It was quite surprising for me to read about how the relationship between public health advocates and physicians in the United States was tense at its best, and downright rivalrous at times of peak competition--such as in the case of dispensaries. The interaction between medicine and public health in Egypt has always been that of a subspecialty with its parent occupation. Public health practitioners were invariably physicians by training.
This is not to say that public health fared any better in Egypt. The focus, like everywhere else, was shifted to individual health behavior instead of social or environmental reform, but it is that public health practitioners in Egypt were more ‘in synch’ with the medical profession and did not, at any point in time, consider themselves outsiders. Indeed, many --probably an understatement -- public health officials sought to also be practicing physicians. I always found this to be an oxymoron-- physicians focus on the individual, public health officials on the population…how can one cater to both needs?
Physicians do not easily adopt the preventive mind set, even in practices like pediatrics. Because of long waiting time and financial costs, most mothers visit them only when the child suffers an ailment. Well-child visits are not very common in Egypt and those who adhere to them are not even sure that they matter in the big scheme of things.
It can be argued that the greatest, and perhaps only, public health service offered by pediatricians is vaccination--and that is, of course, because there is money to be made and incentives by the pharmaceutical companies.
When I was practicing clinical medicine in a university hospital catering to the poor, I realized that a little public health efforts can go a long way in improving the health of the Egyptian population. With malnutrition and Trachoma rampant in lower-class Egyptian children, the need for social reform and basic sanitary measures is self-evident.
The schism between public health and medicine is universal--despite physician’s best efforts to apply principles of preventive medicine. The problem, actually, lies therein. Public health became reduced to preventive medicine in many countries; the socio ecological model of health was abandoned and the burden of improving one’s health fell largely on the individual.
This is not to say that public health fared any better in Egypt. The focus, like everywhere else, was shifted to individual health behavior instead of social or environmental reform, but it is that public health practitioners in Egypt were more ‘in synch’ with the medical profession and did not, at any point in time, consider themselves outsiders. Indeed, many --probably an understatement -- public health officials sought to also be practicing physicians. I always found this to be an oxymoron-- physicians focus on the individual, public health officials on the population…how can one cater to both needs?
Physicians do not easily adopt the preventive mind set, even in practices like pediatrics. Because of long waiting time and financial costs, most mothers visit them only when the child suffers an ailment. Well-child visits are not very common in Egypt and those who adhere to them are not even sure that they matter in the big scheme of things.
It can be argued that the greatest, and perhaps only, public health service offered by pediatricians is vaccination--and that is, of course, because there is money to be made and incentives by the pharmaceutical companies.
When I was practicing clinical medicine in a university hospital catering to the poor, I realized that a little public health efforts can go a long way in improving the health of the Egyptian population. With malnutrition and Trachoma rampant in lower-class Egyptian children, the need for social reform and basic sanitary measures is self-evident.
The schism between public health and medicine is universal--despite physician’s best efforts to apply principles of preventive medicine. The problem, actually, lies therein. Public health became reduced to preventive medicine in many countries; the socio ecological model of health was abandoned and the burden of improving one’s health fell largely on the individual.
No comments:
Post a Comment