The globalization of occupational medicine gave intake. So Warren and I put together a group international OEM physician to talk about the OEM, the past, present, and the future, as well as their own experience as OEM physician in their country. Can we have a second? Oh, yeah, it's up. So first, the speaker, Dr. Charles Ogibuchi from Nigeria, he couldn't come here, so he sent a video It's pretty common for international presentation. There's something I expected to pop up, yes. Including yesterday, yes. Great to be part of AOAC 2022, Salt Lake City, taking part in this discussion on the globalization of occupational and environmental medicine, coming from a Nigerian perspective. Well, my name is Dr. Charles Ogibuchi, in Nigeria, the Supervisor of Food Clinics of NNPC Medical Services in Abuja, Nigeria, and currently the National PRO of the Society of Occupational and Environmental Health Physicians of Nigeria, SOFON. Well, I have no conflict of interest to declare. We'll be looking at the historical perspective of OEM in Nigeria, an overview of how it is practiced currently, and then we'll describe our challenges and explore areas for collaboration, especially with AECOM. So as you see, Nigeria is there with a population of more than 1 million people. That is almost the seventh most populous nation in the world. Agriculture remains a key economic contributor, with 22.6%, and the informal sector has a good chunk of our OH enterprise in Nigeria, with 70 to 80% of our working population. Historically, OEM was introduced by the Medical Examining Board of Liverpool Infirmary in 1789. This was to cater for slave traders. Subsequently, during the World War II, a medical coordination was formed to cater for soldiers. It was later transformed into some form of occupational health services, especially in the U.S. in 1855, to provide some form of healthcare workers to their employees. In 1930, the railway corporation and coal miners also commenced some form of healthcare services and occupational medicine. This was followed by the workmen's compensation, which was repealed into the Employee Compensation Act of 2010. And of course, we have the Factory Act of 1955, also later repealed in 2004. In 1951, the Department of Occupational Safety and Health within the Ministry of Labour and Employment was formed. In 1952, the first chief factory inspector came to Nigeria from the United Kingdom. In 1978, my society SOFON was established. At the moment, we are 149 members. In 1980, the Institute of Safety Professionals of Nigeria, ISPON, was created. It became chartered in 2014. By 2006, the National Commission of Occupational Safety and Health was developed under the Ministry of Labour and Employment. The bill for the establishment of a national commission on OSH and OSH bill was submitted to the parliament in 2010. It is yet to be passed. And of course, the Association of Industrial Engineers of Nigeria was established in 2019. Yes, there are other stakeholders that are there in Nigeria. So how is it done in Nigeria? At the moment, there is still no national OSH board or national commission on OSH in Nigeria. The bill that is meant to establish these organizations and agencies is still pending since 2010. The Department of OSH in the Ministry of Labour and Employment that is saddled and responsible for the regulation and implementation of the national commission on OSH has been there since 1951. The employee commission scheme is there under the Employee Commission Act of 2010. It has been managed by the Nigerian Social Insurance Trucks Fund. Both the employer and the employee contribute a certain percentage into the fund on a monthly basis. It is from this fund that any commission is taken care of. Of course, occupational health provision to the teaming workers are serviced usually by the GPs by 60%. Only less than 9% is serviced by the occupational health physicians. Only international companies, including the IOCs, provide occupational health services in Nigeria. So the key activities in Nigeria are the same globally. There's actually no difference in what we do in Nigeria. So what are our key challenges? Under three broad areas. First, political. Yes, there is still no national OSH board. The bill has been passed. So there's no country-specific guidelines. There's more coordination among agencies and stakeholders. The department's salary regulation, our OSH, is offered by lack of technical OEM professionals. The workers, as of 2016, were few and had no completed training in OEM. The occupational hygiene lab that was there, there are two employees, an American officer and a lab scientist. There was no occupational hygienist. So there's poor enforcement of legislation. There's inadequate OEM information management. And of course, there's overlapping of roles of government agencies with a lack of equipment for environmental monitoring. In this decisional area, there's no OEM faculty in Nigeria. There are two universities that are undergoing master's in safety, health, and environment. But their curriculum is quite unclear. Operating capacity building, competency and skill acquisition in-country. Eastbourne is still the only institute for safety regulators, almost running an absolute curriculum. And yes, there are no standardization in our policies and trainings. Lastly, manpower. As you can see, there's a debt of competent OEM practitioners. Inadequate provision of logistical capacity to carry out enforcement language activities. Inadequate provision of PPEs. Security issues are there. And of course, inadequate health coverage for occupational health providers. So what have we been doing so far? At the moment, Austria-Africa, in partnership with Workplace Health, has started a seven-week program to train safety regulators in eight countries, including Nigeria. The first batch for labor inspectors just commenced. So hopefully, we'll have more competent hands having to cater for regulations. So far, the Department of Community Medicine at the University College Hospital in Bagnore runs a two-week program on occupational health and industrial medical practices every year for the past eight years. We've been having discussions with the Medical College through the Residency Training Department of Occupational Health and Safety of the UCH for a subspecialty training up to the fellowship level. Of course, our annual conferences are ongoing. The last two editions were free for participants. We are also discussing with Trinity Occupational and Public Health Solutions Limited of the UK to give us free discounted spots for Faculty of Occupational Medicine, Diploma in Occupational Medicine course in the UK. Similarly, with Bains Occupational Health Services Limited of Zimbabwe for also the same Diploma in Occupational Medicine course slot with the FOM of the Royal College of Physicians of Ireland. So where do we need assistance from? So far, as you can see, it's almost 44 years old. We've been in collaboration with many external agencies, but we need help. We require more technical support and collaboration, especially from AECOM, in establishing our OEM faculties in Nigeria, competency building and training for all our professionals at the MRO. It will be good for our practitioners in Nigeria to have that experience. Of course, we need to have the passage of the Occupational Health Bill, its implementation and deployment, and of course, we need infrastructures for OEM institutions. So far, this is a criteria we need help in getting on. So in conclusion, OEM practice in Nigeria is gradually developing despite the challenges, but more efforts are needed from all stakeholders, especially AECOM. There is a need to improve and update legislation, training and standards, ensuring passage of the Bill. And of course, tripartite collaboration needs to be ongoing for the implementation of the existing national policy on OHS. I ran out my discussion here today. On this slide, I just have a pictorial section of all our collaborative activities, both in-country and with our external stakeholders. Thank you very much for your attention. I wish you a fruitful discussion and a great conference. Thank you. Our next speaker is Dr. Jesus from Mexico. Thank you for listening to me and thank you for being part of this awesome conference this year. Hi, everyone. This is Dr. Jesus from Mexico. Thank you for listening to me and thank you for being part of this awesome conference this year. Thank you for listening to me and thank you for being part of this awesome conference this year. Thank you for listening to me and thank you for being part of this awesome conference this year. Thank you for listening to me and thank you for listening to me and thank you for being part of this awesome conference this year. I'm sorry I couldn't attend in person this time, but I'm happy to share with you a little insight of what is operational medicine in Mexico and how it goes in our country. So, in Mexico, just a little recap, I have no conflict of interest. And Mexico is a country located in North America, the 38th largest country by area, and we have around 136 million people. And the most people Spanish-speaking all over the world. We have a tradition in the November 2 where we celebrate the dead with flowers, body, candy all over the place. Just a happy reminder of the people who left us and we think that they come at night and eat the things that they love to eat when we're alive and when we present them to them. Now, in Mexico, just for you to know, the main economic activity is manufacturing, almost 20% of the GDP. We have almost 57 million people employed, but 31 million in the informal sector and almost 3 million don't have insurance medical service. Now, to the activities on Mexico, we have the EAMS, which is the main service for workers all over the place. It's there for teachers and education people's service. So, then for the army, for the people who work in the gas industry. And in SAVI, which is for the main population, even if they are not workers, they have some kind of support as medical service. All of them have their own perks, but this is what we have right now. EAMS covers most of the people, workers and families. And then it goes in SAVI, which is not only workers, mostly people who do not have access to other insurance activities. So, in Mexico, we have background that even when we were conquered by Spain, there was some background on laws that were covering sugarcane workers. We have Dr. Jorge Fernandez as the first occupational medicine pioneer with the Mexican Social Security Institute and what we said before. And in 1906, we have the Cananea mining strike, which ended up with the federal labor law in 1910 and the Minister of Labor in 1911. Just for you to know, we had a revolution in 1910. So, about occupational medicine in Mexico, 1999 was the year when the official specialty training was developed. In 1982, we have some occupational medicine societies. In 1987, the Mexican Occupational Medicine Council and the National Federation of Occupational Health Societies and Associations, part of the title here, were developed. And until 2018, 120,000 occupational medicine specialists, but only 22% are board certified. And now, the relation is that in order to be board certified, you have to go to this official specialty training. And we have a lot of needs on Mexico. You see the more darker areas are states where a lot of people are and there are not enough occupational medicine physicians covering that necessity. And these are highly industrial states in Mexico. And in practice, the Minister of Labor enforces laws and regulations. The employers are bound to provide the insurance, mostly dreams, to their employees. And their money comes from employers, employees, and the government. So now, the employers pay an annual premium if they have a lot of accidents of occupational diseases. So, this tends sometimes to go to hide the events in order not to pay all this stuff. The IMSS provides medical services, manages compensations, retirement for illnesses related to their jobs or not related. And most of the preventive activities are sole responsibility of the companies by law. Now, the challenges, we have the climate emergency. We have a professional national shortage. Even during COVID, low interest of companies in hiring medical staff, they just want to comply with regulations. And that is only making some efforts, but not necessarily having medical staff on board. A strict recruitment regulations by the equivalent of the ISRS in Mexico, which left the employers with not a lot of money to spend on occupational health. Low government capacity to train and enforce regulation. The Minister of Labor is just not enough to check out all the necessities on the companies. So, a lot of bad practices are being made. Most occupational diseases are not being prevented. Almost 90% in Mexico are not even detected or prevented. Psychosocial factors are one of the top risk factors present. And we have a lot of underserved populations like EMTs, firefighters, and people working on the trash industry, recollecting trash and all this stuff, even though they're public servants. Chronic diseases epidemic, which we have, we're one of the top countries on diabetes, hypertension, and this has its own limitations for the people. Now, there are new regulations for psychosocial factors that were going to be implemented in 2019, 2020, but the pandemic hit and this just went onto the queue. Involvement of EMTs in other activities of prevention, 50% increase in official specialty training. We have last year, 120 new spaces for the EMTs to be trained. GPs to become occupational medicine physicians at the Mexico Social Security Institute. Annual Congress and training for programs, mostly by the Federation of Occupational Health in Mexico, and multiple occupational medicine companies offering services to another companies. So, mostly on the private sector in order to comply, but sometimes people are not enough trained into the area and they just have a nurse there that needs some training to perform adequately. And multiple private climate initiatives. Unfortunately, the government is not interested in this regard. They are betting for more fossil fuel and this has hit hard. We just hope that if there's another government, this can change. But right now, in that regard, Mexico is not necessarily committing to the climate emergency that we have around the world, unfortunately. Well, just a short recap about what occupational medicine looks like in Mexico. Please, if you have any interest, any questions, and we can share information, I will be happy to. These are my contacts. I was working with an initiative, national initiative with the Red Cross to provide occupational health services to the EMTs. Unfortunately, that hasn't kicked off the way that I wanted to, but we're still trying to figure out what are the steps that needed to be done to go into that regard. I'm sorry I can't join you this year, but I'll be happy to share with you probably next year. And thank you so much for the opportunity and see you around. Enjoy the conference. Thank you. Thank you. Our next speaker is Gabriel Gu from China. Dear ACOM colleagues, my name is Gabriel Gu. I'm currently working as a regional medical leader of Great China at the Procter & Gamble company. I have no conflict of interest. Today is my honor to share something about my adventure with occupational health services in China. I'm a medical student, and I'm currently working as a regional medical leader of Great China. Today is my honor to share something about my adventure with occupational health work in China and my connection with ACOM. I have been working as an occupational health professional at several multiple companies, multinational companies in China for the past 17 years. I started my work as a surgeon in a government-owned hospital and then turned into a general practitioner in a company clinic, and then I started exposed to the occupational health work. This is also a lot of Chinese all-age professionals working experience, similar way. In China, there is clearly laws and regulations regarding occupational health, and they are mainly focused on the treatments and the compensation of occupational health disease or work-related injury. In the past decades, adding some preventative measures into the focus area, such as the hazards, exposure control, and occupational medicine surveillance. There is desegregated authority in charge of enforcing implements of such law and regulation, and the punishment of violation is severe. Although we have the law and regulations of occupational health, but unfortunately there is no systemic training program to develop an all-age professional in China. A lot of all-age staff here, including myself, are learning pieces of occupational health knowledge from real-world experience. These pieces are mainly from daily work regarding the laws and regulations, local health authority inspection funding, and suggested improvement plan. Also, there is a global procedure or programs in multinational companies, or from the peers in other companies. Also, sometimes we could learn from other programs designated for safety profession, such as some course for industrial hygienist or ergonomist is a good choice. I started the connection with ACOM from about five years ago, and ACOM helped me a lot to set up holistic or structured occupational health knowledge system by a systemic training program. Since I have been more capable to work as an occupational health leader than other occupational health professionals. Also, AECOM helps me to set up a great network with occupational health experts from all over the world. And I made friends with some of them. I could seek help from these friends regarding occupational health perspective, and we really got useful feedback very quick. China is developing quickly, and there is a clear gap between the company needs of occupational health professionals versus availability of talents. I think if AECOM could extend its training program and network to more occupational health professionals in China, we could have more suitable talents in the market and draw more attention from current medical staff to turn this into occupational health profession. These are my personal experience with AECOM and my personal experience in occupational health work field in China. And thanks for listening. Hope you all enjoy the AOHC 2022 in Salt Lake City, and hope we could have a face-to-face discussion in the coming AOHC 2023. Thank you. Okay. Thank you for Gabriel. Hello. Yes. The next presenter is Dr. Neer Sher from Thailand. She couldn't come here, so she's sending slides. I will go over the slide for you. Oh, let's see. Oh, sure. So, Dr. Neer Sher is an occupational health physician from Thailand. She is board certified by Thailand, Thai board certified in preventive medicine, and she is the chief in Division of Occupational Medicine Department of Community Medicine. Sorry. Sorry. Warren. Can Warren take care of that? It was some technical problem. Okay. So, all right. The situation of occupational medicine physician in Thailand. Here is a name. Describe the majority of occupational medicine physician employed by government sector, like public hospital. There are limited number of occupational medicine physician working in the hospital, not in the industrial side. Same as industrial hygienist. In Thailand, the safety officer are demanded for industry because the requirement by the labor law. The occupational health nurse are trained, but they also working mostly in hospital. So, in Thailand, if a worker got injured, then they covered by workman's comp. If it's non-work related injury or illness, sickness, then covered by social security. Thailand has occupational safety health environment X, and also they had labor protection legislation. However, the focus on occupational safety rather than more than occupational medicine. Again, Thailand do not have enough OEM physician, so there is a need. She suggests the most important thing in the provider. Here is she point out. The provider in AECOM could come to Thailand to, again, helping them to develop clinical occupational medicine courses. Clinical training course for medical certificate for fitness to work, and design of medical surveillance program. Here she described there are seven occupational residency training program in Thailand. Each year, they produce 20 physician. It's total three years curriculum. Here is more detailed the curriculum in theory and the rotation in clinic, and so on. This is just the degree MSC in occupational medicine. You have to earn certain credits. This is the expected competencies, the fitness for duty assessment, medical surveillance program, diagnosis of occupational diseases, workplace medical emergency preparation and the response. This is the actual curriculum. They can send out their resident to different country. That's pretty cool. She described her experience OEM in Thailand bridge the gaps of clinical preventive medicine. It lead understanding of external cause of human health. During the COVID period, OEM has earned recognition of COVID fighting as well as infectious disease specialist. This picture showed association of occupational and environmental disease of Thailand. They have a total 1,200 members. Board certified is 190. This is the bright future for OEM Thailand. Thank you. I believe the next one will be a live presentation by Adriana from Brazil. Adriana is the first prize winner from the award. Hi. I thought I was going to be in the middle, but I guess I am the first doing live presentation. I tried to be the last, but I couldn't make it. I will try to explain a little bit of the Brazilian occupational health and what we do in Brazil, the legislation, the standards we have. I have just a few minutes to explain to you a very complex legislation we have. I guess I will need a week to talk to you about all the legal problems we have in Brazil right now. Then, to the social security, we have three kinds of legislation. I can memorize that. We have three main legislations in Brazil. We have the health legislation from the Minister of Health, the social security legislation, and the labor legislation. I work at Fundacentro right now as a researcher. The Fundacentro is the research organ from the Minister of Labor and Welfare in Brazil. I will show you something about the labor legislation and the social security. The labor legislation is very old in Brazil. They established the standards in, I put just a little paper here to remember the dates, but in 1977. You know, our rules in Brazil, the last change we have in some rules was in 1979. I worked in the group that was trying to change the chemical exposure standards in Brazil. That is from 1979, and we couldn't make it. We are two years discussing to try to change it. Maybe next week we have a public consultation about that. We are just working for two years, a group of experts about chemical exposures. So, our legislation is from 1979. It's a very old legislation, these labor regulatory standards. And they are, this is the main ones that we have the medical issues here. And this one, the NR7, this says that all enterprises in Brazil, all companies in Brazil, must have occupational medical in their staff, depending on the size of the company. You have to have one, you have to have two, or three, or five, maybe more, depending on the size of the company. We have a program that the medical in Brazil have to apply each year and make exams for the workers. And there are several things that we have to do in Brazil as a medical doctor. Even in this one, it must be an OM physician, a certificate OM physician. We have associations in Brazil, medical associations in Brazil, occupational medical associations in Brazil, that give these certificates to the medical, occupational medicals. I want just to show the data that it's important. This is the most frequent work-related injuries in Brazil. You see, it's most like the major companies in Brazil are in this area. Here is São Paulo, Rio de Janeiro, Minas Gerais in the south of Brazil. Here is the Amazon forest, and there's not too much population there, but we have some industries there. But the main problem is here, in the southwest region in Brazil, and São Paulo is the worst. And this is the number of work-related injuries in Brazil from 2014 to 2021. And you know, because of the pandemic, we have a decrease of these injuries in Brazil. But we can see here, this is the years, a little bit of a peak here, when we come back to work, and then it's fine. And this is, I guess this is a very nice slide, because we can see in 2019, we have, oh, sorry, it's not in English, but due to X-Force and related movement accidents, we have the most common cause of accidents in Brazil. And during the pandemic, after the pandemic, we have biological hazards as the worst. And here's the social security. We have a social security in Brazil that provides the workers who are taxpayers and his family against social risk, guarantee income, cause of illness, accidents, pregnancy, imprisonment, death, and old age. This is the open data from social security in Brazil. If you can see, we have the number of benefits accumulated in 2018. They couldn't give me the data from 2020, because they are managing to change some systems in the social security institute in Brazil. But this is the numbers we have. It's huge numbers. This is a total of retirements. This is the disease, temporary labor. I forgot the name in English. Okay, okay. It's go off the work site. This is the number, the value we pay. This is a month value. 27 billion reals, I guess, about 5 billion dollars, almost. This is the retirement, the huge number. And here, this is by a disease, by disability, is this number. 9% of the retirements in Brazil are about disability. Here, where the occupational health medicine works as a medical expertise. I am a medical expertise for the social security. I came from the social security institute. And this is our daily schedule medical exams we do, 18,000. We are 5,000 doctors working to the social security. And these are the sick pay, the disability pensions, the special retirement because of the exposure to harmful agents. The special retirement, this one is for the disability. It's a little bit different. If you have a disability in Brazil and you work with this disability, you can retire early than most of the people in Brazil. This is for the family, and this is just for the social, the people who don't have money to provide themselves. This is a benefit. The government pays one salary per month for these people. And this is, I think, the worst problem we have in Brazil. Occupational medical in Brazil, they don't go to the work sites. They just stay in the office and dealing with a lot of papers, a lot of office works, and they don't go to the sites, and they don't see the risks we have there. I guess this is the major problem in Brazil. We have to do, the physicians go to the workplace to see the workers, to see what's the hazards, what are the risks. This is my photos. I don't think the video is not working. Can you do the play? This is a film. Yes, yes, yes. Okay. I can talk about it. This, no, backward. Yes, this one. You have to. Yes? Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes, okay? Okay. This is the steel company. This is the caulk going out of the oven. And you know, this company, this is a large steel company in Brazil. I was doing expansion there. And I just could go into the place they are doing the extraction of the caulk. So, in this company, they have the locomotive driver as a job. And in the paper, they have ten locomotive drivers. You are in the office. You see, I have ten. They all have the same risk. But can you forward just a little bit, just to show, I guess? It's coming. It's coming. It's not a rich recover oven. It's a common oven. And you see, this is the caulk. They're going to the tower to put water to cool it down. And you see, this is one of the workers. He's here, inside of this cabin. Without air conditioning, without any mask, without any kind of protection. So, they have ten locomotive drivers. They work in the same site with different exposure. And if the doctors won't go out of his office and see this, he could know what the risk were, the diseases, everything about this worker. This was our problem. I went to a lot of companies and did expansions with my work. And you see, we have another major problem in Brazil, the unions. They are every time trying to get more money to their workers. Sure, why not? But you see, in the steel company, we don't have a strong union. But in the petroleum companies, we have. So, all of these workers working in the command of a refinery in Brazil, they have a special retirement. They retire five years before everybody with his total income. And the steel workers don't have it, because they have a union that goes to the judiciary system in Brazil, and they gain this for them. I don't think they have a problem, but the problem is we have to do an equal system for all the workers. We don't have to privilege some workers in spite of others. And this is another main problem in Brazil for occupational health, because the occupational health medicals don't get to these people, the informal workers and the small business enterprises that don't have the money to pay for occupational health. These are inspections. This is one real inspection we make in a small factory, a small cloth factory. And these are main problems. Bureaucracy, you see, two years to take. The rule is ready, but it's two years to put it on work. Divergent standards. The labor legislation has divergent standards than the social security standards in the same country. We lack local expansion and administration. And this is the conflict we have in Brazil. Just to show you one of the most famous cases in Brazil, the Brazilian Supreme Court in Brazil decided that PPE for noise doesn't work at all. The main action... Brazilian Supreme Court is a constitutional court. It's not a technical court. It's a constitution. They must see the constitution. And the final judgment... I know because I participated as a legal expert to help the lawyers to try to not... It doesn't happen, but unfortunately we lost. They said that the noise attenuation values measured in the laboratory tests and values provided by the manufacturer do not represent those obtained in the field. This is the decision of our Supreme Court. It's almost a joke. For me, it's almost a joke, any technical. I tried to take some sneak peek of my research project and take some data. And, you know, I have... I told you yesterday I have 12 milhões de trabalhadores em minhas dígitas, e eu pego algumas dígitas de poucas pessoas, dígitas de poucas estações de trabalho que eu pego aqui. Eles se retiram, este é o retiro, em 48 anos por causa da deficiência. E trabalhos relacionados são de quase a mesma idade. Este é o retiro, e custa o governo do Brasil cerca de R$ 1 bilhão. Então, se você mostrar isso ao governo brasileiro, você está gastando dinheiro aqui, e você pode evitá-lo se você for oferecer melhor saúde, melhores standards de trabalho, melhores médicos para trabalhar, você pode melhorar essa dígita. E são apenas as doenças de CID que são mais comuns. CIDF e doenças relacionadas ao trabalho. CIDF e doenças relacionadas ao trabalho. É o grupo mais comum. Nós não temos as dígitas prontas, mas eu acho que ano que vem eu posso apresentar o trabalho. E este é o Fundacentro, a instituição onde eu trabalho. Eu trabalho no Rio de Janeiro. Todos vocês são muito convidados para ir lá. Nós adoramos receber qualquer um do nosso país, a nossa base é em São Paulo. Eu trabalho no Departamento de Pesquisa Aplicada. Nós temos muita pesquisa acontecendo. Eu estou coordenada por dois projetos de pesquisa, projetos maiores de pesquisa, que são os projetos de carcinogênios e os projetos de barulho. Nós estamos tentando provar a eficiência do PP. Então, eu sei que o Brasil tem uma solução, está em frente de nós, mas eu acho que nós podemos ver. Nós só temos que passar um pouco de tempo para encontrar o ovo aqui e tentar resolver. Eu não sei se qualquer um pode encontrar o ovo. O Brasil, nós estamos tentando encontrar. E eu acho que vocês podem nos ajudar. Com o ensino, com todo o conhecimento que vocês têm, vai ser perfeito para os médicos brasileiros. Muito obrigada. Vamos guardar as perguntas até terminarmos a apresentação. Muito obrigada. O nosso próximo apresentador real é a Dra. Ana Sofia Victoria Fajido, que é a nova presidente da Sociedade de Médicos de Ocupação na Filipina. Bem-vinda, presidente. Bom dia a todos. Olá. Deixe-me ver. Então, novamente, obrigado, Dr. Jean, por essa boa introdução. Eu sou a presidente nacional da Sociedade de Médicos de Ocupação na Filipina. E, em nome da PCOM, eu gostaria de expressar nossa gratidão para a Sociedade de Médicos de Ocupação na Filipina pela oportunidade de compartilhar nosso advogado sobre saúde e segurança ocupacional nas Filipinas. Então, minha declaração. Sem conflitos. Eu só recebi um pouco de suporte, de patrocínio, para vir aqui, de parcerias profissionais e farmacêuticas. E o desenho para a minha palestra é, só para te dar um profilo de Filipinas, a história da medicina ocupacional nas Filipinas, o estado atual da OIM, e o que estamos fazendo, o que a PCOM está fazendo e o que pode ser nossa colaboração futura com a ACOM. Então, só um pouco de descanso. Isto é só para mostrar-lhes uma vista de um lugar lindo nas Filipinas. Isto é em El Nido, Palawan. É uma das maiores ilhas da província dos Filipinos, de Palawan. E tem um sítio de herança do mundo do UNESCO, os Tubbataha Reefs, para aqueles que gostam de ir scuba diving, e um dos Novos Sete Maravilhas do Mundo em Puerto Princesa. Ok. Tudo bem. Então, as Filipinas são cerca de 1,4 vezes maiores do que Utah. Então eu só queria compartilhar isso. Pode parecer pequena, porque tem água em todo o lugar, mas é 1,4 vezes maior. É o que a internet diz. E em Utah, tem cerca de 212 quilômetros quadrados. As Filipinas são cerca de 300 mil, fazendo as Filipinas 41% maiores do que Utah. Então, a população de Utah é cerca de 3 milhões. Então, eu ouvi. E nas Filipinas tem 112 milhões já. Então, em maio de 2020, era apenas 109 milhões. Então, a pandemia realmente adicionou mais pessoas, mais filipinos. Eles ficaram presos em casa, fazendo bebês. Então, a população trabalhando é cerca de 44%, e a maioria deles é entre os anos de 25 e 65. Ok? Então, aproximadamente, isso seria a força de trabalho do nosso país. Então, cerca de 44 milhões são parte da força de trabalho, e a maioria deles são homens. E, como nos outros países, temos uma grande quantidade de trabalhadores também no setor informal. Ok? Então, o que significa que os serviços, os serviços de saúde ocupacional, não são adequadamente acessíveis para eles. Ok? Então, só para apresentar um pouco da história da medicina ocupacional nas Filipinas, este é o Dr. Gregório Deirit Dizon. Ele é considerado o pai da medicina ocupacional nas Filipinas. Ele graduou da Universidade de Santo Tomás e, na verdade, recebeu um estudo aqui nos Estados Unidos. Então, ele escolheu a Universidade de Harvard, onde ele terminou a saúde pública, a higiene industrial, em 1940. Então, isso, claro, o levou para voltar para as Filipinas. Ele voltou para trabalhar para o Departamento ou o Bureau de Saúde nas Filipinas e dirigiu o Departamento de Higiene Industrial na saúde pública. Então, ao mesmo tempo, ele também conseguiu formar o Colégio de Medicina Industrial nas Filipinas. Ok? Então, também um pouco de história sobre o Colégio de Medicina Ocupacional das Filipinas. Então, de novo, começou em 1966. Ele se movimentou. Muitas organizações diferentes se uniram, a Associação de Medicina Industrial das Filipinas, a Associação de Saúde Ocupacional das Filipinas, e, finalmente, se tornou o PCOM, o Colégio de Medicina Ocupacional das Filipinas, em 1989. Então, eles também foram capazes de criar um bordo especializado que certifica nossos médicos para se tornarem diplomatas e alunos. E, talvez, alguns milagres. Em 2013 e 2014, um dos nossos ex-presidentes, o Dr. Marilyn Alentahan, também foi capaz de atender o AOHC. Ela também foi convidada para falar. E acredito que sou, provavelmente, apenas a segunda pessoa das Filipinas a falar neste evento muito prestigioso. E, em 2017, também fomos ativamente envolvidos na Conferência da Ásia sobre a Saúde Ambiental Ocupacional. E também estabelecemos um programa de treinamento de residência, apenas um, nas Filipinas, em 2020. E, só para compartilhar, este ano, fomos capazes de receber uma proclamação do governo para celebrar a Semana de Medicina Ocupacional em cada terceira semana de março. Sim. Isso foi... Isso foi algo de trabalho duro, em outras palavras, da oficina anterior. Então, a Semana de Medicina Ocupacional é a Proclamação Presidencial número 1316, e foi assinada em março de 2022. Então, este é apenas o nosso Plano de Compromisso de Advocacia, em que tínhamos vários ativistas importantes nas Filipinas assinados conosco também. Então, nós celebramos isso juntos com o governo, o Departamento de Trabalho e Empresa, o Centro de Saúde Ocupacional e Saúde, e aqui, apenas algumas das pessoas-clássicas que nos uniram neste momento. Tivemos o presidente da Associação Médica Filipina, o presidente da Academia Filipina de Médicos Familiares, porque a PECOM está sob a sombra da Academia Filipina de Médicos Familiares. Temos aqui também vários ex-presidentes que nos ajudaram a empurrar essa advocacia. A PECOM tem 29 capítulos em toda a Filipina, com 4.617 membros, e nós também temos colegas em todo o mundo, trabalhando no Médio Oeste, na Europa, acredito que há alguns aqui nos EUA, nós ajudamos trabalhadores e empregados a alcançar saúde e segurança em toda a Filipina, e além disso. Então, nós começamos nossos direitos, e nós temos o Código de Trabalho da Filipina, para agradecer, é claro, para estabelecer os normas de saúde e segurança ocupacional. E nós também temos o que chamamos de Código de Trabalho da Filipina. Então, o R.A. 11058 foi assinado em 2018. Então, os normas que vocês viram no slide anterior, foram criadas em 1978, mas o Código de Trabalho da Filipina para dar penaltis para aqueles que são não-compliantes foi assinado em 2018. Então, há 30 anos, certo? Então, mas ainda assim, o Código de Trabalho da Filipina está se movendo, e nós estamos agradecidos com o governo por, pelo menos, receber essa chamada para que possamos estabelecer essas penaltis para que as empresas possam seguir. Então, isso é apenas implementar as regras e regulações para que elas possam seguir. E então, o que fazemos, como médicos de saúde ocupacional na Filipina? Nós servimos como a ponte para a gestão e trabalhadores para as preocupações de saúde, segurança e benefícios. E, é claro, para ajudar nossos lugares de trabalho a cumprir esses padrões. E nós temos todos esses livros de texto, tenho certeza que muitos deles são daqui, dos EUA, e nós lembramos muito disso, e nós gostaríamos de poder, eventualmente, é claro, ter mais colaborações com a EICOM em relação à educação, como gostariam os outros também. Então, em relação ao administrativo, como esses padrões estão sendo implementados? Como eles estão sendo monitorados? Então, nós temos o Departamento de Trabalho e Empresa, que é a principal organização de governo que regula os padrões de saúde e segurança ocupacional em empresas privadas, no setor privado. Então, eles implementam as leis, políticas, planos, programas, projetos do Departamento de Trabalho e Empresa. Então, isso está sob o Bureu de Condições de Trabalho. Também temos a Comissão de Compensação dos Empregados, que, é claro, provide compensação para doenças relacionadas ao trabalho, e temos o Centro de Saúde e Saúde Ocupacional, que faz estudos e pesquisas continuos para a saúde e segurança ocupacional. Então, aqui está o Programa de Compensação dos Empregados, que provide compensação, perdas de aluguel, benefícios médicos, aluguel de cuidados, reabilitação e benefícios de mortes e funerários. E eu gostaria de compartilhar que o Colégio Filipão de Medicina Ocupacional, durante a pandemia, também foi muito atentamente envolvido na criação do Manual do Trabalho. Isso foi feito em conjunto com o Departamento de Saúde, que o PCOM, em conjunto com diferentes organizações, diferentes empregadores, criaram como gerenciar e prevenir a COVID-19 no trabalho. Então, eles só atualizaram isso no último ano. E nós também somos parte de um Manual de Trabalho sobre a COVID-19, que está junto com a Sociedade Filipina de Microbiologia e Doenças Infectivas. Então, o grupo de trabalho técnico do PCOM também veio com quatro manuais. Este é principalmente uma compilação de diferentes manuais locais e internacionais para que nossos membros possam ter acesso fácil e, é claro, poder se preparar para o retorno dos seus trabalhadores. E, é claro, nos últimos meses deste ano, nós também entregamos manuais de saúde mental. Então, basicamente, para o treinamento dos nossos médicos, nós temos o que chamamos de curso básico em Medicina Ocupacional. E nós oferecemos isso aos médicos, aos dentistas, e este é um curso básico de 64 horas em Medicina Ocupacional. E estes são apenas alguns dos tópicos, trabalho livre de drogas, PTB no trabalho, HIV, hepatitis B, saúde mental, COVID-19, medicina de compensação e muitos, muitos mais. Então, em 2021, nós começamos nosso primeiro curso de treinamento online, e nós acabamos, recentemente, 12 batchas já. E nós começaremos novamente esta semana. Então, nós também temos um curso avançado. Então, este é apenas como era nos anos anteriores. Então, sempre foi face-to-face. Nós também temos visitas a plantas. E nós também temos o que você chama de curso diplomático em Medicina Ocupacional. Então, é um curso mais avançado, treinamento modular em Medicina Ocupacional. Então, nós também temos o treinamento dos treinadores, para aqueles que vão estar ensinando nesses diferentes cursos. E eu gostaria de compartilhar este aqui, que nós fomos capazes de convidar a Dra. Amy Berman para as Filipinas, em 2018, porque nós queríamos focar no hospital, saúde ocupacional e segurança. Então, ela veio conosco, nos deu algumas leituras, e, claro, desde que foi pré-pandemia, realmente preparou alguns dos nossos colegas que atenderam este Congresso. Então, atualmente, desde os 4.617 membros, nós temos 602 diplomatas, 182 alunos, 7.560 medicinais e dentistas que completaram esse curso básico, mais de 1.000 que completaram o curso de diplomatas e um programa de treinamento de residência. Então, estes são apenas algumas das imagens dos nossos diplomatas e alunos novamente conferidos. E talvez alguns de vocês já viram um poster na área do exibido, então, nós estamos atualmente aceitando aplicantes, claro, nas Filipinas. E nós também estamos colaborando e partilhando com a Universidade das Filipinas, Colégio de Saúde Pública. Então, eles oferecem treinamento de habilidades, workshops para métodos de pesquisa de saúde aplicada. E eles também oferecem um mestre em saúde ocupacional. Alguns dos nossos colegas terminaram em MOH, também um curso de pós-graduação em saúde ocupacional e segurança. Então, você tem diferentes caminhos para os médicos das Filipinas se tornarem especialistas em saúde ocupacional. Eles podem tomar o mestre ou o nosso curso básico e diplomático. Então, este é apenas um conjunto de oficiais, uma equipe muito dinâmica, e espero que eles tenham um ano ótimo neste ano de 2022 até 2023. E estes são apenas alguns dos partnerships que nós estamos estabelecendo com os diferentes funcionários locais e internacionais. E então, com a Ecom, é claro, eu acredito que, como outros, gostaria de colaborar com vocês em treinamento, educação, pesquisa e talvez até a tecnologia aqui nos EUA. Então, eu espero que com isso todos podermos fornecer a prática da medicina ocupacional globalmente. Muito obrigada. O Warren tem um minuto para falar sobre a OEM nos EUA. Tenho algumas imagens aqui também. Em qualquer caso, primeiro de tudo, vocês estão todos aqui porque vocês têm interesse na medicina internacional. E eu realmente lhe encorajo a se envolver. É uma coisa tão recompensadora. Eu fui envolvido em ir regularmente para o programa na Tailândia, que nós falamos sobre, em Gungen. E eu posso lhe dizer, quando você chega lá, você é realmente bem-vindo. Eles me levam para o almoço. Eles me mostram o museu do dinossauro local e os templos. E eu lhe dou algumas leituras. E eu sou tratado de uma pessoa realmente especial. E eu acho que não é difícil construir uma oportunidade para conhecer algumas áreas educativas ou alguns médicos ou qualquer coisa em outros países. Não é mais difícil do que conhecer alguém que conhece alguém. E eu acho que eu lhe encorajo a todos a fazê-lo porque é terrívelmente recompensador. Eu trabalho com o governo no Vietnã, eu trabalho com o colégio na Tailândia. Uma vez eu fui para o Vietnã, eles enviaram um escorte de policiais com sirenes para me levar para a cidade, para Hanoi. Você é tratado realmente, realmente bem. Porque a informação que nós temos aqui, todos estão com fome. Todos estão com fome. E a coisa que eu ouço o tempo todo é que nós gostaríamos de enviar nossos pessoas para os EUA para obter algo de treinamento. Mas é muito caro. Nós não podemos fazer isso. Nós gostaríamos de interagir mais. Mas vocês não sempre vêm aqui. E para nós irmos lá, é caro. As pessoas que estão aqui, internacionalmente, é ótimo. Eu posso dizer que a ACOM está se tornando uma organização internacional. Eu estou indo a essas reuniões por muitos anos. E se você estivesse aqui 5 ou 6 anos atrás, você veria uma população diferente. Nós realmente mudamos, e vamos mudar mais. Eu sou um dos diretores, e estamos fazendo esforços para se tornar mais internacional. Então eu recomendo isso. Então eu acho que meus slides, não tenho ninguém para fazer meus slides. É o último. Eu só queria fazer algo rapidamente com vocês. Foi o último set. Foi chamado Global People. Eu não vou falar sobre a história do trabalho dos nossos trabalhadores nos EUA. Mas basicamente, a razão pela qual nós temos médicos ocupacionais é por causa de uma série de eventos que levaram a alguém que queria nossos serviços e estava disposto a pagar por eles. O pagamento é importante em todo o mundo. Em todos os luga series of events to get there. You can't assume that those series of events happen everywhere in the world. So I wanted to just go over some of the issues when you go to other countries. So safety is really a driver for occupational medicine around the world. And you have issues that are involved. First is your workforce, domestic versus foreign. A lot of places we talked about today, mainly domestic workforce. But there are other places, maybe the Middle East or other places, where you've got foreign workers. I can tell you many Cambodians work in Thailand. There are programs to bring Vietnamese to Japan. There are many places where you have to look at your workforce. And it depends upon the employer. The employer can be a domestic company or it can be a foreign company. In Cambodia, many, many Chinese garment factories. That's a different animal than a local company. The workforce can be domestic, local, imported. You have to look at whether you've got a blue-collar workforce or a white-collar workforce. And the customer, you have to look at if they're local or if they're foreign. In other words, again, a country like Cambodia, the customer is Adidas. The customer is a foreign company, and they may be driving the safety. When I went to manufacturing companies that work with Adidas, they say, Adidas gives us a safety manual. We have to follow Adidas policy for safety. It doesn't matter about the countries. They won't use us if we don't follow their safety program. So you have to understand that dynamic. There are other different things. Safety requirements in countries, you have to be ISO certified, or you have to follow European regs, or you have to follow OSHA regs, because not every country has their own program for safety. And the customers are looking for which regulations you follow. The other thing is, this is really important, the value of an employee. I learned this one time when I went to talk about workers' comp cost savings in a territory of the United States. And they say, we don't really care because if we kill an employee, it's only $14,000. So we don't care about the workers' comp costs. So the value of the employee in some countries, particularly developing countries, if they injure an employee, it doesn't cost anything. And that's really important to understand when you go there, because if you're going to try to do something, it's important to understand that. So the cost of death, if there's a government compensation fund, the availability to treat that injury, that's important too. Who pays the cost? The government fund versus direct cost. In the United States, our companies are obligated to buy private insurance for workers' comp. If they have too many injuries, their costs go up. In other countries, they've got a government fund that you pay a fixed fee. It doesn't matter what your injury rate is. So that's a big difference, you can imagine. Monitoring of safety in the workplace, it depends upon what legislation the country has. If there are government monitors, I've been to places where the regulators, the inspectors say, I go to this place and they chase me off. I can't go on there, I can't see it because I'll get killed. So you have to be aware of that kind of dynamic in some countries. Whether they've got labor unions, the ILO, International Labor Organization, does a lot of involvement and training in different places. Public relations, again, a garment factory in Cambodia where all of a sudden everybody's fainting. That's a public relations nightmare. Or in Vietnam where there's an indoor air quality issue or a pregnancy issue. Those public relations issues become big factors in driving what they do. And again, the customer monitoring. If you've got a company that monitors the safety from the outside, it might make a difference. So there are resources. Enforcement, whether there's the presence of any safety specialists. When I first went to Thailand, they told me there was one CIH in the country. That makes a big difference. I've gotten with Workplace Health, Health Without Borders, that program to train basic industrial hygiene to people that come in from the factories, terribly useful. You're just giving some basic tools how to monitor. Get involved in those kinds of programs. Do it. It's fun. Have a good time. There are a lot of places with no safety professionals, engineers. And the basic equipment, safety equipment, when you see people up ten stories high on bamboo scaffolding, you know that's a problem without any straps, guards, anything like that. So if no one is there to pay for any of the doctor's services, if there's nobody to pay for injury management, you're not going to see a lot of occupant docs. You've got to have somebody to pay for it. So as far as the people that do occupant services, those residents in Thailand, I was impressed. They know their stuff. They go out to factories. They do visits. They spend rotations. The right thesis is about silica and all that kind of stuff. They know their stuff. And they also have meetings online with Japan and the Middle East and whatever, all residents talking about TB and things. I've been there. I saw it. They're good. But in some countries, they have mini courses, eight hours, as we talked about, all different kinds of ways of trying to educate the population. Start a residency course in another country. Help them to do it. Mentor them. I talked right before COVID in Ho Chi Minh City about starting a residency course in occupational medicine. They're very open to the idea. We were going to have the folks from Thailand mentor them. Do it. Go out and do it. It's fun, and it's easy, and you'll be appreciated. Anyway, we've got like 15 minutes for questions and answers. I guess my question is from a medical legal standpoint, a state license, how do you, when you are in those countries, are there any things that you need to be worried about from a medical legal standpoint when you're providing those kinds of consultations? For example, I spend a lot of time in Cambodia because my son's there, but if you were to go in and try to practice medicine and treat patients, actually you can do it for a while before anybody notices, but if they complain, you get in trouble. But if you're going there to give advice or to educate or to help them solve a problem, I've done some medical legal courses or cases over there, human trafficking and things like that, nobody's going to give you trouble, really. They're just so appreciative of the help. Nobody's going to give you trouble. So I don't think you're going to run up against anything. Yes, Ted Emmett from Australia and U.S. Thank you very much. This is a great session, but I'd like to reiterate something that came from Brazil, and that is the importance of people visiting the work sites and understanding that, and certainly I've noticed, at times I've been in South America with the World Health, you go with a lot of occupational physicians and really there's very little knowledge of what happens in the workplace. And I think one of the places to start might be taking medical students and giving them a trip to one of the dangerous facilities, a steel mill, for example, like the picture, and then leading that into a discussion of that and health. And I know that in Lebanon, one of my former Ph.D. students really did that and it was extremely successful. In fact, in the middle of the Civil War, he was taking people around to workplaces and the students loved it and they got a lot from it because otherwise we do in all countries get this dissociation between what's really happening on the ground and the clinic setting, which is very artificial. I absolutely agree. Early in my training, going to see a factory, seeing how they do things, really not only helped me to understand it, but it made occupational medicine exciting and fun because I could do things that regular primary care doctor is stuck in an office all day. I can go to a factory. I can go anywhere. I can see how they make bottles. I can see how they fix airplanes. I can learn a lot of things. So I absolutely agree it's a way of stimulating people in the field. Okay, Igor Bello from Venezuela. My question is about informal sector coverage. This is a big issue for a lot of countries. And in Brazil, precisely, I hear about an initiative connecting primary health care with occupational health in a municipal and free system for the people. You can complete this information, how it's working, because it's very interesting. In Brazil, we have the SUS, the unique system of health in Brazil, and it's free for the whole people in Brazil. We provide it. And in the SUS, they have, how can I say, little offices in the municipal cities, and they do this. They do occupational medicine there, and they are studying it. In Fundacentro, we are making a book about this to provide to the local clinics this, like a procedure, how to do it, the standards, how to go with it. Just in the beginning, the Small Enterprises Project, we have it in Brazil. But it's a tiny, tiny, tiny thing, but it's beginning to work. We have it in Sao Paulo, we have it in Rio de Janeiro, but in the small cities in Brazil, we don't have it because we don't have medical doctors there. We have this problem. We don't have medical doctors, a lot of medical doctors, medical doctors in general, not occupational medical doctors, but medical doctors in general. We don't have it in the small cities. The majority of the medicals are in the big cities because of the payment and everything. It's very difficult to go to the country. I have a couple of questions. Where do you work in the health system? Yes, yes. Yes, I work for the Minister of Health, too. I have two jobs. It's very hard to be a public medical in Brazil because we don't have payment enough, we don't have resources enough, but we love what we do. I guess, I guess. Thank you for all the brilliant presentations we have here, especially the last one because the lady hit home. I'm Jean Viegasan. I'm from Kuwait University, and I was born in Rwanda, but then I was a professor at Florida International University. This morning, one of my students, you can tell, he's now an occupational physician who went through my program, and it was really something Professor Emmett talked about, having doctors going in the field. Do we have an occupational nursing in Brazil? Okay. The reason I'm bringing this up, I had talked with an occupational physician from Morocco because we're designing some programs for some African countries where they run heavy, anything, starting from scratch. And he said, why are you designing an occupational medicine program? Think about occupational health and nursing because they're the ones who do the job. I was in South Africa. I was sitting next to the Director of National Institute of Occupational Health. We had doctor nurses. She quizzed the doctors, can anyone tell me, among the doctors, who ever been to a mine? And nobody raised a hand. We had like 20 of them. But the nurses all raised their hands. So you can see, you know, we were like the sitting offices. So that's why the programs we had to design, we got to design a program on occupational medicine, think of occupational nursing, and then industrial hygiene slash safety. We got to have those three. Everyone does it, especially occupational medicine by itself. I don't think we work. I'm sure you will really understand what I'm talking about. We have similar problems in Kuwait and in Qatar. In fact, I'm designing an occupational medicine workshop, one for two weeks, and they have all those issues. They don't have occupational health nurse at all. And those doctors are really busy. They don't have even time to come to a workshop. So you got to think about having those three things, occupational medicine, occupational nursing, and industrial hygiene slash safety. Thank you. When I talk about the program in the NR7, that is the Medical Occupational Health Program, they are nurses, they are physicians, and they are assistants. And the physicians are required in larger companies, but in the smallest one, just the nurse, and we have it in Brazil. It's a very strong force of work we have there. So the work is done by nurses? Yes, yes, yes, yes, yes. I just want to comment that you also have to be very careful because one of the challenges we heard about occupational medicine in the United States and many other countries is where the occupational medicine physician is losing or has an undefined role to play. It's wonderful that nurses at the sites, but a true occupational medicine physician cannot be effective if they're not familiar with the workplace and is spending time at the sites. And the solution is not for that, and I may have misunderstood you, but the solution is not to say, well, we'll get nurses to be at the sites. There's a role for nurses, but the physicians, and it's one of the challenges in the U.S., and it's going to be a challenge wherever you develop a program, whether it's in Qatar or Africa and Asia, is that occupational environmental medicine physicians need to understand what our role is and what our responsibilities are, define that, and do a good job with that, and then work with our nurses, industrial hygienists, and other safety professionals, et cetera. What I'm proposing, actually, it's a teamwork. You have an occupational physician, a nurse, a certified industrial hygienist or whatever you call them, but always develop the program as a teamwork, not just one specialty. If you do one specialty, you fail. That's what we're trying to do. I cannot stay. The problem in Brazil, we have the nurses and we have the physicians, but we don't have enough physicians to cover all of Brazil. You saw the numbers in Brazil. We have 97 million workers in Brazil, and we have just 30,000 physicians, medical doctors in occupational health. That's the problem, and we have to use the nurses and use all the kind of workers we have to go to the most. Yes, that's why. Listen, the one thing I think you should understand is that the dynamics in any one country are unique. You have to understand the dynamics of that country in order to be able to find solutions. You have to know about the government. You have to know about what resources you have, what the money is, what kind of supplies, and unless you understand the dynamics, it's very hard to find the solutions. But I think every country wants to do a better job, even the United States. We want to do a better job, too. So getting involved, helping people to achieve their goals, I think is wonderful, but different solutions, different places. I'm Caravaggio Arias. I'm currently working in the University of Bologna, Italy. Congratulations for the session. My question is quick, but probably the answer is long. What would be, this is for the panel, the most important contribution we as occupational physicians can provide to support countries? Now I'm currently the president of the international component, so we're welcome anyone who would like to join. So what can we do besides speaking in silos and theories and writing papers? Yes, we probably will come back next year, part two, action. In action, yes, we have a year to prepare. So please give us some feedback. We really want to hear what you're thinking. So, yeah, it's a continued dialogue. The action is on the way, yes. I would just say that the message I get the most from when I go around is that the United States is way ahead of us in certain aspects. If you can help us to educate us to get us to the next step up the ladder, that would be the best thing you can do for us. So education, sometimes resources. For example, if you've got an industrial hygienist in a country but no laboratories to support them, they're limited in what they can do. So I've had, you know, in Vietnam they said to me, help us to get the laboratory upgraded, you know, that kind of stuff. And you might be able to do that. You might be able to talk to people, World Health Organization, World Bank, all kinds of things. You might be able to facilitate getting them up the next rung. I think that's the most important thing, education, and just finding out what they need, trying to help as you can. I think we're out of time, aren't we? Yes, David.

occupational medicine

Nigeria

challenges

collaboration

technical support

legislation

infrastructure development

Mexico

training programs

government capacity

Thailand

professionals