Monday, September 17, 2012

Role of Family Medicine in Tuberculosis/TB Control

Dr Seema Sahu, India

Family Medicine is the specialty   of medicine which provides comprehensive health care to people of all age. It provides primary as well as continuum of care and surpasses the barrier of age, gender parts of body and diseases. Family Physician is the first contact for the patient for any ailment/discomfort whether it is physical, mental or psychosocial. He is the teacher, counsellor, friend and doctor whom patient   knows for years and trusts completely. Here is the relationship which has developed over years and has mutual trust and affection instead of that of a business client in the specialist clinics.

India is aiming towards universal access to TB control and care. We are trying to mobilize the community by ACSM (Advocacy Communication Social Mobilization) activities, empowering them to take charge of their own health by making them aware of their rights as patients by giving them patients charter, giving them DOT (Directly Observed Treatment) for cure and even trace them if they have defaulted in taking treatment. We are working together with our civil society partners to achieve this and the task is enormous.  With the emergence of MDR (Multi-Drug Resistant) TB it has become more difficult. Had we developed a health system where there were family doctors in the community taking care of each and every patient, it would have been much different. The family doctor would do ACSM as a routine in the community while providing them curative care. As a normal practice any- one who has cough for more than two weeks would consult their family doctor. The doctor would screen him   and would send the sputum sample if required. At the same time he would educate and counsel him regarding TB. If the test is positive, the family doctor would start treatment, notify the disease and follow him up till cure and even thereafter.  If family doctors who are constantly undergoing continued medical education and practicing evidence based medicine are part of our health system, control of any disease which is of public health importance would be much better and effective. We can save a lot of resources. Imagine DOT in a system where Family doctors are placed in the health system. There will be no need to separately engage in so many awareness campaign and meetings just to make the community aware of TB. The job would be done by the family doctor. He would also be the DOT provider and can counsel and retrieve the patient to DOTS with the help of volunteer in case the patient defaults. The patient would listen to him more than anyone else. Family doctor would also know if there is any contact in the family who is coughing   and needs screening. From the vaccination to promotion of good cough, hygiene, treatment, notification and follow up of Tuberculosis can be taken care of by family doctor efficiently and with limited resource . Even when we do not have well trained family physicians in our country and our Rural Health Care Providers are doing the job of family doctor, we can engage them effectively in TB care and control for promotion, prevention, screening, and as DOT provider. They can strengthen the whole process from cough to cure if only we involve them and train them. This is high time our government should make policy to change our medical education and encourage Family Medicine as important specialty.

About the author: Dr Seema Sahu is a Specialist Family Physician and Public Health Professional, currently associated with World Vision India in the Civil Society TB Project supported by GFATM Round 9 Grant, in the capacity of central level Monitoring & Evaluation Manager. In this article, she described the concept of integrating Family Medicine with TB care and control activities that has expanded and long-term public health importance in a high TB-burden country like India.  

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