Why research in public health needs to be community-based

Health, by definition is not the absence of disease; but rather, the whole human, economic and social well- being, a sentence I remember from a course of public health during my time in medical school.Public health is a subject that the Third World seems to understand well, yet still not applying adequately.Africa and the Third World in general still apply what we would call defensive medicine: reducing maternal and infantile mortality, fighting highly epidemic diseases, HIV, malaria, and others and at the same time, striking against malnutrition bouts here and there, which is the core aim of public health.This predicament is quite understandable, and goes hand in hand with the levels of education of the general population, access to primary health care and the quality of the care provided. It would be thus reasonable to explain that a significant chuck of the national cake is allocated to innovative projects and research targeting the achievement of the medical bit of the Millennium Development Goals. However, the gap which is not covered is much on the generalisation that public health sometimes brings. As deeply as one would think, some diseases can be taken in general context while others cannot; the same applies to patients who are always different, and might thus need different approaches in getting them cured.Medicine in the Third World still relies on relatively old findings from the developed world, which does not always fit in the local context, in matters of diagnosing and treating these diseases. Basing on pre-established protocols will lead to a sense of stagnation in the field and medical practitioners will always face the same problems over and over again.From a relatively short exposure to western medical practice, I tend to have seen an offensive medicine, one that is innovative, bringing in elements of treating diseases with evidence-based medicine, and quite challenging procedures targeting the human well being without generalities. This is far from criticising public health which brought bed nets and HIV- Anti Retroviral Treatment, safe methods of infection control within hospitals and that has considerably reduced mortality from relatively avoidable causes. The people in charge of health in this country should think of changing the way public health is practiced and perceived, not from a central level to local facilities but rather the other way round.One of the solutions to be brought on table would be to avail more funds to the local level, especially the health centres and hospitals. As people facing day-to-day patients’ cases without generalities, more innovation and research would come from that level. This requires as well, a mindset change about the use of evidence-based medicine and a striking way of practicing medicine. Trying new ways of doing things has not killed anyone!Again, the way medical education is imparted does not give the future practitioners away to think broadly, research-wise. Medical education should give more way to the students to not only think about the routine curative medicine but aggressive and innovative methods to treat diseases fitting the local realities.Medicine is not static; it evolves. It needs local and international findings, which are more population- based for effectiveness. There are some universal medical realities, but some have to be dug down from a community or from day-to-day cases registered in hospitals. Research and innovation from a clinical perspective need as much funds allocated to public health based research. Again, the way the medical system is built, a country like Rwanda needs both sides to survive and develop, as a serious health system is still considered by many as the essence of a nation.Health could be thought of as coming from both sides, meaning from central and local levels, and this way medicine would be more complete. Making the clinical field more attractive, bringing in funds for innovation and research would increase the number of medical graduates turn ups in the clinical field and would fill the gaps of health practitioners around the country.The writer is a medical doctor based at Ruhengeri District Hospital and the PR Officer of Rwanda Children’s Cancer Relief.

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Why research in public health needs to be community-based