Medical Educatiin

First time number of nerve fibres is determined in developing fetal human cranial nerves. Axonal numbers conform to the propositions (1) that they do not all grow out at once, (2) do not all survive and (3) that degeneration may occur before or after myelination has begun.

This study aims at testing the effect of Colchicine as an antimitotic agent on the experimentally induced rat sciatic nerve crush regeneration. Animals received a Single injection at day 28 postcrush and survived for 24 weeks. Results showed change in structure as compared with control specimens . These changes include elongation of internodes and elimination of very short internodes seen in regenerated untreated nerve. These changes bring relationship between length and diameters of treated nerve fibres toward normal structure. It seems legitimate to assume that the changes are directly related to the effect of colchicine. Such improvement in the structure of the treated nerves need farther studies to show whether these changes lead to improvement in conduction and other functional elements of the regenerated nerves.

This hidden status of health of the primary school children is very far away from detection, treatment and prevention if the medical care through hospital-based measures is not extended and supported by promotive primary health care measures stated and applied worldwide as early as 1978 (2). The role of laboratory in the primary health care delivery is of atmost importance and validity in application of this care measures as described and recommended by WHO as early as 1974(3). WHO urged member states to develop the laboratory service to provide primary health care. This essentially includes early detection (laboratory diagnose) of asymptomatic diseases such as IPI leading to prompt treatment and further preventive measures.

Description of the first ever PBL medical curriculum in Iraq which started in 1989. It adopted following educational strategies and approaches: student-centred, problem-based, full integration, community orientation. Some early evaluative studies are also stated with original curriculum map of the 6-year projection of the programme.

This study hypothesizes that objective learning in medical schools, when compared with subject-based, offers students unlimited number of real opportunities to discover early the importance of professional skills they need to acquire during study years. Twenty percent of medical students from Basrah, Mosul and Tikrit universities (Iraq) were asked to indicate the importance of 16 equally important skills ranging from decision-making, self-learning to clinical and communication and administrative skills. More than 50% of students from Tikrit indicated the importance of 15 skills compared with only 5 skills from Mosul and Basrah. This is attributed to the effect of the problem-based objective curriculum adopted by Tikrit only as compared with the subject-based curriculum adopted by Mosul and Basrah colleges.

A survey on the prevalence of thyroid enlargement has been carried out in Al-Shewish village for the period of Nov. 1993 to May 1994. The prevalence rate was 26.5%, where in male 30% (16) and female 70% (37) of thyroid gland enlargement were visible. The thyroid enlargement was most prevalent between the ages of 10-30 year in both sexes. Examination of relatives revealed some evidence of a familial incidence of goiter. Our findings regarding the family history strongly suggest that the prevalence of goiter is due to environmental factors.
Med. J. Tikrit Univ. (1997);3:73-77

We report on a new clinical teaching and training module for undergraduate students of fourth year (first year of clinical intervention phase) in Tikrit University College of Medicine (TUCOM), Iraq in 1992. This module's integrated  blocks are based around clinical complaint rather than disease or disciplines.
Medical Journal of Tikrit University (1997); 3: i-ii

Abstract
The present study was undertaken to evaluate the competence of rotating residents in handling clinical problems, falling under the purview of the major clinical disciplines, which they come across during their routine work. Three hundred and one rotating residents (55% of the total) who graduated in June 1981 from the four universities of Iraq, namely, Mustansiryia, Basrah, Mosul and Baghdad, and were currently undergoing their residency posting in the various hospitals of Iraq were selected for the study. Two approaches were used to assess the level of competence: first, on the basis of the resident's responses to fifty simulated patient-management problems and, secondly, their critical performance in patient care adjudged by their respective supervisors. A minimum passing level (MPL) was fixed for patient management problems (PMP). The score for the consultant's observations could range from -70 to +100 to represent the very poor and the very good performance. Only 2% of the residents were found to have reached the minimum pass level of competence taking their overall performance in the various disciplines. No significant variation in performance was observed in relation to the university of graduation. None of the residents could reach the MPL in the case of obstetrics and gynaecology. In the case of medicine and medical emergency the findings were almost similar. The residents put up a much better performance in orthopaedics and paediatrics (45.0% and 27.5% respectively). According to the supervisors' assessment nearly two-thirds of the residents secured at least 50% of the maximum score. The study underscores the need to redefine our educational objectives specifically, with aim of developing competences at a defined level in the learner befitting the needs of the health system through a competency-based curriculum.

For completely different circumstances, it happened that I was twice assigned, as Founding Dean, to establish from scratch two medical colleges in two different countries. In 1988, I was appointed in Tikrit University, Iraq and in 1997 in Hadhramout University in Yemen. The philosophy of the two programmes reclines in their abbreviated acronyms: Tikrit University College Of Medicine reads abbreviated as TUCOM pointing to its active orientation towards community in playing an active “To You (we) COM(e)” rather than wait to treat sickness. Hadhramout University College Of Medicine, again reads HUCOM which blankly means in Arabic “bunch of wisdom” i.e. the comprehensive role of the old Islamic profession of Hakims in being scientist, philosopher, care provider and a wise man. Both programmes adapted innovative competency-based educational strategies and clear orientation towards community for first time in the two countries. In the two cases, the founding teams pursued sturdy, painful but pleasurable and enjoyable journeys still reviving till now. Hadhramout Journal of Medical Sciences (HJMS) Volume1, Number1, June 2012; 5-7

The purpose of this guide is to support Member States in strengthening existing, or establishing new, human resources for health development departments at the central and subnational levels. Thus, at the institutional level, any department or unit responsible for human resources for health development, management and training-related activities, such as human resources development departments in ministries of health or in other sectors, is urged to use this guide. Top policymakers, directors of human resources development and health professionals are encouraged to use the guide to improve and sustain the human resources development function of health system development. However, country focus and local context should be taken into careful consideration.
It is therefore important that each country adapt the models and tools provided in the guide to meet its own specific needs and expectations in human resources capacity development.
WHO Publication: ISBN 978-92-9021-646-9; ISSN 1999-7787; NLM Classification: W 76

Just after independence of South Sudan in 2011, I was assigned as consultant by WHO-GHWA to support SSMoH to revise and develop their national policy for the development of human resources for health. The policy we produced in close collaboration with the nationals has not been published nor made accessible to researchers. This may be useful for further research and reference.

Twelve adult rats received a crush lesion of the left sciatic nerve in the upper thigh. Following survival times of 2 weeks to 6 months, the animals were perfused with glutaraldehyde. Longitudinal thin sections from regenerated nerve segments were
examined by electron microscopy. At survival periods of 2 weeks to 1 month, exceptionally short internodes composed of a Schwann cell lacking myelin, a more or less wrinkled Schwann cell-myelin sheath unit, or Schwann cell cytoplasm containing lamellated bodies and lipid droplets, were found intercalated between conventional regenerated myelin sheaths. Such intercalated sheaths were always bordered by sites with a nodal differentiation. Although much less frequent, short distorted myelin sheaths were also found at roe times of 2 and 3 months, but they have not been round in sections from 6-month specimens. In the long-terre regenerated nerves many paranodes were distorted by prominent myelin folds and some nodes of Ranvier exhibited abnormal axon-Schwann cell networks and adaxonal Schwann cell protrusions. These observations show that internodes in regenerated rat sciatic nerves are subject to extensive remodelling. This includes intemodal shortening and nodal migration, myelin sheath breakdown and demyelination, elimination of redundant Schwann cells and nodal fusion. These morphological changes rnay have important physiological implications.

The relation between internodal length (L) and fibre diameter (D) was examined light microscopically in teased specimens from
normal developing rat sciatic nerves, and from rat sciatic nerves which had regenerated following crush lesions at various postnatal
ages. In newborn rat pups virtually all sciatic nerve axons are unmyelinated and myelination is an essentially postnatal event. Between
2 weeks and 6 months maximal L increases from 500/~m to 1400/~m and maximal D increases from 6-8/~m to 16gm. The increase in L
matches the length growth of the hindlimb. Signs of myelin sheath remodelling are absent during normal development. Examination
of regenerated nerves showed that the lengths of the internodes along large-medium-sized axons, are strongly dependent on crush
age. In neonatally crushed nerves, the slope is close to normal. With increasing crush age the inclination of the regression line gradually
decreases. Signs of myelin sheath remodelling are not seen in regenerated nerves crushed at birth or 1-2 weeks after birth. However,
such signs are present in regenerated nerves crushed 3 weeks or more after birth. These observations support the view that myelin sheath remodelling in regenerated rat sciatic nerves is directly related to a deficient length growth following myelination.

In neonatal rat pups the femoral and tibial epiphyseal cartilages on the left side were coagulated with a microcautery device. The
subsequent femoral and tibial growth in length was markedly restricted on the left side, but the foot and the pelvic region exhibited
normal longitudinal growth. After 6 months the sciatic nerves were removed from both sides. Electron microscopic analysis of nerve
specimens from the stunted side revealed that the number of axons was 20% less compared to control specimens. Light microscopic
examination of teased preparations showed a normal nodal spacing in the pelvic segment but abnormally short internodes in the
femoral segment of the left sciatic nerve. These results suggest that the number of axons in the rat sciatic nerve adapts to a target
maldevelopment that sets in neonatally, and that internodal elongation during development proceeds according to the local growth
in length of the nerve rather than to the length growth of the whole nerve.

A total of thirty-two adult rat (Sprague Dawely) of both sexes weighing 250-350 g were used in this study. These were classified equally and randomly into two groups: Group (A) and group (B). All the animals were exposed to induction of left sciatic nerve crush injury by using fine forceps after application of surgical procedures. Rats in Group (A) were left to survive for 15, 30, 90 and 180 days post crush (p.c.) (four animals per each period) and considered as control animal. Group (B) were injected by Acetyl Salicylic acid (ASA) 25 mg\kg as anti-inflammatory drug for successive 14 days post crush (p.c.) and  left to be survive for 15, 30, 90 and 180 day p.c. (four animals per each period). Histological examination and statistical analysis of the nerve specimens for all survival periods of both groups indicated that application of Acetyl Salicylic Acid (ASA) in case of group (B) resulted in development of longer internodes and thicker diameter of the regenerated nerve fibers after 180 day p.c. when compared with that of control group at the same period. The mean internodal length of the nerve fibers of group (B) after 180 day was 396 µm and its mean diameter was 8.4 µm while the mean internodal length of the nerve fibers of group (A) after 180 day was 277 µm and its mean diameter was 7.2 µm. The results of the present study demonstrate that application of ASA for 14 day intramuscularly and continuously in group (B) improved the regeneration of the injured nerve fibers better than the untreated group (A). This may reflect the role of ASA to suppress the signs and complication of inflammatory process at the site of sciatic nerve injury and enhance the regrowth of new nerve fibers faster with better parameters than the control group (A).

In 2006 and following the signing of the CPA, the first strategic plan was developed to achieve the major objectives to avail the required adequate numbers of human resources for health equipped with appropriate competences to be equitably distributed to provide quality service to all population of South Sudan. The purpose of that plan was partially achieved during the period of its implementation between 2007 and 2017 due to variable factors and constraints. As the plan runs until 2017 and with the new political and developmental atmosphere after independence, it seems legitimate to revise and update the second half of the plan to run between 2011 and 2015. In revising and developing the updated version has taken into consideration the lessons learned from implementation in the last five years and the major changes in structural and functional elements. The main purpose of the plan is to provide direction for effective planning, implementation, monitoring and evaluation of human resources for health intervention to achieve the nationally planned health outcomes. As this strategic plan 2011-2015 has not been made accessible to researcher up till now, I thought of uploading my final version for researchers and those interested in HRH South Sudan.