Not seeing beyond “medicine” is no longer enough

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The Covid-19 pandemic has shown us a finger in the face of how important public health is in strengthening the health system. So what value do we really place on the subject?

September 03, 2021, 12:15 pm

Last modification: 03 September 2021, 12:24

A doctor takes care of a patient at Dhaka Medical College Hospital. Photo: Salahuddin Ahmed

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A doctor takes care of a patient at Dhaka Medical College Hospital. Photo: Salahuddin Ahmed

When I started medical school, I heard about a topic that most students joked about. Our elders gave us the impression that this medical school topic is one of the most unnecessary topics, if not the most.

It doesn’t help with surgery, prescribing medications, making department visits, or even doing minor sutures when a patient cuts. The only use of this subject, according to them, is to know the organizational chart of a health center if someone is unlucky to stay there for a long time or to give some hygiene advice if someone ever needs it. . The name of this subject is community medicine.

An elderly person, with a kind heart and great intention to help me succeed in this subject, went ahead and told me to memorize the definition of “public health” and “primary health care” (this that I did, and I now use it to surprise listeners often by reciting it in front of an amused audience), if I wanted to get the topic across brilliantly.

In our day, community medicine was taught in grades three and four. I found some truth in what my elders told me on the subject. I later learned from many medical graduates that community medicine, as a subject, also enjoyed a similar reputation in their respective medical schools.

According to them, the pedagogy is boring, the teachers are demotivated (the common perception is that the teachers of community medicine come into this field “by chance”, not “by choice”, because they did not succeed in obtaining a diploma of medicine. (graduate studies in a “reputable” clinical discipline), the textbooks are unimpressive and out of date, and the topics covered in the subject are far removed from actual professional needs.

I was lucky, because when I reached my third year, a young public health graduate from a Belgian university joined as the head of the department and brought a breath of fresh air to the department in terms of ‘pedagogical approaches.

For the first time, contrary to the common perception regarding community medicine, we were not asked to memorize anything, not a single word. For the first time in my entire life in medical college (and beyond), I encountered what is called “group work”.

The new teacher divided the students into small groups and gave us some real issues that public health professionals may face in their careers. For example, he might ask, “Imagine you are working as a doctor in a health complex in Upazila and one morning you find that a large number of patients with diarrhea arrive at your hospital. What’s the first thing you’ll do? What could be the successive steps to solve the problem in the long term? “

In the fourth year, we had an exceptional trip, part of the curriculum, but often overlooked in many medical schools – Residential On-Site Training (RFST). The whole class booked a minibus and drove to the Palashbari Upazila health complex for research field training.

On the first day, I met a farmer working in a nearby field. When asked if he uses a sanitary latrine, he glanced at me for a few seconds, held my hand, dragged me to a nearby hut – barely a roof above the head. He said, “This is all I received from my ancestors. Now tell me sir, should I sleep in it or build a toilet there?

Illustration: SCT

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Illustration: SCT

Illustration: SCT

The next day I met a young mother who was cooking rice, spinach and lentils, holding her one year old child in her lap. As the goiter is endemic in northern Bangladesh and exacerbated by iodine deficiency, I asked her if she uses iodized salt for cooking.

Again, there was the same blank stare for a few seconds and an intense response, “Iodized salt costs Tk 5 more per pack, which means around Tk 50 per month. This amount is a two day living cost. for my whole family. That means, sir, if I go for iodized salt, my whole family has to starve for two days. “

These field experiences have changed the world I had known for so many days. The famous 19th century physician and thinker Rudolf Virchow once said: “Medicine is a social science, and politics is nothing but medicine on a large scale.

I realized that it is not the medicine we learn in medical school that can cure the overwhelming “illnesses” in the community; but it is the deprivation of the right to vote of people that we must first heal. This cannot be done without addressing the social and political determinants of health, as Virchow rightly envisioned it centuries ago.

I decided to pursue my career in community medicine, but I haven’t found a clue where it is taught. After much research, I realized that community medicine is a “misnomer” used in our medical schools to represent a broad discipline called “public health”.

Later, I realized that medical schools are more interested in “medicine” than “health”. Perhaps this is the reason why some veterans of medical education in our country considered community medicine to be a more appropriate name for a subject in medical school rather than public health.

I don’t know the purpose of such a naming principle, nor do I know its policy, if there was any. What I do know is that this name is ambiguous at best and misleading at worst. This naming approach ignores the people’s right to “health”. It limits the mindset of budding doctors to the confined mandate of “medicine”.

Needless to say, “health” is a much bigger concept, and medicine is only a tiny part of the study of health recovery. According to the World Health Organization definition of health, it is “a state of complete physical, mental and social well-being, and not simply the absence of disease or infirmity”.

Medicine concerns only one aspect of health, that is to say the curative aspect, while other integral aspects are the preventive, promotional and rehabilitative aspects. Thus, the emphasis should be on “health” rather than “medicine”.

Second, students aiming for graduate studies in community medicine will find it difficult to identify the subject’s parent discipline, which is public health. I therefore propose to rename this subject in our medical curriculum in Public Health.

However, I sincerely agree that just changing the name of a topic won’t do much to maintain a topic’s image and position. The Covid-19 pandemic has shown us with one finger in the eye how important public health is to strengthening the health system, communicating health messages, promoting a healthy lifestyle, predicting the evolution of a disease, planning an evidence-based pandemic response, developing a people-centered health policy and leading an effective health sector.

Dr Taufiq Jaorder. Illustration: SCT

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Dr Taufiq Jaorder.  Illustration: SCT

Dr Taufiq Jaorder. Illustration: SCT

These are all core functions of different sub-disciplines of public health, namely epidemiology, health economics, medical anthropology, health communication, health policies and systems, management and health. health administration, etc.

Therefore, in medical schools and beyond, the curriculum for this discipline should be revised to the current global standard, pedagogy should be improved to include a participatory problem-based learning approach, and career paths. public health professionals in government health services should be defined and respected.

Public health education should be reformed in a way that prompts aspiring health professionals to pursue it “by choice”, not just “by chance”.

Doctor Taufique Joarder is vice president of the Public Health Foundation, Bangladesh.

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