Community Medicine medical care directed towards service of the entire population of the community, with emphasis on preventive medicine. Illnesses have been seen in the past as individual issues affecting a victim. In fact, the system of medicine traditionally developed in a manner that diseases were treated as matters of individual concern. Occasionally, follies and prejudices propelled by religious dogmatism made this individualistic notion of disease even more pronounced. For instance, infirmity and illness were considered penalties for vice.
With advances in scientific knowledge and better understanding of the causes of disease, knowledge about germs, relationship of nutrition and illness, and progress in the science of epidemiology etc, new dimensions in medicine have been opened. Subjects like social medicine and community medicine have been introduced to describe certain aspects of science to focus the community at the centre of interventions rather health of individuals. Certainly, certain types of problems can be better addressed through the community than the individual. For instance, a nation-wide nutritional education campaign with respect to food habits that would reduce vitamin A deficiency and prevent night blindness would eventually benefit individuals, but the community approach would yield faster results in the long run with less cost.
Today, the world is a 'global health village' with shared health threats. Diseases are no more respectful of national boundaries but due to increased human mobility can rapidly spread to vast areas across many countries, and often continents lying across vast stretches of ocean. Human health can no more be regarded as isolated regional problems that can be tackled by an isolated approach, but requires joint action and joint responsibility towards addressing shared problems. The Alma-Ata declaration endorsed 'Health for all by the year 2000' but the honest intention is not achieved.
Community medicine addresses issues such as cheaper methods of treatment, less costly inputs to achieve health, cheap and effective methods to train and use community workers in health care, efficient deployment of resources by identifying high-risk targets, community motivation, health awareness creation etc.
Bangladesh has a huge population but relatively easily accessible communities. This is partly due to the fact that population density is high which offers certain advantages in community medicine because access to communities is less costly logistically.
The lead work in community medicine in Bangladesh was triggered by the dreadful disease cholera, which for many years killed tens of thousands in explosive epidemics that came with remarkable regularity. The Vietnam War in the 1950s provided an incentive to the South East Asia Treaty Organisation (SEATO), which was created in 1956 to counter the spread of communism in Southeast Asia, and to support research on cholera with the aim of protecting American soldiers fighting in the area.
The Pakistan SEATO Cholera Research Laboratory (PSCRL) was established in Dhaka in 1960. This institution in its early years of operation carried out clinical studies on cholera patients and made valuable contributions to the discovery of the oral rehydration therapy on the basis of which the well known Oral Rehydration Solution (ORS) had been formulated. The Cholera Research Laboratory was transformed into International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) in 1979 with a field study station of 200,000 population located in rural Bangladesh. This large population was under constant demographic surveillance, the outcome led to the drugs and vaccines and many other significant and often pioneering research activities in community medicine. It was here that the community efficacy of ORS was formally established as an intervention of profound value with the potential to save millions of lives if used properly. The intervention was quite appropriately termed as the one of most significant medical discoveries of the twentieth century. Today icddr,b spends a large parts of its resources on health projects directly targeted at the community.
Another pioneering institution in community medicine is the Bangladesh Institute for Research and Rehabilitation in Diabetic Endocrine and Metabolic Disorders (birdem) founded in 1980. It is an organ of the diabetic association of bangladesh (DAB) and a 'WHO Collaborating Centre for control of diabetes. Although its primary focus is to serve 4 million diabetic patients, it also addresses total health care issues. At the community level DAB has 46 affiliated societies working throughout the country.
At present many non-government organisations (NGOs) in Bangladesh are involved in community research activities. For instance, Bangladesh Rural Advancement Committee (brac), an internationally reputed national NGO of the country being the world largest, works on field application of oral rehydration therapy, making cost-effective home treatment available to communities using home ingredients such as salt and molasses dissolved in water, a formulation locally called 'lobon-gud'. The organisation has programmes on TB therapy where a common problem is that the patients often discontinue the rather long (one year) treatment schedule. Experimental field research was initiated by BRAC that included provision of incentives to participating patients. Patients are required to deposit a token sum of money (Taka 100, roughly equivalent to $ 2) towards treatment cost most of which is returned at the end of the completion of the treatment. This increased treatment completion rate and provided great benefit to individuals and the community.
Many NGOs in Bangladesh are at present involved in health care activities at the community level. Areas where community medicine projects are being implemented in Bangladesh include vitamin A deficiency, arsenic-toxicity, diarrhoeal diseases, goitre, intestinal parasites, and immunisation programmes for children.
Community medicine is likely to contrive as a high priority area of medicine in Bangladesh. Population projections suggest that there will be about 250 million people by the middle of the present century. That is, the country will have to cope with a population density of nearly 1700 persons per square kilometre. The rural communities will have some typical rural problems characteristic of a poor economy, poor sanitation, inadequate safe drinking water, high infectious disease load, problems related to nutrition, environmental degradation, as well as over-crowding at the household level. There can no better cost-effective health intervention than those aimed at the community as a whole that will reduce preventable disease burdens and allow individuals to reap the benefit of the limited health resources of the country.
Community-based medical colleges and similar educational institutions in the health sciences have been established in recent years in rural setting in the private sector. These institutions are suitably poised to involve the community in health matters through direct participation of its members. Health education can substantially reduce the incidence of many common infectious diseases, and abolish many others altogether through successful immunisation programmes. The emphasis that the discipline of community medicine receives these days from the medical community is exemplified by the fact that some private universities of the country are now offering courses in community medicine. Recent government decision to establish a community health centre at every word or village level will be of great benefit in the health care system of our country. [Zia Uddin Ahmed]
Public Health workers today need to lead from the front and have faith in their own inner voice and be the source of strength which the world so desperately falls short of. Let this mark the renewal of a new project in world history. Public health can only be a calling for those who seek to listen. The world is waiting.
– Dr. Edmond Fernandes. MBBS, MD, PGD-PHSM
Community Medicine is understood by different names today (Social Medicine, Preventive Medicine, Public Health, Community Health) and perhaps suffers an existential crisis thanks to regulatory agencies that have never really understood the branch and have not gone beyond dry textbooks and sundry lectures. The Medical Council of India seems to take forever to understand that Community Medicine is a clinical branch and barely able to comprehend the field.
For medical students, the interest in community medicine dies a natural death (because of no exposure to real-time field work) and there are two types of people who join the MD – Community Medicine (Specialty branch of medicine) field. One set of them join the branch because they are madly in love with it and the other set join the branch because they had to fall in love by force because they did not get other branches.
To an ordinary lay man, they are unaware of Community Medicine as a discipline and it is not their ignorance. The fault-lines can be traced back through the decades.
Why then do I call it the sexiest profession of the 21st century?
What binds us together is stronger than what drives us apart and community medicine is the umbrella of medicine which connects the dots together. It is an enterprise of responsibility, a living embodiment of what it means to be human and watch the true face of human suffering in all its fullness.
Community Medicine is not about the textbook of Park which MBBS students read, it is even less about anything to do with Park at all. But opinions and conclusions are drawn because Park is what medical students end up reading, they do not go 50 kms from the area of the medical college to understand the human face behind disease and death, poverty and pathogens, have not visited institutes of national importance, do not engage with UN agencies and civil society organisations and lack the will to volunteer.
But I firmly believe that Community Medicine is the single most authoritative branch of medicine the world has ever witnessed, if not understood. Yet some organisations and institutions pay poorly. Public health workers deserve much more than what they ask. They sacrifice the prime time of their lives and moments facing field challenges, grant challenges and red-tapism in the bureaucracy which suffers from stage 4 Cancer.
It is a public health problem when children die in their infancy, it is a problem of public health when motherhood is politicized and when we see human face as a statistical number while interpreting maternal mortality. It is a public health problem when people die in Syria from a civil war and when the Geneva Convention fails. It is a public health problem when the Sendai Framework for Action is not implemented to strengthen disaster resilience around the world. It is a public health problem when it becomes difficult to create a green corridor for organ and cadaveric transplant and when we do not have accurate statistics for most of the problems. It is a public health problem when sometimes our numbers are nothing but fiction.
Great responsibility lies in the hands of public health specialists not only in India, but also around the world. Public health workers and the world at large must understand that the future of human kind that would come after; lies in their hands. The focus cannot remain merely to target certain diseases which are sizeably high, but concerted effort needs to be made for all diseases whether it is chronic kidney diseases, whether it is road traffic injuries, whether it is neglected tropical diseases, whether it is even trachoma.
What public health workers do in the field and amidst communities will be the brand incarnate for all times to come. Society will judge us not by what we speak, but by what we have achieved. Yes, history is evidence that public health victories like eradication of Small Pox, and then Polio changed human destinies forever. It was a hard fought battle involving government departments, civil society organisations and well-meaning volunteers who gave their time, sweat and every bit to make the world a better place.
A community medicine doctor touches thousand souls at a time. For some public health doctors, it happens through their community centric clinics, for others it’s through policy reforms, for others it’s through research, for some others it’s through training and for many others it’s through academia.
I believe, that more people die with diabetes and hypertension and malaria and diarrhoeal diseases than people who die from rare diseases. That’s why public health matters. That’s why governments need to co-operate and relate. That’s why corporate companies need to foster hands of friendship. Community medicine is at the very heart of the health system and much depends on how this rank and file performs in society, for society.
The time has come when community medicine must rise up and redeem that promise which sustained hope for centuries. It is time to give voice to those millions who thirst for a healthy life.
The day every Indian and every global citizen of the world will have access to affordable and quality healthcare at their door-step is the day when public health workers can afford to claim their victory. That is our challenge, this is our moment. Can we rise together to ensure this happens in our lifetime and leave the world more beautiful than what we inherited?
For this to happen, our public health infrastructure will have to be improved, heavy investment is necessary in this sector and corporate companies must come out of their private centric commerce and join hands with field organisations. Government agencies must fast-track public health matters which organisations bring up from time to time and not resort to time delay tactics which we witness every-day. They are accountable if not to their own people, certainly to their maker.
Lastly for the benefit of many professionals who wonder what are the options as a Community Medicine or Public Health Specialist from a job perspective, these are a few that come to my mind.
1. Join Civil Society Organisations (CSOs) and work as consultants in the field or as research officer, training officer and many more.
2. Join United Nation agencies like WHO, UNICEF, UNDP, UNHCR and likes in different capacities.
3. Join as Epidemiologist in health systems institutions.
4. Join Government departments, ministries at central and state government levels.
5. Join as a faculty in healthcare universities.
6. Join public and private sector industries as technical experts.
Note: These are only select thoughts which would become a major book by 2018.
DISCLAIMER : Views expressed above are the author's own.
With advances in scientific knowledge and better understanding of the causes of disease, knowledge about germs, relationship of nutrition and illness, and progress in the science of epidemiology etc, new dimensions in medicine have been opened. Subjects like social medicine and community medicine have been introduced to describe certain aspects of science to focus the community at the centre of interventions rather health of individuals. Certainly, certain types of problems can be better addressed through the community than the individual. For instance, a nation-wide nutritional education campaign with respect to food habits that would reduce vitamin A deficiency and prevent night blindness would eventually benefit individuals, but the community approach would yield faster results in the long run with less cost.
Today, the world is a 'global health village' with shared health threats. Diseases are no more respectful of national boundaries but due to increased human mobility can rapidly spread to vast areas across many countries, and often continents lying across vast stretches of ocean. Human health can no more be regarded as isolated regional problems that can be tackled by an isolated approach, but requires joint action and joint responsibility towards addressing shared problems. The Alma-Ata declaration endorsed 'Health for all by the year 2000' but the honest intention is not achieved.
Community medicine addresses issues such as cheaper methods of treatment, less costly inputs to achieve health, cheap and effective methods to train and use community workers in health care, efficient deployment of resources by identifying high-risk targets, community motivation, health awareness creation etc.
Bangladesh has a huge population but relatively easily accessible communities. This is partly due to the fact that population density is high which offers certain advantages in community medicine because access to communities is less costly logistically.
The lead work in community medicine in Bangladesh was triggered by the dreadful disease cholera, which for many years killed tens of thousands in explosive epidemics that came with remarkable regularity. The Vietnam War in the 1950s provided an incentive to the South East Asia Treaty Organisation (SEATO), which was created in 1956 to counter the spread of communism in Southeast Asia, and to support research on cholera with the aim of protecting American soldiers fighting in the area.
The Pakistan SEATO Cholera Research Laboratory (PSCRL) was established in Dhaka in 1960. This institution in its early years of operation carried out clinical studies on cholera patients and made valuable contributions to the discovery of the oral rehydration therapy on the basis of which the well known Oral Rehydration Solution (ORS) had been formulated. The Cholera Research Laboratory was transformed into International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) in 1979 with a field study station of 200,000 population located in rural Bangladesh. This large population was under constant demographic surveillance, the outcome led to the drugs and vaccines and many other significant and often pioneering research activities in community medicine. It was here that the community efficacy of ORS was formally established as an intervention of profound value with the potential to save millions of lives if used properly. The intervention was quite appropriately termed as the one of most significant medical discoveries of the twentieth century. Today icddr,b spends a large parts of its resources on health projects directly targeted at the community.
Another pioneering institution in community medicine is the Bangladesh Institute for Research and Rehabilitation in Diabetic Endocrine and Metabolic Disorders (birdem) founded in 1980. It is an organ of the diabetic association of bangladesh (DAB) and a 'WHO Collaborating Centre for control of diabetes. Although its primary focus is to serve 4 million diabetic patients, it also addresses total health care issues. At the community level DAB has 46 affiliated societies working throughout the country.
At present many non-government organisations (NGOs) in Bangladesh are involved in community research activities. For instance, Bangladesh Rural Advancement Committee (brac), an internationally reputed national NGO of the country being the world largest, works on field application of oral rehydration therapy, making cost-effective home treatment available to communities using home ingredients such as salt and molasses dissolved in water, a formulation locally called 'lobon-gud'. The organisation has programmes on TB therapy where a common problem is that the patients often discontinue the rather long (one year) treatment schedule. Experimental field research was initiated by BRAC that included provision of incentives to participating patients. Patients are required to deposit a token sum of money (Taka 100, roughly equivalent to $ 2) towards treatment cost most of which is returned at the end of the completion of the treatment. This increased treatment completion rate and provided great benefit to individuals and the community.
Many NGOs in Bangladesh are at present involved in health care activities at the community level. Areas where community medicine projects are being implemented in Bangladesh include vitamin A deficiency, arsenic-toxicity, diarrhoeal diseases, goitre, intestinal parasites, and immunisation programmes for children.
Community medicine is likely to contrive as a high priority area of medicine in Bangladesh. Population projections suggest that there will be about 250 million people by the middle of the present century. That is, the country will have to cope with a population density of nearly 1700 persons per square kilometre. The rural communities will have some typical rural problems characteristic of a poor economy, poor sanitation, inadequate safe drinking water, high infectious disease load, problems related to nutrition, environmental degradation, as well as over-crowding at the household level. There can no better cost-effective health intervention than those aimed at the community as a whole that will reduce preventable disease burdens and allow individuals to reap the benefit of the limited health resources of the country.
Community-based medical colleges and similar educational institutions in the health sciences have been established in recent years in rural setting in the private sector. These institutions are suitably poised to involve the community in health matters through direct participation of its members. Health education can substantially reduce the incidence of many common infectious diseases, and abolish many others altogether through successful immunisation programmes. The emphasis that the discipline of community medicine receives these days from the medical community is exemplified by the fact that some private universities of the country are now offering courses in community medicine. Recent government decision to establish a community health centre at every word or village level will be of great benefit in the health care system of our country. [Zia Uddin Ahmed]
Public Health workers today need to lead from the front and have faith in their own inner voice and be the source of strength which the world so desperately falls short of. Let this mark the renewal of a new project in world history. Public health can only be a calling for those who seek to listen. The world is waiting.
– Dr. Edmond Fernandes. MBBS, MD, PGD-PHSM
Community Medicine is understood by different names today (Social Medicine, Preventive Medicine, Public Health, Community Health) and perhaps suffers an existential crisis thanks to regulatory agencies that have never really understood the branch and have not gone beyond dry textbooks and sundry lectures. The Medical Council of India seems to take forever to understand that Community Medicine is a clinical branch and barely able to comprehend the field.
For medical students, the interest in community medicine dies a natural death (because of no exposure to real-time field work) and there are two types of people who join the MD – Community Medicine (Specialty branch of medicine) field. One set of them join the branch because they are madly in love with it and the other set join the branch because they had to fall in love by force because they did not get other branches.
To an ordinary lay man, they are unaware of Community Medicine as a discipline and it is not their ignorance. The fault-lines can be traced back through the decades.
Why then do I call it the sexiest profession of the 21st century?
What binds us together is stronger than what drives us apart and community medicine is the umbrella of medicine which connects the dots together. It is an enterprise of responsibility, a living embodiment of what it means to be human and watch the true face of human suffering in all its fullness.
Community Medicine is not about the textbook of Park which MBBS students read, it is even less about anything to do with Park at all. But opinions and conclusions are drawn because Park is what medical students end up reading, they do not go 50 kms from the area of the medical college to understand the human face behind disease and death, poverty and pathogens, have not visited institutes of national importance, do not engage with UN agencies and civil society organisations and lack the will to volunteer.
But I firmly believe that Community Medicine is the single most authoritative branch of medicine the world has ever witnessed, if not understood. Yet some organisations and institutions pay poorly. Public health workers deserve much more than what they ask. They sacrifice the prime time of their lives and moments facing field challenges, grant challenges and red-tapism in the bureaucracy which suffers from stage 4 Cancer.
It is a public health problem when children die in their infancy, it is a problem of public health when motherhood is politicized and when we see human face as a statistical number while interpreting maternal mortality. It is a public health problem when people die in Syria from a civil war and when the Geneva Convention fails. It is a public health problem when the Sendai Framework for Action is not implemented to strengthen disaster resilience around the world. It is a public health problem when it becomes difficult to create a green corridor for organ and cadaveric transplant and when we do not have accurate statistics for most of the problems. It is a public health problem when sometimes our numbers are nothing but fiction.
Great responsibility lies in the hands of public health specialists not only in India, but also around the world. Public health workers and the world at large must understand that the future of human kind that would come after; lies in their hands. The focus cannot remain merely to target certain diseases which are sizeably high, but concerted effort needs to be made for all diseases whether it is chronic kidney diseases, whether it is road traffic injuries, whether it is neglected tropical diseases, whether it is even trachoma.
What public health workers do in the field and amidst communities will be the brand incarnate for all times to come. Society will judge us not by what we speak, but by what we have achieved. Yes, history is evidence that public health victories like eradication of Small Pox, and then Polio changed human destinies forever. It was a hard fought battle involving government departments, civil society organisations and well-meaning volunteers who gave their time, sweat and every bit to make the world a better place.
A community medicine doctor touches thousand souls at a time. For some public health doctors, it happens through their community centric clinics, for others it’s through policy reforms, for others it’s through research, for some others it’s through training and for many others it’s through academia.
I believe, that more people die with diabetes and hypertension and malaria and diarrhoeal diseases than people who die from rare diseases. That’s why public health matters. That’s why governments need to co-operate and relate. That’s why corporate companies need to foster hands of friendship. Community medicine is at the very heart of the health system and much depends on how this rank and file performs in society, for society.
The time has come when community medicine must rise up and redeem that promise which sustained hope for centuries. It is time to give voice to those millions who thirst for a healthy life.
The day every Indian and every global citizen of the world will have access to affordable and quality healthcare at their door-step is the day when public health workers can afford to claim their victory. That is our challenge, this is our moment. Can we rise together to ensure this happens in our lifetime and leave the world more beautiful than what we inherited?
For this to happen, our public health infrastructure will have to be improved, heavy investment is necessary in this sector and corporate companies must come out of their private centric commerce and join hands with field organisations. Government agencies must fast-track public health matters which organisations bring up from time to time and not resort to time delay tactics which we witness every-day. They are accountable if not to their own people, certainly to their maker.
Lastly for the benefit of many professionals who wonder what are the options as a Community Medicine or Public Health Specialist from a job perspective, these are a few that come to my mind.
1. Join Civil Society Organisations (CSOs) and work as consultants in the field or as research officer, training officer and many more.
2. Join United Nation agencies like WHO, UNICEF, UNDP, UNHCR and likes in different capacities.
3. Join as Epidemiologist in health systems institutions.
4. Join Government departments, ministries at central and state government levels.
5. Join as a faculty in healthcare universities.
6. Join public and private sector industries as technical experts.
Note: These are only select thoughts which would become a major book by 2018.
DISCLAIMER : Views expressed above are the author's own.
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