical students, our people, and our community to overcome difficulties during the COVID-19 pandemic.
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Jarina BegumJarina Begum, M.B.B.S., M.D.
CMCL-FAIMER Regional Institute 2018 Fellow
Associate Professor, Department of Community Medicine
Great Eastern Medical School and Hospital
Srikakulam, India

Things may go wrong
Virus may get strong

But we learned the way beyond
So made true relation & worthy bond

Nothing is completely normal...
Nothing fitting to the rationale...

No one is in absolute health...
Seems like an undeniable myth...
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If you will ask me about normality??
It’s like Einstein theory of relativity...

What exists in matter is time, space, and gravity...
We know it as our subconscious mind & subjectivity...

Yes it is going to stay
There is no other way

Home is of course sweet home
But no other place to roam

Hours seems like ages
And the walls like cages

We all are scared to death
While doing the aftermath

It was just a small ripple indeed...
Brought the world into stampede...

Are we really expecting a miracle...
When we realize no one is invincible...

Fear & crisis flaming everywhere,
We could do nothing but stare...

Don't want to look at the number...
Just be at home in deep slumber...

Hoping for the light to come through
Enduring all the pain and accrue

Going back to Stone Age like a caveman
But with laptops, mobiles, and virtual plan

Aspiring for a world with Naturalism
Evolution, adaptation, and Darwinism...
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Abebe BekeleAbebe Bekele, M.D., M.Med., Ph.D.
FAIMER Institute 2014 Fellow
Founding Dean and Deputy Vice Chancellor of Academic and Research Affairs
University of Global Health Equity
Kigali, Rwand

“Some have described the COVID-19 crisis as a ‘great equalizer.’ After all, it has invaded the world’s richest economies, with the virus infecting some of their most prominent figures, from politicians like UK Prime Minister Boris Johnson to Hollywood royalty like Tom Hanks. But developing countries, especially the poor within them, remain far more vulnerable than their developed-country counterparts, not only to the pandemic’s health consequences, but also to insecurity—and instability—stemming from the response.
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So far, the most effective measures for limiting the spread of COVID-19 are travel restrictions, physical distancing rules, and full quarantine, where applicable. But rapid implementation is essential.

We have seen that in some African countries, such as Rwanda, where the government grounded all passenger flights for 30 days after confirming just 11 cases of the virus, and then placed the entire country on lockdown for 28 days. Neighboring Uganda soon followed suit, along with Nigeria, South Africa, and Ethiopia, among others.

But the responses elsewhere have been fragmented and weak. Given the scale of global interconnectedness, this should worry everyone.

Developed countries have stronger healthcare systems, but they are still deeply vulnerable: the United States recently reported more than 1,800 COVID-19-related fatalities in a single day. Imagine the effects of a similar outbreak in Africa. There are fewer than 500 ventilators in Nigeria, a country of 200 million people—roughly two-thirds the population of the United States, which has 172,000 ventilators. And as long as the virus is spreading in one country, every country is at risk of new waves of infections. But the danger extends beyond the virus itself. In many developing countries, the vast majority of workers depend on modest daily wages, and cannot work remotely. Social-distancing measures thus threaten their very survival. Only through strong leadership and informed decision-making can African governments protect these vulnerable groups.

Again, some countries are setting a positive example. Rwanda’s government has announced plans to deliver food to more than 20,000 vulnerable households in the capital, Kigali, and to provide essential services, such as water and electricity, for free. But, on the whole, social protections are nowhere near adequate to safeguard Africa’s poor during lockdowns.

For a continent whose recent history has included a lot of violent conflict, this is a recipe for disaster. Economic stress breeds frustration, especially with the authorities, heightening the risks of unrest, renewed civil wars, and military coups. As John Nkengasong, the director of the Africa Centres for Disease Control and Prevention, has warned, the pandemic could be a ‘national-security crisis first, an economic crisis second, and a health crisis third.’

The international community is not doing nearly enough to help African countries mitigate the COVID-19 threat. This is partly a matter of resource constraints: in a pandemic, funding from multilateral institutions like the International Monetary Fund, the World Health Organization, and the World Bank must be shared across many countries, and governments are focusing their resources on domestic needs.

So limited are public resources that many countries are now relying on philanthropic aid. For example, the Chinese billionaire Jack Ma donated 1.1 million testing kits, six million surgical masks, and 60,000 protective suits and face shields to Africa. (He also donated one million face masks and 500,000 test kits to the US—something that would have been unthinkable just a few months ago.) US corporations and billionaires have also made large donations.

But we cannot rely on the benevolence of philanthropists and corporations to win this battle. We need a unified global response—including coordination on measures like travel restrictions and quarantine rules—with effective leadership. And we need rich-country governments and multilateral organizations to increase support to low-income countries, without adding to their international debt.

Resources—from personal protective equipment to testing kits to ventilators—should be allocated according to need. At a time when WHO Director General Tedros Adhanom Ghebreyesus is warning of an ‘alarming acceleration’ of virus transmission in Africa, the continent’s need is clearly growing.

But containing COVID-19 is not enough. Countries must urgently strengthen their health systems, to protect against future outbreaks. This requires investments not only in equipment and infrastructure, but also in personnel, emphasizing medical professionals who are trained to think holistically. At the University of Global Health Equity in Rwanda, we teach our students from the outset to look beyond the immediate clinical reality to account for relevant social, economic, historic, and political factors.

The COVID-19 crisis has demonstrated how fast a new disease can envelop the world, causing widespread suffering and death. Rather than wait for the next outbreak to erupt, and then play catch-up again, all countries should be working to apply the lessons of this pandemic to bolster preparedness and prevention.

Although COVID-19 does not affect all equally, it does confirm the axiom that, in today’s interconnected world, global challenges require global solutions. The only way to build a safer post-COVID world is to ensure that Africa is not left behind.”

This piece originally appeared as an op-ed titled “Averting a COVID-19 Security Crisis in Africa,” published by the Project Syndicate on April 20, 2020.
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Sucheta DandekarSucheta Dandekar, M.Sc., Ph.D., M.H.P.E.
FAIMER Institute 2010 Fellow
Former Professor and Head, Department of Biochemistry
Seth G.S. Medical College and King Edward Memorial Hospital
Mumbai, India

I received the news of the FAIMER institute being postponed on March 4, 2020. My husband and I were to fly out of India on March 5, 2020 to come to the USA. We reached Miami and spent time there with our son's family, but by March 16 things were getting serious. Our return was scheduled for March 23. We had a Swiss Air ticket and the airlines cancelled all flights out of Zurich. Suddenly we were left without a way to return to India, as India decided to ban all International flights into India from March 23. Fortunately, our friend suggested that that we could fly to New York and take a direct 15-hour flight to Mumbai. We did that. We got back in the nick of time, on the last United Airlines flight out of New York. The flight was full of students returning home as most will have online classes.
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My husband and I arrived from the USA on March 21 at 8 pm at Terminal 2, Mumbai Airport. After a tiring journey, we were not sure what to expect. The international airport was a surprise of disciplined activity. It is so well managed by interns and community and medicine departments of the medical colleges. King Edward Memorial (KEM) Hospital interns and preventive and social medicine (PSM) department friends were on duty that day. As senior citizens, we were immediately taken for the quarantine stamp and explained that we would have to go for the tests. There was a choice between Seven Hills Hospital and some hotels on negotiated payment. We chose to remain in the Municipal Corporation of Greater Mumbai (MCGM) as I felt loyalty and knew I would be taken care of there. Our bags were disinfected on arrival at Seven Hills, along with the cab that we came in. We were given beds and clean bedsheets.

Interns, residents, nurses, and SMOs from all the medical colleges and peripheral hospitals were sent in rotation and were toiling round the clock. They worked tirelessly, answering every senior passenger’s queries patiently. What surprised me was that we were not only asked about our medications, but there was a facility to procure them for those who were running out of them. We were served breakfast, lunch, tea, and dinner. Water bottles, sanitizers, face masks, towels, toothbrushes, and toothpaste were provided for those who needed them; all made available for free. Community medicine, microbiology, medicine, nursing departments, and many others like housekeeping came to the rescue.

The Deans of the medical colleges ensured the smooth running of the system; kudos to them. All the departments of MCGM were so good to us, I cannot thank them enough. All services were free of charge. The security took care of the people, ensuring that they did not gather in herds and also looked after the belongings. Nowhere in the whole journey at Seven Hills Hospital were we ever referred to as patients. We were called passengers. That was a great morale booster indeed. Also, families were not separated and there were no male and female demarcations.

We were discharged on March 25 in the evening, after our throat swabs were negative. There is a lockdown in Mumbai but the MCGM sent us home in buses with emergency vehicle stamps on them. We were then placed in home quarantine until April 4.

The quarantine experience has taught me a lot. I met so many people from all walks of life and though we had social distancing, we talked to each other on phone. That was fun. We kept our spirits going. I wrote a post about my positive experience and the role played by our interns and residents and this has gone viral. The Commissioner's office contacted me and they have spread the blog to many groups. The newspapers also interviewed me and students’ parents have been calling me. Our students are helping in the quarantine places, taking blood pressure, counselling the inmates, and helping in the discharge process. My book in Biochemistry is coming up for the second edition so I am going to try and finish it. I am preparing for some workshops that are scheduled for later in the year. Telling myself that this too shall pass and we shall have a new beginning.
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Sanjoy DasSanjoy Das, M.D.
CMCL-FAIMER Regional Institute 2015 Fellow
Professor and Head, Department of Forensic Medicine & Toxicology
Himalayan Institute of Medical Sciences
Dehradun, India

With COVID-19 spreading its tentacles globally and the world going into a standstill all of a sudden, life became entirely different, difficult, and disrupted. As a Forensic Medicine expert and medical teacher, I thought that I shall have nothing to do and this worried me...until... one day I was chosen to work as the Nodal officer for COVID-19.
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This made me plunge into an entirely new dimension of reading all the guidelines issued by the government; planning isolation areas and facilities for COVID suspects; and charting out methods of triage, routes, testing, treatment, discharge of patients, and disposal of dead bodies. In addition to these, regular preparation of updates for reporting, public awareness mechanisms, and networking with various stakeholders including relatives and media have slowly become a part of my job description. Many a time I travelled back down the memory lane, reflecting on the communication and networking areas that I had so lovingly learned during my FAIMER Fellowship days.

Teaching-learning has always been in my mind, and one day, I dawned upon creating a different type of multiple choice questions (MCQs) for my students; especially when classroom teaching and assessment has come to a grinding halt. I started creating graphic MCQs using Adobe Photoshop with stems conjured to induce high order thinking. This made me realize that Forensic Medicine & Toxicology has an unfathomable bounty of resources for such creativity. To date I have designed about 500 such MCQs. I am waiting to administer these to the medical students and build a question bank of graphic MCQs after assessing their difficulty indices.

As a nature photographer, I have discovered that there are more birds and small animals in my backyard than I had ever imagined. I am planning to prepare the second edition of my book on wildlife, titled The Jungle Call. I have adapted myself to the theme of staying safe, helping COVID containment, and creating... even some new recipes in the kitchen.
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Sanjoy DasBen Halili, M.A., Ph.D.
FAIMER Institute 2014 Fellow
Head, Instructional Materials Development Office
Zamboanga State College of Marine Sciences and Technology
Zamboanga City, Philippines

We are beginning a nationwide quarantine. By midnight, nobody is allowed to go out. When rebels attacked our city in 2013, the same measures were practiced but more stringent. At least then, we knew the enemy and it was contained through dragnets and bullets, but the current pestilence is invisible and might have already invaded us.
Mergan Naidoo
Mergan Naidoo, M.B.Ch.B., M.Med., M.Sc., Ph.D.
FAIMER Institute 2019 Fellow
Family Physician
Associate Professor and Academic Leader, Teaching and Learning
School of Nursing and Public Health
University of Kwazulu-Natal/Wentworth Hospital
Durban, South Africa

I am a now a full-time clinician at a local hospital. We have run out of personal protective equipment (PPE) and we have no N95 masks in the hospital. We are currently all using surgical masks which may prove to be a major problem as we still see many patients with tuberculosis (TB) on a daily basis. I examined three patients with suspected TB during my ward round yesterday. The 24-hour hotline is overwhelmed and nobody answers it anymore. Yesterday, a sister hospital had a very ill patient with suspected pneumonia though to be due to COVID-19.
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They intubated the patient in the Emergency Department of a district hospital and then could not get the patient accepted at any intensive care unit (ICU) because the COVID-19 ICU needed the patient to be confirmed as a case and the non-COVID-19 ICU did not want to risk infecting others. It is an absolute ridiculous state because the emergency physicians are not equipped to manage such patients for a prolonged period of time and this is also not good for other health care workers (HCWs) and patients using the facility. Test results take 24-48 hours. There is a lot of panic, even among HCWs. A patient of mine was refused an emergency CT scan of the brain on Friday as the radiologist wanted me to exclude COVID-19 despite the patient not satisfying the case definition for a person under investigation. (Written March 23, 2020)

I am now the chair of the COVID-19 task team (TT) at my hospital, and we are slowly implementing measures to deal with the anticipated surge that we are expecting in the coming weeks. We still have minimal PPE at the hospital, and we have started using private sponsors who have been great in supporting HCWs at the institution. The Gift of the Givers, a South African based humanitarian organization heard of our plight and assisted with PPE. As a TT we meet daily and tweak what we are doing. Patients with suspicious symptoms are triaged out of the queue before they enter the facility, given a mask, and moved to a special area in the hospital, where they are assisted. We are advocating for universal cloth masks for the public and a group of women sewed approximately 600 masks which we distributed to all staff and encouraged them to wear in public areas. Our lockdown has been extended to five weeks and one is only allowed to go out to get groceries or medical assistance. The outpouring of assistance from private individuals has been phenomenal with various companies helping with food, PPE, and even ventilators. Our infections are predicated to peak in July/August 2020, so we are still very early into our epidemic. The lockdown has allowed us to prepare our facility for the coming uncertain days ahead. (Update provided April 17, 2020)
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Jyotsna Rimal, B.D.S., M.D.S.
Jyotsna Rimal, B.D.S., M.D.S.
CMCL-FAIMER Regional Institute 2013 Fellow
Professor and Head, Department of Oral Medicine and Radiology
Coordinator, Health Professions Education Core Group
Department of Health Professions Education
BP Koirala Institute of Health Sciences
Dharan, Nepal

By specialization, I am an Oral Physician and Maxillofacial Radiologist. After lockdown, the university management decided to halt the outpatient service until further notice. BP Koirala Institute of Health Sciences being one of the Level 3 hospitals in the country, the logistic, infrastructure, and hospital consumable needs were reprioritized. In spite of having plenty of Personal Protective Equipment (PPE) provided by the government and donations received from organizations, the rapid response team (RRT) was not utilizing them.

Though not active in the hospital services, I was vigilantly observing the gap. I did not have a frontline role; however, my human side did not allow me to just stay at home idly. The concern of health care professionals, especially allied health workers, was bothering me. The RRT was working hard like Trojans but there seemed to be a chaos. After a conversation with RRT team members, it was realized that the PPE kits were incomplete. N95 masks, protective eyewear, and face shields were not included in the kits.
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My department team agreed to help out on this. We approached the Rotary club who arranged N95 masks and protective eyewear. Face shields were not available in the market, hence our team decided to make face shields in the department. Other dental departments also extended their support. So far, we have supplied 350 face shields and are continuously making more. RRTs were also overburdened in providing hands-on training of donning and doffing procedures for PPE. To extend support, our team got trained by the RRT and provided training to a total of 75 allied health workers in small groups.

It is a difficult time for all. Altruistic behavior is what is needed at this point of time. FAIMER association has been an integral part in inculcating team building and community of practice in me. I am happy that my team has been able to hone altruism in this crisis situation.
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Z. Zayapragassarazan
Z. Zayapragassarazan, M.Sc., M.Ed., PhD.
PSG-FAIMER Regional Institute 2015 Fellow
Convener, MCI Regional Centre
Advanced Trauma Life Support (ATLS®) Educator
Additional Professor and Head, Department of Medical Education
Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)
Puducherry, India

The COVID-19 pandemic has offered me new experiences that can be reflected upon to gain further insights on how educational systems are undergoing transformation at various degrees and how these transformations would redefine medical education and health profession education in the near future.
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The lockdown which has been imposed to strictly implement social distancing to combat COVID-19 has threatened the right to education of students all over the world. This has forced educational institutions to shut down until further orders and have suddenly shifted to online teaching and assessment of their students. Institutions and individuals once skeptical towards online have resorted to online tools as an alternative to classroom teaching. This situation has forced all teachers and learners including the technologically challenged ones to start using different technological tools for their teaching and learning activities. Institutions have started exploring alternate ways for engaging their remote learners to keep them productive during the lockdown period. Teachers have actively started looking for alternate methods for assessing their students using valid and trustworthy tools. Teachers and educational administrators have started thinking about technological tools that can complement or substitute classroom teaching. Institutions have started conducting webinars to train their faculty in using digital tools. Implementation of online teaching has transformed the way students use their mobile phones and laptops and have suddenly become aware of educational apps and have started devoting dedicated screen time for their learning tasks.

Our institute (JIPMER) was successful in engaging our teachers and students to use Zoom, Canvas, and Google Classroom for online teaching and assessment activities. This lockdown has provided a doorstep opportunity for teachers to explore and experiment with various technologies for teaching, learning, and assessment purposes. Just three weeks before the lockdown we from the Department of Medical Education in JIPMER organized an in-house workshop on “Information and Communication Technologies (ICT) in Medical Education” providing hands-on experience on selected tools for online education. These encouraged our faculty to employ the technological tools comfortably and were able to cope up with this unprecedented educational crisis due to COVID-19.

The Department of Medical Education coordinated with the Dean (Academic) for successful implementation of online teaching, learning, and assessment activities. I utilized this opportunity to compile different strategies for engaging remote learners in the wake of COVID-19 and published a strategy document titled "COVID-19: Strategies for Engaging Remote Learners in Medical Education" in the F1000Research which can be accessed from https://doi.org/10.7490/f1000research.1117846.1.

Though I am extremely happy to witness the role of technology in medical education in the current scenario of educational crisis, at the same time, I am also excited to know to what extent the educational responses by medical institutions to this COVID-19 has yielded the desired outcomes. It has increased my interest in knowing the effectiveness of these technological tools employed for teaching, learning, and assessing students in a professional course like MBBS, which is typically conducted as a formal face-to-face educational and training program all over the world.

It has invariably been a heated discussion in many of the faculty development programs about how difficult it is to change a system. In the present climate, I have understood systems ordinarily require a crisis to transform, i.e., necessity is the mother of invention. This has forced educators like me to think of newer perspectives in training the teachers of health profession education.

The education policy makers once apprehensive about allowing cell phones inside college campuses have now started feeling the presence of classrooms inside the cell phones. The lockdown is an opportunity to educational researchers to test how effective it would be if health profession courses are offered as distance education programs. Since most teachers and students have suddenly embraced this type of education, this gives us an opportunity to study the success factors behind remote learning. The apprehension regarding the validity and trustworthiness of unsupervised online tests has motivated me to prepare guidelines for unsupervised online tests. This COVID-19 pandemic has minimized the digital divide among teachers and students and a new beginning has started in the health profession education. Students and teachers have learned to use their mobile gadgets and computers purposefully for their teaching-learning activities. The current lockdown is only for physical spaces and physical contact and not for our minds. The techno pedagogical practices that emerge in response to COVID-19 may be investigated to identify the best educational practices. These best practices may then be recommended for implementation in medical and health profession education which, I believe, could transform the way we educate our future doctors and other health professionals.
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[last update: May 15, 2020]