Thursday, October 13, 2011

Why Public Health :: Matter of Life

Why Public Health ? Why International Health ?

That question appeared in my mind. And also in minds of others people; friends, colleagues, families, who has questioned my decision. Why am I taking interest of this subject and even pursued my master on this subject.

I would say: Because it's really important (especially in developing country, where I came from).

It's a simple answer, yet defines so many things that we're (Indonesia) lack of.

We have (currently) huge problems in mass transportation, infrastructure, community health, waste managements and sanitation, human capacity, emergency/ disaster preparedness, development problems... Just name it and you could find it here, in Indonesia, the biggest archipelago with 237 millions of population.

homeless, Braga corner
It does really sound fantastic to have such big number for population. It also describe our problem to organize the system (politic, economy, health) that would fit enormous number of citizens, spreading in more than thousands islands, with different needs and characteristics.

But I would limited my theme just into Public Health.
The area that I interested the most.

Back to my question in the first sentences,
' Why Public Health ? '

When I was doing my governmental duty, post graduated from my medical school (I was so proud that I had finally graduated from a long and suffering yet impressive medical study. I was ready to save people's life and also the whole world). I was located in Sumbawa, an island next to east of Lombok. Why I was there is part of my plan, a bit of accident also coincidence.
I was there only about 9 months. But it was enough for me to decide I could not save the world just by saving people's life one at a time.
It was just TOO frustrated.

Basically what I did, I was saving this patient from one disease but then he would died by something else. He would died because he even couldn't get the money to come into the nearest health facility to get treatment in time. He would died due to lack of nutrition. He would died cause his ignorance that simple medication would actually could cure his symptoms.

Another patient that I treated, would just keep coming back for the same issue.
Malaria is highly prevalent in the area, and just medications to cure the symptoms not really actually treat the environmental cause of Malaria.

In the end, I decided that if I really want to save this people, or this nation (in terms of health issue) I have to do something bigger.
And it has nothing to do with being a clinician.

Somebody has to do something. I want to do my part. It's my calling.

So I took a master program in International Health. It took 3 years (I sent my application 3 times, in 3 consecutive years) to get what I want. My whole 1 year entire program was funded by European Union (I got Erasmus Mundus scholarships) and I studied in 2 different universities in Europe; Royal Tropical Institute, Amsterdam and University of Copenhagen, Denmark.
It was a fantastic year and I learned a lot (still a bit from what I should know) about health systems, managements, and policies.
And I am sure this is my passion, this is what I would like to do further in my career path.

Before I got enrolled in my master program, I also had a chance to work as a researcher in the field of HIV. Most of the time I was doing social studies that related to people living with HIV.

Doing this as clinician, (if it's not one's calling) it's even more frustrated.

If only we're clinicians could treat all the symptomatic people with HIV, it still will not eliminate the problem (because far more people with asymptomatic actually need intervention as well).

Most of the time, these people not even aware that they actually AT RISK.
Or those who already aware that they at risk are AFRAID of SEEK further treatment (sex workers and transgenders are highly stigmatized, they hardly seek treatment if they get sexually transmitted infections. Self treatment are pretty common for them).
Or those who already reached the health care facilities, sometimes get DISCOURAGED by the unfriendly approach of health care workers.

This is a chronic disease (and also infectious disease). And it has so many social aspect apart from merely the clinical aspect. It touches issue of gender relation, sexual behaviour, addiction, adherence, stigma and discrimination & so forth.

It's a very interesting subject (for researcher) but also complex and confusing in its intervention.

And it was not easy because it cannot be intervene by only clinical intervention.

You have to talk with religious leaders, political officers, sex workers and their pimps (also the owner of pubs/ karaoke bars), local governments (of course) to really target the cause of social problem of HIV.

As you can see, public health could be indeed a very important and essential aspect in Indonesia- by giving example of HIV epidemic (my interest).

There's also a whole aspect of public health need to target.

Just take a stroll in the streets of Bandung- my hometown- and see how many street kids on the red light asking for small money.

Does it bother you people?

I guess we all know about this fact, yet don't know what to do.
(Or don't care about it anyway).
It was so hopeless and we BLAME to the government how come they let this happen.

Of course we should blame someone when something wrong happen.
But it doesn't solve the problem.

This street kids represents (common) social issues in Indonesia: lack of social insurance, huge social inequality (riches get everything, poor left with nothing), public ignorance etc.

I was so annoyed by this fact!

And I felt it long before I got the chance to study to Europe to see how this wealthier nations managed their health systems and managements.

I would like to do the same for my country! Because this is my country (many expats or international donors would help Indonesia, but few of Indonesian themselves feel the same calling).

I know I could do it in so many ways.

For now, I am writing it down as a promise to myself.

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