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.
