Let us identify ‘Typhoid Mary’ in our society, scale up the role of medical microbiology in medical education

The drug or doctor is most needed for our society? The question may appear absurd but in reality, most of the health experts and administrators in our country strongly think that drugs are most needed for our society than doctors. The recent move to empower pharmacist to prescribe certain drugs is the best example.

The Government and as well as the newly appointed Deputy Director of WHO from India Dr Soumya Swaminathan has admitted that the role of unorganized health care providers in our society whether quacks or RIMP’s or the duly qualified practitioners from faith and traditional healing cannot be neglected or negated.

Whether all these groups of health care providers have adequate knowledge and training in diagnosing the disease or not but based on the broad clinical complaints of the patients, they dispense/prescribe drugs. In most occasions, the patient would get some relief. Naturally, such ‘doctors’ have a lot to cheer from such coincidences and the repetition of such coincidences easily builds a good reputation for such ‘doctor’ in the given locality. If we look at this reality and then speak, we cannot deny the role of all such health care providers. The point is that can we therefore regularize, formalize and patronage the services of such ‘doctors’ to imposter as a real doctor and gift them to poor people in rural India?

Even in formal health care services in rural India these days where the duly qualified MBBS doctors are the key players, diagnosis is given the least importance and in most occasions, drugs are prescribed based on broad clinical complaints. When the drug does its job, the credit goes to the doctor. In several occasions, some of the duly qualified doctors to treat the patient exactly like the chemists' shop providing some drugs to the patient. It means, some doctors seldom care for diagnosis. But now the treads appear to have changed. But such change should not be seen or interpreted as doctors have become very meticulous to diagnose the disease before the treatment. The money most of the doctors earn through diagnosis is far more than doing surgery.

When shall we shift our focus and trust in our healthcare policy orienting towards proper diagnosis, understanding the etiology, characterization of the pathogens, understanding of the epidemiology etc., then dispensing ‘some’ drugs in the name of treating the patients?

The present debate is essentially about the general health care practice prevalent in the country and not about critical care/emergency care. The emergency situation is the true extension of failure of a primary health care delivery system. Most of such failures are not due to the drugs or the drugs were given are ineffective but the diagnosis was not accurate.

Considering the dense population of India coupled with innocence, ignorance, illiteracy and impoverished economic status of people, diagnosis is as important as treatment. Although the prevalence of non-communicable diseases is on increase in India, the rampantness of infectious diseases is no less in our society. The non-communicable diseases although affect the quality of life of the sufferer but it does not spread in the society but the communicable diseases can easily reach epidemic to pandemic proportion if the etiological agent is not identified, characterized and its source is not arrested.

Unfortunately, our present medical system both at the health care delivery stage and in medical education, the importance of medical microbiology is highly at the superficial level. The role of medical microbiology is limited to certain rare occasions and the inclusion of medical microbiology education is done at the symbolic level.

Most of the advanced countries give greater importance to medical microbiology in the health care delivery system. At the policy level, all those countries have recognized the role of medical microbiology, as critical as critical care specialties and surgery.

But in India, medical microbiology is often subjected to racism by medical graduates owing to their superiority in medicine. But the important question they miss to recognize is that whether doctor or drug in most needed for the patient and whether the doctor or the drug really make a difference in the life of the patient? When the doctors take pride on their social status and superiority, what is the role of these doctors in the discovery of new drugs? When our medical system update its drug knowledge more aggressively than expertise in diagnosis & epidemiology and treat the patients, can’t we ask such question?

The government of India, ICMR, and other premier medical institutions in India must give utmost importance to the characterization of the pathogen in every infectious disease. The government must set up a laboratory at every village level so that the basic understanding of the pathogen is well done. All these pathogens must be studied further in the microbiology laboratory to understand what are the changes taking place in these pathogens to evolve a robust healthcare strategy for our nation. Similarly, medical microbiology education must be strengthened in our medical education from the first year to house surgency and also in every specialty PG courses in medicine.

If we fail to reform our medical education and scale up the importance of medical microbiology education in medicine, we may go ignorant about the likely existence of Typhoid Mary in our society and may run after newer drugs.

S Ranganathan