Investigative public health: The scope of public health detectives

Dr KK Aggarwal

Resurgence of infectious diseases is a reflection of the existing public health system in the country. Infectious diseases occur every year in India with monotonous regularity and we are unable to control the frequency of their occurrence and their subsequent spread.

A public health approach to health care may be the answer. Unlike clinical medicine, which focuses on individuals and diagnosis and treatment, public health deals with the whole community and is preventive.

Every preventable death should be audited, and every index case of any communicable disease should be traced for the source.

The time has come for investigative public health department with appointment of public health detectives, who will help establish the cause of the outbreak and how can its spread be limited. Here lies the importance of contact tracing and their monitoring. Contacts can be the immediate family and/or those who have been in close proximity to the index case, including the health care workers who have looked after the patient.

·         Monsoons are not off, and every first reported case of dengue should be traced for its origin.

·         Typhoid is continuing (summer to monsoon) and every case in the community should be investigated for the common source of food. Recently in the US, typhoid outbreak was traced to patients who ate fresh papayas imported from Mexico and sold in a common food store. The CDC issued a safety alert advising consumers to not eat fruit imported from Mexico.

·         Last week Delhi reported its first death due to diphtheria. Source of the first case should be traced and surrounding areas.

·         Every case of GeneXpert positive TB should be traced back to the source including contact tracing.

·         Every unexplained death should have post-mortem X ray, CT, MRI or mini tissue biopsies to know the cause of death.

·         The index (first) case should be traced in diseases like diphtheria, flu, acute food poisoning etc.

·         Any new symptoms should be reported to the public health department.

·         The department should provide free investigations for the illnesses.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

A bridge course for dentists and Ayush?

  

The Dental Council of India is asking for a bridge course for dentists, which will enable them to become mid-level healthcare providers. However, this has to be viewed in the right context.

A large number of seats in dental colleges are lying vacant for the past few years; this is particularly the case with the private dental colleges as these colleges charge a very high admission fee, running into several lakhs. Yet, private dental colleges keep mushrooming randomly.

Only 40 of around 300 dental colleges in the country are in the government sector (Press Information Bureau, October 13, 2018).

Many of these private colleges are ill-equipped and fail to meet the requirements and standards; therefore, they need to be shut down or closed. A bridge course would be a lifeline for such colleges.

The WHO dentist-population ratio is 1:7500. The dentist-patient ratio in the country at present is around 1:8,000 (Press Information Bureau, October 13, 2018).  But this number is disproportionate in the urban and rural areas. The disparity is particularly glaring in the rural areas, where there is just one dentist for 50,000 people.

Will not the proposed bridge course, if it comes into being, further add to this shortage?

Similar is the case for Ayush doctors…

Some facts to ponder

·           Dentists already treat fever, prescribe antibiotics, treat primary health problems linked to dental hygiene, treat oral cavity-linked diseases, give IV fluids; they have a link with anesthetists, then why give them another primary care course?

·           Allowing Ayush doctors to practice allopathic medicine at a primary care level sends a message that Ayurveda is not competent to provide primary care to people. They why continue with the Ayurveda course? If Ayurveda cannot treat common ailments such as cough, cold, diarrhea, fever, infections, breathlessness, asthma etc. why treat them as main stream system of medicine. The same holds true for Homeopathy and Unani systems of medicine.

·           Naturopathy and yoga provide no drugs and hence cannot be equated at par with systems that prescribe drugs.

A question then arises - Why is the government contemplating a bridge course for dentists and Ayush doctors?

Will such mid-level health providers actually enhance the public health system? Or, is this a move to protect the interests of private dental college owners?

The respective systems of medicine should be strengthened and made more effective. A common basic curriculum in primary health care can be designed for all who wish to become doctors. And only after completion of this basic course, they should advance further in their chosen subject or the chosen system of medicine.

India has a deficit of an estimated 600,000 doctors. But, crosspathy is not the answer to this conundrum.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA