A huge number of medical undergraduate students in India rate PSM (Preventive and Social Medicine) as the most tedious subject during MBBS. The ennui is exacerbated by the monotonous nature of the writing in the subject’s important textbooks. Public health indeed is such a wonderful area of study that a student, on getting their first copy of Park’s, must be at least as excited as they are on touching their first shimmering Harrison’s. It seems an impossible dream for now.
There are several issues troubling Public health education in India, as are there infinite problems plaguing the public health system itself. Authorities from our PSM/SPM departments seriously need to find ways to attract bright and enthusiastic minds to their PG courses, rather than the generally fatigued and ‘choice-less’ (no offence intended) individuals they manage to induct now. Public health (PH) is getting more and more important in an ever-shrinking world, and is going to require lots of committed advocates. The endemic apathy of medical students towards the subject needs to be addressed urgently. We can very well start with standardizing the name for the formal subject in the curriculum – ‘Public health’ I’d propose — rather than scaring away already dispassionate students with many different names (PSM, SPM, CFM, Community Medicine, etc.) Other arch subjects like Medicine, Surgery, Obstetrics, etc. do not boast of such a fancy versatility of monikers by region, so why should Public health?
A subject is as good as its teacher. We need energetic, knowledgeable tutors for Public health: doctors and researchers who will speak effusively and passionately about, say, John Snow and how he helped arrest a cholera rampage in 1854 London through common sense; or about how early post-Independence India was the very place where future radical tuberculosis treatment regimes were first tried out. Rather what students generally get is a lecturer who mostly prates on about elephantine definitions or unending lists of numbers (birth rates, mortality rates etc.). Public health, kind of like history, is so much about stories and people; and interestingly both subjects are adversely served by teachers who concentrate more on numbers (rates in PH and dates in History).
For example, students will find a lecture on maternal mortality several times more interesting if it is embellished with the fabulous story of Ignaz Semmelweis and how he demonstrated the ‘iatrogenic’ causes of dying mothers in wards. How many medical students in India know of the Nobel Prize winner Barry Marshall, who famously drank a glass of Helicobacter pylori broth to prove once and for all that ulcers were caused mainly by bacteria, and not ‘stress’? Stories abound in Public health, itching to hit the eardrums of students. We need passionate tutors who’ll take them there.
Young people always root for role models. Each teaching hospital invariably has its crop of formidable physicians and surgeons who are worshipped fervently by students and patients alike. Most young doctors are in awe of their heroism and desire to emulate them. On the other hand there are few, if any, PSM professors who inspire their students so greatly. Although public health does boast of several heroes, these are generally not as feted as are flamboyant surgeons and stately physicians. An example is Dr Carlo Urbani, the WHO epidemiologist who effectively saved thousands of lives by his prompt, bold response to the initial SARS cases in 2003; his courageous work was an important factor that prevented the SARS epidemic from blowing up into a pandemic. He died in the process though: the unforgiving SARS virus claiming his illustrious life.
Back home in India, we have countless examples, like Drs Rani and Abhay Bang, who have revolutionized the delivery of rural health and maternity care. Organizations like WHO and Doctors Without Borders are nothing but imposing conglomerates of hundreds of unsung public health luminaries. Young medical students of India should be exposed more to the towering and lives-changing work that is being done by such individuals and organizations.
While there is no need for every MBBS doctor to go into public health or even like the subject of Public health, it is absolutely important for them, as doctors, to know and understand public health very well. For a nation to be at peace, public health and education are the two most important areas of priority. It is high time the Medical Council of India recognized this and reformed the way medical students are educated in Public health.
(This article was previously published on the website MDCurrent India.)