Dr K Leelamoni is a former Head of Department of Community Medicine at the Government Medical College in Kozhikode and Thiruvananthapuram, and later at the Amrita Institute of Medical Sciences in Kochi. She has worked in the field of community medicine for 48 years. She writes:
It has been more than two months since India reported its first case of COVID-19 and, during this short period, the number of cases has crossed 4,000 even after a national lockdown. We have withstood the H1N1 and swine flu pandemics over the past decade but those did not require such a drastic measure.
For decades in the field of community medicine, a stream of medical studies not many are aware of, the stress has always been on the role of strengthening the health of the community with simple steps like personal hygiene and basic sanitation. Nevertheless, it needed a pandemic to open our eyes to accept basic hand and body hygiene, and cough etiquette, in our daily lives.
The basic principle of prevention and control of a disease is based on the levels of prevention: Primary, Secondary and Tertiary. Primary prevention stresses on health education or awareness and specific protection, which includes use of protective measures and immunisation. Early detection of disease and prompt treatment constitute the secondary level whereas disability limitation and rehabilitation form the third level.
The decision about which level is needed is usually decided by community medicine experts based on the epidemiological features of different diseases. In acute respiratory diseases, the first and second levels are important whereas in polio and leprosy, tertiary prevention also has a major role.
Unfortunately, priority is almost always given to tertiary care alone by starting big hospitals and healthcare centres, which do not reach the common man’s life. Clinicians, of course, play a major role in treatment and patient care, but the benefit is only to the patient and family. But for public health experts, by applying the primary level of prevention alone, they are protecting an entire community. Unfortunately, unlike clinicians, the results of public health efforts are not visible immediately.
Even in the medical curriculum, community medicine is a major discipline to be taught right from the first to the final year with three months training in the subject required for basic training of doctors. However, this important stream is ignored by many for the glamour and lure of clinical medicine -consultations, surgeries, etc. Once a medical student complained to me about his poor marks in the subject – a minimum is required to clear MBBS. Then, he made a startling admission: He had joined the medical college to become a flourishing physician and make money, not to waste time on sanitation and hygiene.
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But what students like him don’t know is that when they are posted to primary health centres, they will realise the importance of the subject. Once, during an inspection at a Primary Health Centre, I met the same student, now a doctor, with a text book of community medicine on his table. He sheepishly admitted that he had now understood the relevance of community health.
Today, almost everyone across the country knows about the significance of quarantine, isolation, social distancing and safe sanitary practices. But what many don’t remember is that these principles were stressed at the time of the H1N1 pandemic, too. What I clearly remember from that time is a discussion with policymakers on creating awareness about cough hygiene; providing a separate ward for suspected cases; keeping a minimum distance of one metre between hospital beds; and providing protective materials for hospital attendants. Forget the policymakers, even doctors did not take the recommendations seriously.
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Now, a word of caution. There is no doubt that we will be able to contain the COVID-19 pandemic by strictly applying the prescribed safety measures and practising safe distancing along with effective quarantine and surveillance. But there needs to be an equally aggressive awareness campaign about the social stigma and discrimination that will follow, as more and more people return home from hospital and quarantine. This is due to fear and anxiety about a disease, especially one which is new, and can be alleviated by sharing accurate information about the virus and how it spreads. Getting the recovered patients to share their experiences in person through media channels is a very important tool, in this respect.
What is equally important is to continue the safe practices that we are banking on now to keep the pandemic at bay: taking a shower every day, washing our hands with soap every time we return home, and covering the mouth while coughing. These simple measures should become an intrinsic part of our lives, as much as brushing our teeth.
Every crisis has a silver lining. In India’s battle against COVID-19, we can be proud of our health system and its dedicated professionals who are working round the clock. At a time when other countries are focusing only on tertiary care, we are truly ahead of the curve.
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