Village doctors need focus

Like many non-formal professionals in the country, the village doctors have traditionally been an integral part of our rural communities. To people living in the remote areas of the country, they are truly "a friend in need is a friend indeed." In the present times of fierce fight for survival, they are continually being battered. Defeated both materially and morally, many of these doctors accept the fate of finding them peter out. Yet their clients, who are equally star-crossed, turn to them. Sizeable numbers of village doctors still respond to the calls of helpless patients. Their crude forms of treatment bring relief for many sometimes.
Keeping these rural doctors under a wide focus, the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B) has recently come up with two new studies on them. One study highlights the remarkable role these amateur doctors play in treating patients with diarrhoea, tuberculosis and a lot of common ailments. This study was conducted by Centre for Nutrition and Food Security under the international centre. In a small village quite far from any formal medical and healthcare facilities, the sudden attack of the much-dreaded disease of diarrhoea is like a bolt from the blue. In the past, patients with 'diarrhoeal illness' used to rush to herbal medicine practitioners or local faith healers. Some would prepare concoctions at home to cure the debilitating impact of the disease. Few of the remedies, would, however, work. As a result, scores of patients, especially children, would die. The village doctors have brought about a radical change to this dismal picture. As we have seen, although almost all of these self-taught physicians lack formal medical knowledge, they, thanks to their undeterred zeal, have learnt how to make the oral saline. In the urban areas too, including the capital Dhaka, it is used as the only antidote to the remission of diarrhoea's fury.
The study stresses creating opportunities of adequate training for these rural paramedics which will help them treat patients more effectively. It is not only diarrhoea, the rural doctors attending patients in far-away hamlets also cure a lot of other diseases. But they are excluded from the formal health programmes.
The health authorities can quite successfully tap the potential of these informal health service providers. The rural amateur doctors, with a little training, have long proved their worth in the national tuberculosis programme.
Village doctors with adequate training can play a laudable role in the treatment of tuberculosis. In fact, these community-based healthcare providers have traditionally been playing a remarkable role in the rural healthcare scene. What they need now is a boost to their mostly unsung job.
As the study has observed, the community doctors comprise the largest section of healthcare providers in the country. Statistically, around 13 of these doctors provide healthcare service to every 10,000 persons in the rural areas detached from the formal medical facilities.   Given the state of poor healthcare facilities in the vast rural area, it becomes clear that lack of logistic support, adequate training and incentives stand in the way of these doctors' providing sufficient cure to the village folks.
The other ICDDR, B study carried out by its Centre of Equity and Health Systems sheds light on a largely unknown healthcare-related reality in villages. It tells us about the veiled pressure on the financially-constrained village doctors to prescribe one or another pharmaceutical company's drugs. Exploiting their financial and logistic vulnerability, the medical representatives of different companies ride the roughshod on those doctors' prescribing trends and force them into picking their drugs. The otherwise normal practice assumes alarming proportions in the village, as the informal doctors there eventually discover themselves facing the Hobson's choice. Few of them could come out of this dilemma, and finally become fully dependent on the medical representatives. However, there are rewards, irresistible and generous at that. In exchange for prescribing a company's medicine, the rural doctors get incentives -- either cash or 'gifts'.
Upon falling victim to an aggressive marketing pursued by pharmaceutical companies, the helpless village doctors cannot muster enough strength to verify a particular drug's potency or the harmful side-effects. In the meantime, the rural healthcare takes another beating.
shihabskr@ymail.com