Why Public Health?
One of my senior colleagues inquired about my career in public health. He asked me whether I had chosen the field by chance or by choice. I replied to him boldly, “By choice and by profound determination.” Hearing such a reply completely astonished him. He asked, “Doctors have a better future in clinical practice. Then why you are interested in public health?”
I completed my MBBS course on July 2011 from Dhaka Medical College; a reputed medical college of Bangladesh and completed my internship in November 2012. I decided to pursue my career in public health from the very beginning of my internship. The decision was very tough indeed. Everybody in my family and relatives were very upset and frustrated to see me not trying to build up a clinical career. My seniors, classmates and juniors keep asking me why I have chosen public health as a career.
To explain my motivation for public health, I started telling them a story. Suppose one finds a very precious thing in the dustbin, lying very carelessly among the filth. He picked and cleaned it up. Then he put the thing again in the dustbin along with the filth. The story is a metaphor of our current healthcare system. Most of our patients are coming from very unhealthy conditions. We treat them with care and put them back again in that unhealthy condition. So the ultimate results of our efforts goes in vain in most of the time.
When a patient comes with a disease to a doctor and/or hospital, he also comes with his entire social, cultural, personal, familial and religious practices. So if we are treating the disease only and not putting our effort in changing the surrounding environment, we are actually treating the patients partially. And in this way we will not be able to reduce our existing burden of morbidity and mortality.
Let me draw an example. To achieve MDG goals by 2015, Bangladesh needs to reduce maternal mortality rate (MMR) to 143 per 100,000 live births. If only we have efficient doctors at our facilities, will we be able to achieve this goal. The reasons for not achieving the desired result in spite of having good doctors in the healthcare facilities are many; lying in our social, cultural, financial and religious backgrounds. Many of our rural people do not know the importance of ante-natal care (ANC) due to their ignorance.
If they know the importance, many of them do not allow their pregnant women to go to hospital for ANC or delivery due to social practices and religious views. Even if they do allow, some have financial constraints or nobody to accompany as they don’t have a birth plan during ANC. So it is not possible for an obstetrician to reduce MMR; rather, the public health people will educate the people about the importance of ANC, hospital delivery and post-natal care. They will motivate people and make them act positively to reduce maternal mortality.
In no way, I am underestimating the value of clinical care. Surely the doctors are playing a very important role in our healthcare. But the problem is that our doctors are too much focused on secondary and tertiary care; not giving emphasis on primordial and primary care. It’s time to change our view towards public health.
Bangladesh is in crying need of Public health experts and researchers to improve its healthcare conditions. We need young, enthusiastic and motivated doctors willing to work in public health arena and contribute immensely with their innovations and integrity. And by working together, the clinicians and public health experts will build a healthy Bangladesh.
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