News #5 | April, 2009
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Tutorial Clinical Practice in Tropical Medicina – Training Periods in Angola and Cape Verde
Tutorial Clinical Practice in Tropical Medicina – Training Periods in Angola and Cape Verde
Pofessor Francisco Antunes
Full Professor at the FMUL,
Director of the University Clinic of Infectious and Parasitic Diseases

In 1999 the Faculty of Medicine of the University of Lisbon (FMUL) created the subject of Tropical Medicine as an optional discipline in order to make medicine students sensitive to the learning and specialising of the identification of problems related to public health in tropical regions, the observation and identification of the main agents or parasite infections, the laboratory identification of the main tropical haematological and dermatological diseases and the observation of clinical cases. 

Difficulty in finding patients with genuinely tropical pathology in Lisbon’s Santa Maria Hospital and affiliated hospitals led to the need to create cooperation protocols with hospitals in Portuguese-speaking African countries in order to make it possible for some students who had taken the subject of Tropical Medicine to have Tutorial Clinical Practice in the specialised clinical unit. 

In September 2004 Tutorial Clinical Practice was approved in Cape Verde, through dispatch 72/2004 by the Dean of the FMUL, and it was granted the respective value in credit units foreseen by the cooperation protocol signed with the Agostinho Neto Hospital, in Praia City. Then similar protocols were successively established with the Américo Boavida Hospital, in Luanda, Angola (2005) and with the Faculty of Medicine of the Eduardo Mondlane University, in Maputo, Mozambique (2007), thus widening the supply of places aimed at Clinical Tutorial Practice (in Tropical Medicine). In preparation this year is the signing of a protocol with the Ayres de Menezes Hospital, in St. Thomas City, St. Thomas and Prince Islands. 

Thus, seven students in the subject of Tropical Medicine from the academic year 2002 – 2003 held their first training period in Tutorial Clinical Practice in September 2004 for a period of four weeks. Taking advantage of this stay, the students were given the opportunity to participate in research projects (contemplated in the cooperation protocols). The students collaborated on two projects, one on tuberculosis and another on intestinal parasites. Evaluation of this training period was carried out by the students in the Magazine of the Lisbon Faculty of Medicine (2007, series III; 12: 145-162), transcribing, in relation to the students’ experience, one of the final paragraphs from the text "Learning to be a doctor in Cape Verde – about a Clinical Training Period”: “The unanimous feeling is that our experience in Cape Verde was extremely enriching; we are aware that they did not gain from this, but us; we didn’t go their to teach, but to learn. It is without doubt a journey to be repeated, perhaps now somewhere else. We vehemently recommend all those who wish to do so: go and get to know, and if you can look, and if you can notice … There is a whole world waiting to be discovered”. 

Since 2005 it has been possible to hold the Tutorial Clinical Practice training periods, besides the Agostinho Neto Hospital, at the participating Américo Boavida University Hospital, in Luanda, involving um total of eight to nine students from the 4th and 5th years in the degree in medicine. 

In September 2007 the four 5th year students who did the Tutorial Clinical Practice in Tropical Medicine at the Américo Boavida University Hospital were received by the Angolan Minister for Health, Dr. Ruben Sicato, who spoke of the enormous satisfaction Angola had in contributing towards the training of Portuguese doctors, stressing the Ministry of Health’s interest in collaborating with Portugal in several different areas of health. 

Besides having held the clinical training period in the Services of Paediatrics, Gastroenterology, Dermatology, Infectious and Parasitic Diseases, Emergency Ward and Clinical Pathology, they carried out a study visit to the Sleep Disease Hospital, a hospital of renown in Angola for patients with African human trypanosomes and to the Anti-tuberculosis and Leprosy Dispensary. They also visited the Esperança (Hope) Hospital, founded in 2005, to deal with health problems for those with HIV. In relation to this training period, we here transcribe a fragment of the text published in the Magazine of the Lisbon Faculty of Medicine (2008, series III; 13: 17-27): “We got to know a reality that is very different to that of Portugal, we had contact with diseases that many of our specialists had never had the opportunity to observe, like those that have long disappeared from Portuguese reality, and we experienced, for a month, the constraints and difficulties that the health technicians live out everyday in going about their professions. As future doctors we feel very privileged to have had this opportunity, both on a personal and professional level”. 

Besides the clinical training period, the students collaborated in sample and data gathering for a research project on Pneumocystis jirovecii in those co-infected by HIV, and cooperated in taking data and biological material for a study on the subtype variability of HIV, virological response and resistance patterns in HIV patients on antiretroviral therapy in Luanda, Angola. On this last project they co-authors of works presented at the 46th Interscience Conference on Antimicrobial Agents and Chemotherapy, in San Francisco (2006), at the 5th European HIV Drug Resistance, in Cascais (2007) and published in the Journal of Antimicrobial Chemotherapy (2008; 61: 694-8)

This teaching of clinical practice in medicine, in centres with conditions of aid and pathology that are different to those in our medical schools in Portugal, besides its innovative character in our country, is indeed a great advantage from the point of view of the medical training and humanistic learning that are intended for FMUL students.

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Prof. Doutor J. Fernandes e Fernandes
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