The minutes of the Venice meeting

COMEM Chairman, Dr. Bekkat-Berkani greets all present, recalling the recent creation of this new Organisation that brings together the Medical Associations of European and non European Countries of the Mediterranean region.
This is followed by Prof. Amato, Vice Chairman of COMEM, who warmly welcomes all foreign representatives to Italy, and informs that the constitution act of the Conference has been formalised in the presence of an attorney. He also expresses his desire, together with that of the colleagues, to become operational on several fronts of the professional activity.He fondly mentions Sabir, the ancient language used by fishermen, sailors and traders when talking to each other, and hopes that, in the same way, also among the countries present it will be possible to find meeting points and communication elements.
Dr. Abu Faris, second Vice Chairman, says that he is honoured in attending this meeting in the wonderful city of Venice, following those in Algiers, Genoa and Amman, and which he considers to be the tangible demonstration of the desire to reach the noble objectives that have been set.. He says he is confident that an in depth discussion will enable overcoming the difficulties being encountered by professional doctors and that this meeting is a great opportunity, in the interest of all countries represented.
Dr. Di Martino, of the Italian Ministry of Health, says she is happy that she shares the exciting words that she has just heard, and states that the Ministry has been working very intensely in favour of health diplomacy within the Mediterranean region.
Dr. Scassola, President of OMCeO, Venice, thanks everyone for attending the event and underlines how his city is a permanent laboratory engaged in the research of an equilibrium between a health ecosystem and professional positioning, which he hopes the policy will be very interested in, to ensure that it becomes an important tool in support of States and Governments.

1. APPROVAL OF THE INTERNAL RULES
2. The rules, already approved in Amman but not yet implemented, are approved for the second time.

3. APPROVAL OF THE MINUTES OF THE AMMAN MEETING
4. After some interventions in order to clarify and better illustrate certain items, the minutes of the Amman Meeting of May 20th are approved unanimously.

5. JOINING
Chairman, Dr. Bekkat-Berkani informs that the constitution acts have recently been signed, allocating some powers to Vice Chairman Amato to facilitate the fine tuning activities.
He informs that frequent meetings of the "bureau" are expected, who will then inform the General Assembly. It is important, in his opinion, to know who joins. Geographically COMEM includes European Countries and Countries with a European tradition. Any application from a Country wanting to join COMEM must initially be assessed by the Bureau and then the Assembly. He informs that requests from Arabian Middle Eastern countries have also been received.  He also reminds that joining is in any case at a national level and voluntary.
Dr. Alaoui, from Marocco, points out that art. 2 of the Statute states that the same is subjected to the jurisdiction of the location of the legal headquarters. In view of the fact that these may change, he would like to add the sentence "in accordance with the values and responsibilities of the Conference". He asks for more clarity, due to the fact that in the Arabian language there seems to be some confusion between GIPEF and COMEM.
Dr. Abu Faris points out that the Medical Associations of Arabian Countries are in a particular situation, which however should not be an obstacle to their participation to this conference.
Dr. Biclet replies that the historic and humanistic contribution of Arabian medicine across times cannot be overlooked. Besides, COMEM wishes to extend its interests to Mediterranean Countries and countries nearby, whilst preserving a Euro-Mediterranean connotation. There is also the possibility to be an observer member, but only on a temporary basis, while an actual refusal must be suitably justified.
After thanking for the commitment demonstrated in the activities aimed at ensuring the success of this meeting towards a project for the promotion of health as a human right, Dr. Ibrahim Al Alsharf, from Libya, states that geography should not constitute a limit, and that, on the contrary, Arabian Countries are a unique entity on a cultural and civilisation point of view, which can only bring a widening that should only be seen as a positive occurrence.
The Bahrain representative, an observer country, after reminding everyone that the Chairman of the Medical Association, Dr. Jamal, is a member of the Gulf Cooperation Council, confirms that he is taking part to the present meeting with a constructive attitude, and asks to become an effective member, due to the very close connections with Europe, also suggesting that the name be changed into Euro-Oriental.
Dr. Alaoui (Morocco) believes that the requirements for joining must be clearly in accordance with art. 6 and 7 of the statute, within the framework of Mediterranean civilisation.  The assembly has the power of accepting any proposals, provided they are from national institutions.
Dr. Alanzì (Kuwait) takes part in the discussion as representative of the High Council of the Arabian Medical Association, to emphasize his intention to support any type of initiatives in favour of doctors and patients: besides, in his Country the Association "Doctors without Frontiers" is particularly active, pursuing objectives that have no geographical limitations or separations.
Representing the United Arab Emirates, Dr. Numairy points out that his Country is an observer member, but has asked to become permanent. He asks clarifications on the statement made by the Chairman that applications to join will be assessed and reviewed at a later date.
Dr. Berkani replies to both that as the spirit of the Conference is to bring together as many countries as possible based on culture and history, also for Arabian Countries, on the basis of the Statute, there can be a voluntary act of adhesion, so that the cooperation and collaboration objectives may be extended, also by making the technological means available to those who are behind. However the indicates that a constitution act has just been produced and it is not possible to change a legal document: the Countries that want to join must forward an application, which will be reviewed following a procedure set by the bureau, without jeopardising their possibility to attend the meetings.
A representative from Jordan points out that in order to attend this meeting Jordan representatives are missing the EID celebrations, and adds that having the adoption of COMEN already taken place in Amman, they expect that a decision on their request to join should be taken today.
Also the Sudan representative expresses his thanks for the organisation of the Conference and the desire not to remain an observer member, as advantages can only be gained from becoming an effective and permanent member. He asks for a recommendation in view of the next meeting for opening COMEM to all Arabian Countries. Dr. Berkani replies to him and to all other participants that adhesion is a voluntary decision which must follow a procedure in order to allow members to become effective.
Dr. Biclet adds that the selectivity in joining is only a demonstration of how the core must be so strong to support the creation, and demonstrate the friendship and the importance of the relations among the Countries.
Chairman Berkani confirms his agreement on the principle expressed by the Jordan representative that it is necessary to make the joining procedure easier for the various countries, for submission to the bureau, but also points out that all Countries belonging to the Conference must be subjected to certain legal requirements of the Statute. He then invites them to produce their applications in the appropriate way, reassuring them that they will be reviewed during the next general assembly.
This is followed by an intervention of COMEM Vice Chairman, Prof. Salvatore Amato, who is also in charge of the Observatory of Palermo.  The states that in its four years of activity this Association has made an important quantum leap during the Palermo meeting. It is important that common motives and objectives are found, within the framework of a particular sensitivity towards the person, and with the strength that only those performing the medical profession can have towards others. He reminds everyone that in Amman a work was carried out based on the comparison of Ethical Codes, which he asks to be sent. He adds that the Observatory of Palermo works with little economical means, driven by a strong voluntary spirit, and with the help of the local Medical Association. As the current topic being dealt with by the Observatory is the transplant of organs, Prof. Amato emphasizes how, talking of the Centro Trapiantologico del Mediterraneo (Mediterranean Transplant Centre), the fact that there are donations of organs that go beyond race, language and any other differences, is a tangible and positive signal of the coming down of barriers.
Moving on to the topic, included in the Agenda, of Pharmacological research, after a presentation from Dr. Bianco, Dr. Sergio Dompè, Chairman of the Pharmaceutical Industry, and Prof. Claudio Bordignon discuss the important issue of the possibility of international biomedical research across the Mediterranean Countries. They use a number of interesting slides to present extremely important data and news.
At the end, Dr. Conte makes a short presentation of the COMEM Portal being created, which should be seen by all countries as a virtual meeting point for cultural exchanges, with the aim of providing information, communication and training programs.
In expressing his positive opinion on the initiative, Dr. Alaoui complains that he has only become aware of it now, and therefore asks for more information, including how the participation of everyone to the project will be organised.
Chairman Berkani, stating that the objective must be effectiveness for all partners, declares that all points included in the daily Agenda have now been discussed.
On the following day, Saturday 4 October, Dr. Berkani starts with discussing the comparison of the training systems for doctors, implemented in the Mediterranean Countries, with the aim of identifying any differences and similarities between Northern and Southern countries.
Dr. Lamuscello is called upon to illustrate the training characteristics of Northern Countries: he discusses the European Directive to which all doctors of European Countries must comply to ensure that in the future they possess certain requirements. The Directive states that the doctor performs a liberal intellectual profession, and gives importance to Professional Orders, Federations and Associations.
The free movement of doctors must be based on a principle of automatic recognition. Specialisations are recognised if present in at least two Countries. It also calls for a paper on which the professional career of the doctor is recorded, so that the transfer from one Country to the other follows similar requirements. He also adds that the basic program requires 5500 hours of theoretical and practical activities, under the supervision of the University. After the base program, a further activity is carried out under the supervision of a competent body, mainly focused on clinical activities.
Chairman Berkani observes how a comparative approach shows that in the South Mediterranean there are two countries with a type of study organisation and two countries with another type of study organisation. Also, in Magreb some countries follow the French system, while others follow the Anglo-Saxon system.  In Algeria there are at least 10 faculties of Medicine and 10,000 students. Three years of specialisation are required and the acceptance to Medicine is also subjected on the grade obtained in secondary school. The degree is a state qualification. The general medicine doctorate lasts 3 years plus 4, while for the specialisation degree, 3 to 5 years are needed. In Tunisia there are four faculties of Medicine which are over 5 years long. Access to the post degree course is possible after one year of practical training, while the duration of the specialisation course can be 3, 4 or 5 years.  The system is public and free, guaranteed by the State.  In Jordan there are four faculties of Medicine. Courses are divided into semesters, with two years of theory, followed by three years of training and one year of practical training. The specialisations available are 22. In the Arab emirates the teaching of Medicine is very recent: there are three universities, one of which only open to women. There are then two private universities, one for males and one for females. The system is American based, with two years plus three, plus one stage year. An exchange of teachers is being implemented with northern countries: the more technologically advanced countries help the others, which is considered normal, in this period of globalisation. Continuous training is made easier by the use of the Internet. Some doctors also move abroad, although attempts are made to avoid the emigration of qualified individuals.
Dr. Alaoui proposes the creation of an ad hoc Working Group between North and South, for an exchange of experiences aimed a promoting the development of training in the Southern region.  It could be a strong commitment for the future.
In Lebanon, points out Dr. Aftimos, training follows partly the French, partly the English and even the American models. He asks what are the minimum training requirements for accessing the practice of general medicine.
Dr. Ayadi, intervening on the recognition of the European Degrees, asks if it may not be appropriate to intervene and reflect, through COMEM, on a project on the working times or the University studies to reach harmonization.
The Vice Chairman of COMEM, Prof. Amato, indicates that comparison exercises are being completed on the professions, focusing, for example, on migration flows, mainly together with the Ministry of Health, but not with Universities and training bodies, and asks himself if the University are focusing on the needs on the number of doctors, and the needs of patients, rather than on economic needs.  Besides general and specialist training, he also asks himself what is done for 50 years old doctors who have left University 20 years ago. He therefore suggests that an active comparison is carried out on the problem of training that changes with times, through cultural and training exchanges, but also through an excellence laboratory.
Dr. Berkani finds the proposal of Amato interesting, also in terms of ensuring that we have a guarantee on our "products", the doctors.
Dr. Scassola intervenes stating the need for more knowledge also in terms of health models and the corresponding objectives. In view of the constant development recorded, a separation between university level and daily practice is not possible. Associations have the duty to provide the Ministries with a valid tool that will also benefit doctors 50 years old or more, which make up the Italian average. An operating response is needed.
The Jordan colleague Faris underlines how one of the problems of COMEM is training, particularly specialist training, which in his country is the reason why many young doctors leave the country, on one side only leaving older doctors to operate in the country, on the other giving rise to the medical tourism phenomenon. Approximately 70 % of Jordan doctors with degree cum laude are absorbed by nearby Countries, causing a brain drain, which they want to avoid in order to achieve their objective of improving the health service in their own Country.
Dr. Alsharf asks for more information on the European experiences relating to continuous training and professional assessment, as well as the quality and the connection system between the two ends of the Mediterranean.
Dr. Numairy, United Arab Emirates, would have liked a more detailed presentation: in his country training is private, but the State monitors. On the other hand, public medicine is not managed by the State.
Dr. Vorbauer points out that the only model that can be of value is the relationship between doctor and patient. He invites everyone to be pragmatic, to start a small working group that will begin by focusing on accreditation, to continue with updating, until a common denominator is reached. However, he is not particularly positive on the impact the Association can have on the Ministry.
Dr. Montané states that the migration flows are not only North-South, but also occur within Europe, and cannot be stopped due to free circulation. He feels it is important to work on bilateral conventions, in order to favour exchanges.
Mohamed Abdeen from Sudan feels that the role of the Associations in the individual Countries is important, and must be decisive in improving the health service. He hopes that the Venice document will contemplate an allocation of duties, so that also Sudan may provide its own contribution, and that the working groups will produce the documents for the next meetings.
The head of the Italian delegation, Dr. D'Autilia, in defining the discussion very useful and constructive, indicates that there is the need for better organisation, not only in view of the next meeting, but also because the strength of this organisation is also in the documents it produces. Very interesting points have been raised, but the shortfall is due to the lack of knowledge on the health services of some Countries, such as the Arabian countries. He hopes that a working group for the acquisition of the information will be created, so that COMEM may become an exchange platform for the knowledge of systems. He would also like to know, at a later date, the importance given by other realities to non conventional Medicines, which are becoming widespread across Europe. Dr. Berkani promptly replies that there are no alternatives to medical science and the only alternative to science is a more modern science.  Non Conventional Medicines are subjective.

The second part of the meeting is, as Dr. Berkani announces, dedicated to tangible proposals, the first of which is the creation of an ad hoc Commission on the harmonisation of training systems, and therefore the creation, for the general assembly, of a dossier on training, university qualification and specialisation, to publish in the respective countries.  As a communication mean, he proposes electronic mail and other possible systems, as well as a meeting of the Commission before the General Assembly. Two Countries of the North and the South Mediterranean may exchange their experiences.  He asks Alaoui if he is available as he was one of the promoters of the initiative. Dr. Alaoui says thank you, but indicates that he is going to be extremely busy for the next 6-9 months. Dr. Berkani asks other candidates and suggests that the next meeting takes place in Rabat. It is therefore agreed to operate using electronic mail, not limiting participation to some countries, but extending it to all.
While the draft of the Venice Declaration Proposal is being distributed, Dr. Bianco refers that the intention of this document is to find points of contacts among the various training systems, which may increase the levels of reciprocal knowledge.  Moving on to the section of the proposal, he lists some points: the first one is on the creation of the Working Group; the second is the gathering in a database, of all information on elements that may be useful for future work; for the third point he recalls yesterday's report of Dr Dornpò, which although a bit complex, in reality only referred to applied research, something that must become widespread, as it constitutes the tool for the growth of professionals and for the improvement of the quality of the health service.  Due to the fact that research development needs accredited professionals and organisations, he proposes to establish, possibly in Venice itself, a reference point for the creation of a reporting model, where the delegates will meet to share and discuss the results of their activities in this field. It could be called a "school" due to the intention of perfecting the culture of the methodologies of clinical research, in terms of the ethical and civil aspects of the experimentations.
Chairman Berkani, in expressing his approval for the proposal of the Italian friends, invites all other countries to ask questions: the only thing he personally asks is for clarifications on the financing of such an ambitious project.
Dr. Bianco replies that as Venice is the meeting point of various cultures to which ideally also the local institutions take part, he would hope in their support, as well as a contribution at a European level, from the Information Communication Technology, and more. We too - he states - as Associations and Organisations, could contribute in a measure equal to the use of resources. And he does not fail to underline the enthusiasm and the drive that are at the basis of the initiative.
The Libya representative, Dr. Alshraf expresses his approval for the project, but points out that without financing it will be difficult to implement. The presence of pharmaceutical companies, which on one side may provide a contribution, on the other side may entail the actual risks that experimentations may be carried out which may be unacceptable in countries without resources.
With a positive attitude, Dr. Abu Faris believes that good ideas will always obtain financing. He suggests that the meetings are followed by a contact point on a monthly basis.  He expresses his wish that these initiatives will not die down, and that the Countries must interact, each involving its own experts.
Dr. Alaoui then expresses his thanks for the commitment, the initiatives, the Observatory of Palermo and the Venice Association. However, he believes that gradual steps must be taken: in first instance he thinks that strategic criteria must be established for the future, which also deal with structure, timing and objectives. In his country, it is not normal practice to draw final reports for each meeting, and a higher degree of attention is paid to aims and objectives. He believes that first of all it will be important to define the essence of COMEM and its activity, which represents a common treasure that has no North or South. The same also applies to the Venice school, which must be a place for competence and capability, but which characteristics need further clarification.
Also Dr. Aiadhim believes it would be more appropriate to talk of "proposal" rather than "declaration": the project is interesting, but the details must be defined. A research laboratory has been entrusted to Palermo, but in terms of training there must be a name that gives the right to train, may be with the involvement of Universities. Besides, the legal form must also be considered.
Several interventions follow sustaining that the creation of a research and training centre must be postponed to a later date, and the Medical Association should not be the only involved party.
Dr. Berkani intervenes by clarifying that "school" means a place where clinical studies are carried out, not biological or genetic studies, all with the utmost ethical approach. It is nevertheless necessary to carefully assess the project and find the funds needed.
Dr. Bianco expresses his fears that the presentation might have failed to give the correct picture: he intended to propose the location and the contents. In the same way as the Palermo laboratory is a location and tool for the converging of proposals and capabilities, in the same way the aim of proposing Venice was that of creating a sort of showcase, where the activities of doctors working together may be assessed. Clinical research is intended as an applied research that no one knows how is performed in other countries: in practice it would be a container which content must be decided and contributed together. The document may also be a working draft, if approval is currently not possible.
Summarising the various interventions, Dr. Berkani concludes that this is a tangible proposal on which to reflect and decide at the appropriate time, a project that has been embraced in terms of aims, but which needs to be better defined. This will be done during the next meeting which will take place in Beirut during the first week of June.  He also reminds everyone that subscriptions must be paid, stated in the report, during the next meeting of the bureau in January.  He summarizes once again that requests to join have been received by the United Arab Emirates, Barhain and the Republic of Sudan. As the Statute has just been signed, the principle clearly indicates that anyone applying to join is virtually granted membership, but there are small changes on a juridical point of view, to be able to accept new members.
The representative of Bahrain proposes to host the 2009 meeting. However as he is not yet an effective member, his proposal will be discussed.
The Treasurer announces that after the formalisation of the Association, the joining fee must be regularised.
In "miscellaneous", Dr. Alaoui recalls the problem of emigration and would like to direct the attention of the institutions on these citizens, also through COMEM.
The meeting is called to an end with Dr. Berkani thanking for the warm welcome and the great way the event was organised