al-jazeera. hello there i'm julian was almost here in london the top stories on al-jazeera fighting in yemen sunday the province has intensified with the hood he's reporting more than thirty five airstrikes by the saudi m.r. ossie coalition in the past twenty four hours there targeting a main highway as of the port city which is a key supply route to the rebel held capital of some now the u.n. envoy to get in martin griffiths is there for fresh talks with hooty rebel leaders under simmons has been following the story from nearby djibouti and a warning you may find some of the images in his report disturbing anyone trying to bring peace to yemen may not need reminding of what's at stake nevertheless those without a voice of influence or crying out loud now for him you know how just one hundred

sixty kilometers from her data they try to keep babies alive malnutrition could potentially soon be the biggest killer in this conflict nearby families all eating wild volubly just to survive. we cook tree leaves we have no nutrition we will die here and we have no one but god. yes i mean personally i don't you believe but since my salary has been cut it's only mean mean for my children even though it is causing of each of us in drowsiness but what can we do. in her dado the fighting has taken another quantum leap as saudi led coalition forces and government troops on the ground continue their campaign to cut all supply lines from the red sea port the saudis are accusing who the fighters of opening fire on grain silos in order to claim it was the coalition that's

responsible whoever did watch the un pressure to stop the fighting has never been greater the u.n. special envoy martin growth this is now in the capital center for talks with the who the leadership what may help him is a memorandum of understanding signed by the un which gives safe passage by for injured these needing medical treatment it's reported they'll go to cairo in egypt but is this enough to get dialogue going even though the number of civilian deaths is still rising there is a coalition diplomatic initiative trying to convince the u.n. that her data has to be taken for the huth is to be pressurized to talk of peace this conflict is now a lethal mix a very in motivations for diplomacy fighting and suffering no one would predict the outcome andrew simmons al-jazeera djibouti. more than two million people have been

forced to evacuate is time for. china's guangdong province at least two people have been killed in the storm there lee fifty thousand fishing boats have been called back to port as part of an effort to minimize damage the typhoon is carrying winds of two hundred kilometers per hour and to rain shield rains. in the philippines the death toll from typhoon manget has risen to fifty three and that number is expected to grow dozens of others are missing and feared buried in a landslide getting thirteen miners in could guy in provence over the u.s. residents of north carolina are being warned the worst is yet to come from storm florence florence crashed into the state as a hurricane on friday killing fifteen people for weakening to a tropical depression i'm just of thousands of homes and businesses have been left without power. south korea's president is preparing to play chief negotiator between washington and pyongyang at a summit with the north korean leader. on choose state to hold talks with kim jong

il and it's set to be the third meeting between the two leaders and the first since kim summit with the u.s. president donald trump in june. scuffles have broken out between police and protesters demonstrating against planned pension reforms in russia three people were detained during the rally and some petersburg which was attended by around five hundred people is the latest protest against the changes that it didn't it president vladimir putin's approval rating wants to lift the retirement age from sixty to sixty five a man and for fifty five to sixty four women. you are firm now today those are current headlines stay with the read the people's health is coming up next we'll be back in just under an hour with a full hour of news but by. seven

billion people who live going to plan is here. and every year six point five trillion dollars is spent keeping the health. the pursuit of good affordable health care challenges governments worldwide that we go to six very different countries to see the constant battle to successfully deliver the people's hero. each year over half a million medical students graduates around the world when you tell your parents or your doctor this why all of the training of young doctors is vital to us all what do you tell a mother one there's a very strong possibility that she could be burying her child within the next year for twelve months we follow young trainee doctors from one of the most pioneering

medical schools in the world but most exhausting thing i've ever done i think a skill which poses fundamental questions about what makes a good doctor you have to be ok with the fact that you're not going to learn it all and prepares them to make difficult decisions. he has his brain is gone. because their decisions make the difference between life and death and how to trust him because self life and. just north of my acura foals on the bank of lake ontario in canada is the my coochie take root school of medicine at mcmaster university. for decades has forged new approaches to the training of doctors. dr simon arch kosky is a graduate. he is now in charge of the intensive care unit at hamilton

general hospital she's doing so well actually this is doing great. we're going to get you up and moving around a bit ok we're going to be careful with that lady governing the surgery but it's good for you to get out and serving. care taker come back come back you know. nine years ago he saw his first patient as a young medical student. who was absolutely terrified you're going to walk in the room with her as can be like you're not a real physician you don't belong here you're not good enough and i distinctly remember seeing the patient talking the patient come into the room and then realize . and that was probably the truth i didn't know anything and you look at anyone at the end of their med school residency training you look at them after and you look at them before they're different people they're fundamentally different. no simon is responsible for the most vulnerable patients in the hospital. the things that go into making a good doctor you have to know your stuff you have to work hard you have to

recognise you're never going to be done learning you have to be able to put the needs of others above yourself the last thing you need you have to have empathy. simon's transformation started at mcmaster medical school. when it opened back in one thousand nine hundred sixty five it pioneered a radical teaching philosophy which is now used widely of around the world. five thousand applied to canada's most popular medical school but only two hundred ten. this is day one for the two thousand and fifteen and take good morning. your first priority will be to learn to be great physicians your work in small groups and teams exactly the way that most of medicine is practiced. four thousand nine hundred twenty doctors have trained at mcmaster over the last forty years

feeding canada state funded health care system these students all got here through a unique selection process called the multiple mini interview. the applicants a challenge with a series of rote gleason ariel's when you do your first one or two stations it's still kind of a training you're very nervous your hands are shaking you don't know what to do with your water bottle there are issues of paper and i like that a lot more than traditional interview because it's fun it's fast pace it challenges you in a similar way that medical school challenge you it's quite stressful it's very high energy fast paced these scenarios test for more than just academic ability to look for empathy communication skills and moral reasoning. qualities the master's program believes will make great doctors it was two hours and we had to do twelve different stations where we go through different scenarios questions always throw at you that you've never heard of before and you just stuff to think on your feet

you're getting multiple assessments or multiple. and i think that is a better measure of how much how you would be in different situations. since the introduction of the selection process at mcmaster in two thousand and four nearly every other medical school in canada has adopted it. applicants must have an undergraduate degree but it does not need to be scientific in just three years these students will be transformed into a new doctors. recognized as being from one of the most innovative maybe cool schools in the world. it's all begins with the pioneering approach to teaching mcmaster has virtually abolished lectures. and has introduced problem based clarinet. jennifer key somewhere has been a mcmaster medical student for just over a year and. the sales day rate to glaring means she and six other students in her

group are presented with weekly case studies to resolve under supervision. this is our problem based tutorial were given cases by instructors we read over the cases and from there we develop learning objectives for our group that's where the bulk of our scientific learning comes physiology are pharmacology subjects that traditional medical schools would take in class form genetics embryology all of those things come out of these cases so that we're trying to apply it to real life situations teens face have a right to be called babies brassard expect parents to research abnormalities of both feet and create offer sound you. know which while legs are. not going commonly any kind of an atomic all things that come up on the twenty we call to sound create a lot of anxiety as you can imagine in the supervisor's rule is to guide the

student so they can find the best solution themselves for this area we refer to prenatal genetic counselors and the phenomenal so give them all the statistics on their rates and how often it seemed in conjunction with whatever else and whatever else that is it's a great resource and open to obviously everybody and there's one in every area. by making students find their own solutions mcmasters police it trains them to cope with future changes in medical knowledge which they keep talking about the circular curriculum so things will come back and come back and come back it's a matter of teaching us where. to go for information so if they'd if we learned traditionally went out to our clerkship and looked back in our old notes and then graduated and had to sort of keep up on all the knowledge we're starting fresh what are our resources where do we go where do we check where is now you know we're sort of discovering that together and while we can sit around the table and say i found this one this was a really good resorts and we can get to know all of those resources while we're still here this kind of problem based learning is now used increasingly around the

world. for the next stage students are taken to the center for simulated learning where they are taught to treat patients not just the disease i'm jennifer more and i'm one of the patients partners i am going to be master a long time so i always enjoy coming back here with my students jennifer suffers from arthritis and is one of many volunteers to help students like r.t. rana prepare for the reality of patient care no area of your life is feared when you have or you have a high surf really for three. one hundred. seven start with inspection and i'm kind of looking just at. the contours of the rest and i'm making sure there's not like a squaring on any side. really really helpful to be able to practice what someone may need has a limited range of motion or something else that we would hope to find on

a concept. unlike more traditional medical schools on the mcmaster program students meet real patients from the very beginning. these real life clinical settings intensifies their training progress is testing their medical knowledge and ability to relate to the patient. the students are also learning what sort of doctor they want to be doing their last fifteen months of training the undertake ten six week placements in different medical specialties. perry is currently in psychiatry today i am going to be out there's a clinic with child psychiatry about the limits going there. will be soon patients all day until about five o'clock so i mr morris been approaching medicine from a top down perspective where their understanding of anatomy and physiology of the basic sciences guides are clinical encounters in psychiatry the enigma is that we

don't know many of the physiology is about as we don't know the the basics. we don't know why our drugs work we just know that they work so it's been a lot more difficult for me just because i find there's a lot more just memorizing that i have to do without actually. coming out of from like a logical puzzle in the no way. that's been challenging. dr lipman is perry supervisor but it's twelve year old noah who's about to teach perry what it's really like to have a mood disorder. i have two sides you have to factor in me really nice or not being nice i just don't like feeling that i have a disability tough on it makes life harder perry with two years training has to find the skills to help the young boy. to get in trouble in school today yeah oh. yeah you know everybody just oh no you.

don't listen buddy i don't. know. just. my last few days he's having trouble falling asleep and so with that. you know his mind on it's scary that i'm going to sleep for ten hours and that assumes it is only five minutes when i were. a going to come back and have. maybe. all think you know what that's very sweet of you i like you too i was offering to you i'll try my best. like many students before him perry's preconceptions stripped away. ok i'm like oh my god i'm going to try to actually every child in a couple got broken home that would be miserable it would be like abuse is going to be those terrible terrible. it was not the case alone that although there is

a lot of family children coming from families with difficulties oftentimes the parents are really there to help their child as much as possible by body parries used to more immediate results. so sake a tree presents a challenge. but help comes in with depression i can't just give them an antibiotic one antidepressant and expect them to get better within twenty four to forty eight hours and never to have to present again and to just be ok. it's not that i can cure their depression that's not my goal my goal is to make them feel better whatever that is my goal to improve their quality of life and in fact one child i mean they're able to get up in the morning and go or go to school where before they were just lying in bed all day that is a huge success in my mind. perry is a first generation immigrants from china arrived in canada each ten his parents have clear expectations of his medical career just the other day after i was

talking to my parents about what specialty i should go into and my dad hates family doctors. he. actually be no doubt big family doctors are only stupid people. specialist and. an archaeologist are so hard on our ophthalmologist. perry is a good handle because he said you know it's there and it's. become the surgeon. before i think he said harvard. medical school has been a huge investment for perry and his family. twenty six thousand two hundred ninety three dollars and thirty three cents for one year of tuition dollars so yeah that's about some that could be someone's yearly income

there goes one is six thousand dollars. with a year to go perry doesn't have to say he's future just yet. the clinical placements test a whole range of skills medical knowledge decision making and people skills all in real environments. she found out about a second year student is on her first day on a pediatric intensive care unit petes i.c.u. none of us know what it means to be a med student we've devoted so much of our lives to this grand idea of getting in. that we never really think about what that means so i'm starting with you i anticipate that the things i like about it i see will still be there i'll be it in children now i'm a little bit anxious on how i'm going to deal with a very worried and emotionally fragile adult. all of them to share the same

location or surgical service make sure the scene fine film person who would first see one scene to destruction. she bodies being strewn in at the deep end and asked to help in the kia to you to show you how the women she's a girl who's fallen out of a second floor window. and hit her head i'm responsible for making sure that the imaging that's when our president her gets done making sure that her parents are updated with what's been happening. making sure that we update her file on our chart so that it's reflective of the progress that she's made while she's been here environment's not know it's just a little bit of trepidation when you haven't met any of the patients and you know like ok help solve problems in the middle of their care and they're like i know nothing of both. i just wanted to check in with eve so i wasn't sure how much she

had been told so far were noticed a bit of a deviation with one of her neck bones so i want to be completely sure that there's nothing else going on so that's why they're going for the m.r.i. making sure that everything's as it should be and any question is come up at any point in time in here all they grab me and grab any of the other people as you know and i'm here for a while so if you see my face and you have something you want to know i'm always be able to answer i was right thank you gotten very patient seeing all of my notes now and stuff to do medications so it's a fairly successful first day. don't you karen june issue funny soon. reviser. created a city. that it is her job to check whether she has medical knowledge is up to scratch a classic or medical student question asked what's the difference kiss up to the

judge at the girl please are going to have a hard facts and distinction on the border whereas your subdural ones are marked as actually appear almost. a donor through up and honestly when you get a question wrong on someone that you. literally like there's a blinding apparent because if you really get to know him there's like this loco oh my gosh really. i'm so sorry i'm so sorry for my stupidity. and you submission to the pediatric intensive care unit is a very sick child. his future lies precariously between life and death. facing this level of responsibility is the true purpose behind these clinical placements. and the ensure that students lay in lessons that can't be found in books and we're going to have a multidisciplinary team meeting because this patient has multiple complications

and the very poor prognosis and there's certain decisions that need to be made in his best interest so where ever best interest is being considered it's important to have a team approach so that is not unilateral decision making for think them point it involved in this discussion because the communication aspect of it is difficult to teach it's vital that students like shivani attend these meetings this is where she sees just how moral and medical decisions come together to treat or not to treat to meet seeing him at this stage and seeing him in clinic you know on a month and a half or two months ago he has had. a very big deterioration. followed we can't smile is not necessarily an awareness and vironment we should have seen a clinical improvement right now and i'm afraid we're added to a level where are we going to get back. into should be highlighted he's exhibiting

minimal interaction despite recurrent surgeries with. with the intent to improve optimize this function he's actually minimally interactive if the prognosis is correct and this is the best cerebral function he can ever regain and a surgical decompression of brain some would not necessary improve his cortical function then improvement of the brain stem function does not necessarily improve his quality of life you may actually be prolonging is inevitable death. and suffering are set in. this cruel of us to even prob those discussions with there are necessary and make these conversations so hard there is no good news to be shared bad things are about to happen we have all of course have our fingers crossed that it won't and that things will turn out brilliantly but what do you tell a mother there is a very strong possibility that she could be. the next year. in

this moment that i not the one who is i'm going to make this decision and. the doctors decided not to appreciate and shivani takes the phonology of the decision to heart. i feel the birth of the story from a doctor that i possibly can i feel incredibly like a student and like a learner in less than a year i'm going to hold the degree that i'm directly tied to anything and everything that happens is the patients under my purview and that's the heart flutter and makes me catch my breath sometimes people can. that there are. not very. commitments to course tries to prepare its students for the complex realities facing doctors. something that graduates dr simon. deals with

every day. sometimes you have to move from one environment but it's very emotional and you have to communicate you know a lot of empathy you have to go directly from that to a resuscitation or you have to go to another family and maybe that news is good news and all of a sudden you're going from a very tragic situation to one that's all bit appier and more pleasant and you have to be able to make that transition and sometimes i mean to do that within ten minutes i think it's a skill you have to learn how to do it your own needs in your own emotions a little bit on the back burner temporarily while you deal with the issues in front of you. so mcmaster at the medical school were introduced to the clinical environment very early start with family medicine irritations the book learning and the real life learning are sort of taught at the same time with time to get more comfortable with the decision making to get workers to go with the response. in their sponsibility. the ultimate goal of

a medical school is to turn people into doctors able to make life and death decisions twenty five year old gentlemen. procedures are for the city to put into. its role it's. not totally sure what the underlying causes so we've done a number on final to get some food to make sure it's not effective make sure it's not an. easy. first time and these traumatic situations are part of everyday life as a doctor but for grain richter the patient's mother it's never acking they incubated them from grimsby to hamilton and so he was pretty much in a coma. by the time he got here. and that's been used to play about it for the last four days. you're talking to a doctor or even looking at

a dog you look in their eyes and see type of person they are and whether they really care. you know of that they haven't met that man the spot i've known for a week and i have to trust to these companies something slightly the sense ready so if i do. al-jazeera recounts the shocking story of the assassination of counts folk abene dot. the first u.n. envoy trying to bring peace to the middle east how his negotiations with him helped save thousands of jews from nazi concentration camps and how these mediation skills put him at the vanguard in the quest for peace in the middle east. killing the

count on al-jazeera. al-jazeera as there was a tory breaks but it's also the to see what happens next iteration. of it in part by the time we're square mobile barricaded all seven streets that b.b.q. here the movies now is but what about change people have gone to hear the area the mission of the national army is to search the entire complex and i'll just your stories about telling it from the people's perspective what they think is happening in their culture. the russian orthodox church has deep pockets in the upper the expansion may bear its crucial role in putting its grip on power with some elevating the former k.g.b. officer to saying to president putin is our leader that given to people in power investigates how often it's attempted elimination by the soviet union religion has returned to the hall to the russian state the orthodox connection on al-jazeera.

hello that i'm dealing with almost here in london the top stories currently on al-jazeera fighting in yemen so data province has intensified but the hoochie rebels reporting more than thirty five airstrikes by the saudi emira coalition in just the past twenty four hours that targeting a main highway eyes of the port city which is a key supply route for the rebel held cap. bill of some the u.n. envoy to game and martin griffiths has just arrived there for talks with hooty there's. more than two million people have been forced to evacuate as typhoon manga tears through china's wang dong province of these two people have been killed in the storm nearly fifty thousand fishing boats have been called back to port as part of an effort to minimize damage the typhoon is carrying winds of two hundred kilometers per hour and to wrenshaw rain is all over in the philippines the death

toll from typhon might get has risen to twenty three and that number is expected to grow dozens of others are missing and feared buried in a landslide sitting thirty minute guy in provence. said korea's president is preparing to play chief negotiator between washington and pyongyang at a summit with the north korean leader and will travel to pyongyang on tuesday to hold talks with kim jong il and it's set to be the third meeting between the two leaders and the first since kim summit with the u.s. president donald trump in june that is also looking to improve economic ties with the north that that is than it once was and that it would be good the president has explained the goal of the upcoming summit the first is to improve and develop into korea relations secondly to mediate and catalyze the dialogue between north korea and the u.s. for denuclearization the third is to end military tension and threats of war

between south and north korea. residence in the u.s. state of north carolina are being warned the worst cissie it to come from storm florence florence crashed into the state as a hurricane on friday killing fifteen people before weakening to a tropical depression hundreds of thousands of homes and businesses have been left without power. london mayor sadik com has called for a second referendum on bricks it can says the british public should have a say on a final deal including the option to hold a second bolt. those are your current headlines you're up to date stay with out to see where the people's health continues next that we'll see you in just under half an hour's time for a full news hour that forward to company there but by. the

michael gita groot school of medicine at mcmaster university in ontario canada has a pioneering three year medical program. it focuses not just on strong clinical knowledge but teamwork moral thinking and putting the patient first. the test of any medical skill is how well they prepare their students for the complex challenges of their country's health care system. the rico the mit shivani an airbus medical student in the pediatric i.c.u. . no she's a qualified doctor putting all that she's learned into practice. when i compare what i knew at the first to medical school versus what i knew last in medical school versus what i know now i myself know that those are exponentially

different places that you know in a very short period of time i can amass huge amounts of knowledge and be able to make clinically relevant decisions based on that knowledge and that comes with time . even as a qualified doctor shivani has to continue her studies she has chosen internal medicine as her specialty which requires a compulsory postgraduate residency for a minimum of four years. the one thing but for me and a lot of people who graduate from mark is that i'm always going to have things i don't know and being ok with that and being ok with i guess the practice of researching and learning and constantly being on a trial where you're educating yourself to keep yourself up to date that's something that everyone struggles with. this process of continuous study is not a major element of the. eighteen system responding to the need for doctors to keep

up with the extraordinary speed with which care and treatments are changing. the way. to do you shivani is participating in a more code blue to suit your version of your patients unstable you want to work for this team i rudely of a cardiac arrest on a ward so that's why we had marco it's a means to really help you be able to manage critically ill patients when you don't have all the resources available the senior dr gates the scenario that's really what this court you know you're going in the same room ok when you get this call on the person for i'm just calling about mr ass he's a forty year old german air of you know he was actually made earlier today with a little bit of a commute are pneumonias been in quite well i'm just hoping i can give him some cough syrup why does he really want cops or that there's a just when a cop for the cop in so much like his family can be leaving here and i mean i don't personally i do is my belief you know from urge because you know we're very it would really give me

a good read let's go see his racing because they know it's very very helpful because it forces you to make those quick decisions and to really think on your feet to serve and i'm sure you are the residents here a little bit concerned about you can't tell me what's going on i'm having pain in your chest it feels a little tight whereabouts and that also are also you know right in the middle it's really just physics and the city. and as it radiating anywhere else. these small cool it's a here to train young doctors to make the right decision in real life and death situations including knowing when to call for more experience called leaks like t.v. i have a very old joran who came in with what this it was wired ammonia that he has been complaining of chest pain he's talking kartik at one thirty respirators forty on rebreather setting ninety percent i believe with a more senior doctor present and the medical protocol fulfilled. she valley gives the patient a shock absorption saturation is very improved no these intubated is our history we

can get a little bit agitated all right very good. when we met perry give her a year ago he was undecided about his future specialty. now against his father's dream of having a surgeon in the family perry has chosen family medicine to my mom supported me very much she's there like you know what perry valley medicine is a great life you can work and just be happy. my father was very opposed to me going to family medicine and the reason i think for that is mostly because he wanted me to be a specialist but a very traditional way of thinking i think of specialists are better than general as special as or better the family doctors in family practice perry can air in about one hundred ninety thousand u.s. dollars a year this is less than half of what you could earn as

a specialist i used to say oh money doesn't matter i'm going into medicine as i love it which is still true i do love medicine even the lowest earning doctor is still a doctor you know and they're still making way very comparable weight twenty years ago the government started initiatives to promote family medicine including increasing the amount they could air in it has worked and perry is joining the most popular specialism amongst graduates. but this is not the end of the learning process for a doctor here the neonatal resuscitation program trained doctors nurses in assisting newborns that need a little bit of help in canada one of the core competencies for a family doctor is that we are able to double reviews. and we're going to practice . this. we can do everything to we can be we can. and we can do pretty much everything y'all have to rotate and

do forty five seconds one two three one two three one and two three and relations and three while too. such stations not only reinforce best medical practice but remind the new doctors how careful they need to be in a society where patients have the right to question their treatment and have the power to see. this is the highest risk of population if something goes wrong they have eighteen years. we have to keep our generically children are eighteen years until the research of adults i think it's. a modern doctor must keep accurate well written records of their patients consultations. the fear is that in a critical case who recordkeeping can turn

a peer decision into a possible career ending nightmare so that's why you need to say get the baby to the resuscitation table now because it could be. very detrimental. right from the start the importance of keeping medical records is drummed into the students. and as so often at mcmaster it is the newly qualified doctors like shivani who are brought in to hammer the message. as a medical student that is the only thing that will ever be expected of you is to get us all and nurture the history from your patient and be able to relate intelligently to your supervisor your seeing your whoever it is that you're you know talking to the patient both history is our where every thing important comes from technically legal binding documents a little bit so that the note that you write in a patient's chart can be taken to court and can. be asked to be broken down so be

very careful about the words it use be confident in the ones that use obviously you're coming from a place of skill when you write these things down but all that you have to be able to stand by. everything they say really the fear of god is put into us when it comes to like don't screw up or they're going to take your license away from you and everyone has a story of someone who's had their life this is that it was hard to go to the college because they've done not the right thing. mcmaster students are made fully aware of the disciplinary process through the provincial college of physicians and surgeons. the college oversees the practice of just over thirteen thousand five thousand physicians in ontario. and twenty fourteen there were two thousand six hundred sixty investigations and twenty seven disciplinary hearings. if for whatever reason there was the threat of me losing my license of being

a physician like what would i do with myself in the back of oliver head there is a very real threat that you know if something goes wrong everything i worked my entire life for goes away. seventy two year old margaret montfort has been admitted to the intensive care unit her husband caro believes that her life was saved by an anonymous phone call it was just one o'clock in the morning here received a phone call to both of us up i went to the answer phone and there was no one there . he thinks there is a good thing because it will disclose that if asleep and margaret says she needed to get out and she says she was frightened. she wasn't feeling well she was truly very needy really decided i was going to call nine hundred. fifty k.

summary so blood clot in along as her heart stopped she got c.p.r. for that they gave her blood thinners and then unfortunately because of her broken ribs from the c.p.r. ended up bleeding requiring want to transfusions she took a very difficult to stop. was critically ill almost died simon kosky the mcmasters graduate is in charge of the unit. no amount of training can fairly prepare him for the volume of work and the stress involved now and a little bit tired because yesterday was very busy and to stay in overnight has now been here for thirty hours so in syria right now i'm going to be here again for the rest of the afternoon before i get to go home on a busy day it can be very stressful and we're often worried that you're going to make a mistake you're going to forget something that has to be done she's doing great or big things with her really trying to get her strength out. trying to get is me

lines into third is we can. see you in a white cloth it went into your blood. the stress on your heart caused your heart to stop you doing really well trust me the way you were you were. think you're going to make it. here to cross over or we work together as a team lose all the bedside nurses you spray treat there because social work physiotherapists all of our pharmacy staff is a huge group of people here there is a level of responsibility i have but it's not a burden that you bear alone it has to be in the responsibility integrated where i think we're providing better care. market and has been the karo are a testament to the training of doctors like simon. canada boasts a life expectancy of eighty one the fourth highest in the world. but it's not

a pear shaped system a long waiting times prohibitive pharmaceutical costs and a relatively low number of doctors compared to other developed countries still causes problems. to help sort out some of these problems the medical authorities encourage doctors to get involved in designing change. it is a process that begins june in training. today second year student jennifer keitt summer is presenting her ideas on how to avoid crisis for tammy and the patience to her fellow students so i'm starting this presentation with a picture of charlie rose because she has come to symbolize for me a system gone wrong that failed someone a crisis that could have been averted so charlie rose as an eight year old cats that was owned by a woman that i met during my palliative care elective she was a woman who had absolutely no social support system no family to speak up no one

that she wanted notified of her death no neighbors whose name she knew no friends lived alone an apartment with a cat she truly had no one what i'd like to advocate for today is that as physicians we need to help people with end of life planning and there's a real role for physicians in this capacity to avoid crisis like like we've seen with charlie rose's mom. over to the system might need to improve meant the students are taught to always put patients first when you're taking care of a patient you know your first responsibility is towards that that patient they are taking care of not to words the health care system as a whole that's very clear at least in canada from a legal point of view you can't deny someone treatment simply because you think it's too expensive and not worth it the focus on the patient is vital because new system can provide everything all of the time. are you doing.

good. often put into positions of limited resource and in those moments of scarcity sometimes i do have to make decisions so for instance if there's only one bed available and two sick patients upstairs i'm taking care of which patient gets that bad first and who has to wait until a second bed is available we try to minimize the resources that we waste but while at the same time trying to provide care but those costs never really intervene to. calculus of what care should we provide overall. canada the eleventh richest country in the world can afford to spend five thousand seven hundred eighteen dollars per person on health care the global average is

barely one fifth of that. mcmaster encourages its students to go abroad and to put their knowledge to the taste and different environments. at the end difference taken dear she finally went to india for two months so i went to india and i spent seven links during a rural medicine unlike the north east every part of that system is so different from mine i saw a doctor see fifty sixty patients in a day. with a child coming through the door who had renal failure a very very sick arrested and they were actively seeing someone in the process of dying before. families panicking in the background and crying we got him stable enough to be transported in the nearest hospital is like an hour away and i just remember in that moment knowing as the ambulance robot that i had just seen someone

being sent to their death. this fifteen or fourteen year old child was going to die because the resources didn't exist to help him. and i remember going back to my room writing a. i don't want that to be the type of medicine i don't force the path as i like i know all of these people and help but it would break me in the long term to be in a place where not every person came through my doors or someone that i could help. shivani learned the limitations of her training and also some fundamental truths. i think our curriculum is designed for the setting that we're ending but a lot of what we learn is transferable to other places i don't think it takes

resources or money or any kind of privilege to be able to teach someone how to speak to another person with empathy and kindness i think there's no place in the world that that would be a detriment where like shivani simon also went abroad junior his time at mcmaster. or been in uganda worked there for a number of months and it's a very different kind of environment where physicians are very independent there isn't a lot of shared care and responsibility that we have here where one person's responsible for everything and there is a shared responsibility you're more likely to lead to errors you're less likely to provide coordinated care more likely to be wasteful but the basic skills and approach remain so valuable. is just so busy and so hectic there is also very little time to communicate so you had to really learn how to communicate effectively in a very short time period we didn't have the luxury of having quite as much time as

we do here to spend talking to people physicians i was working with there did appreciate the communication skills. several of them had trained in canada as well it certainly point and you could see how the training affected the way they practice of. being a good communicator is at the heart of that master's teaching. a doctor must be able to both relate to the patient and cure the disease. learning to be a doctor is primarily about learning to save lives and keep people healthy. but day is an ever present part of the work. right you do said his forty nine he has suffered just traumatic brain injury although his heart is still beating his brain function stopped just over twenty four hours ago. the doctors have done all they can his family has been called in to witness the final tests before simon can

declare him dead. if your brain is damaged in stops functioning all together then the body can't survive very long without support so when we do declare someone brain dead they're legally dead just as if their heart had stopped because every element that made that person they are their entire brain their brain stem everything is gone and the family often want to be present for these because it's at the time they need done all the testing declared and that is the believe that will be the death. it is a moment that puts to the test everything simon has learned since he joins mcmaster nine years ago. reasoning legal question during teamwork and above all his ability to relate to richard's family which is my second cousin. i'm fifteen and he was going to be fifty in march come and.

sit down i love you so it was solid. this year and a very disheartening. life but it did set him. on medical school we did a lot of our communication training things like how to break bad news when you've got a situation like this that so devastated and i think it's one of the most important things we can do is care providers is to make sure that people are getting the support they need when going through that you know traumatic injury or death. so we do a few things here so we're going to start at the top and work are way down so we're going to start with the. people's is very strict regulations around the process of declaring brain dead peoples around response and so we don't see

a reaction to light the way we normally would. the corneal reflex so most of us if you touch the eyes they blink and that's a reflex you can't control that because we are. declaring someone dead everything has to be exactly perfect so it's very strictly. in ontario is supposed to tell us. to go seventy question so far with everything make sense what we're doing. we do we look for any any sign we can. have brain activity. so we just looking for any breathing. data side has provided us with step by step procedures that he was going to perform on my cousin richard. he has shown us compassion it is the direction to information we couldn't have a better position. so we would say the time of death is seventeen

time so five ten pm the time of the last gasp that was drawn there. guys want to spend a bit of time hold his hand. at this point we would say that he has died his brain is gone his body is still here with us. you can never really predict the way your emotions are going to work some today when we pronounce the patient i saw the mother start crying over her dead son

it really hit home i actually became a little bit teary myself. taking care of people taking care of people's health taking care of the health of people's families it's a privilege people put a lot of trust and faith in you and you're providing them with health care i think it's important to reciprocate that trust and be worthy of that trust and provide the best care you possibly can. training doctors who can inspire such trust isn't easy it requires human skills. but it lies at the heart of what it means to be a truly good doctor. where ever you are in the world.

hell it's not warming up again anytime soon yes i know he's in the back of a cold front even a day's worth of sunshine doesn't seem to make much difference this is of course on australia i'm talking about and the temperatures reflect only a very slow warming nineteen in sydney and twenty in adelaide it's daytime sunshine is doing it it's much the same for the west in perth the breeze here like one but more or less in sas not the warmest of directions but it is more or less sunshine from wall to wall just bit of cloud edging in to the far west maybe of victoria and tasmania so that potentially active fronts on its way towards new zealand particularly south on this made contact already now it does contain enough action

anough cold to give bit of snow for southern alps rain for most of us doesn't reach north doesn't jerry monday on tuesday it probably does if you get ten end of the right and sun's come up this time in a cold across church at twelve degrees now i'd like to report the end of proper rain in japan wockhardt reported perfectly but we have got a good regular line here the rains in shanghai and he's just about north of polisher between the two but a cloud otherwise bright or even sunny conditions i'm lost a dry twenty seven enjoy it in tokyo. capturing a moment in time. snapshots of the lives. of the stories . providing a glimpse into someone else's wild. inspiring documentaries from impassioned filmmaking this. week nice documentaries to open your

eyes on al-jazeera. discover the stories you didn't know about. you we miss the life changing scenes. notice the changes that affect all of us. experience our world and be a part of it. refocus al-jazeera balkans international documentary film festival side of the world from twenty first to twenty fifth september. on culture because this week ten years later why young people are picking up the bill for the global financial crisis could a seismic economic event be brewing at emerging markets plus behind gated walls bubbles and crashes in the global housing market counting the cost on al-jazeera.

this is al-jazeera. hello there i'm julie macdonald this is the al-jazeera news hour live from london coming up the saudi led coalition launches a new wave of airstrikes on yemen targeting a key supply which at the u.n. envoy tries to kick start talks in the capital fun. typhon manget smashes into china killing two people after blowing through hong kong forcing the city into shock. in the philippines it's devastating wake leaves at least fifty three dead and a trail of destruction.