Community Posting

“The power of community to create health is far greater than any physician, clinic or hospital.” Dr. Mark Hyman

I viewed community posting as an opportunity to develop a better understanding on the roles of public health medicine in the context of healthcare. Since the beginning of our clinical years, I have only managed to spend time mostly in the hospital, learning how inpatient clinical medicine works on a tertiary level. I have been lectured countless times on how to initiate fluid resuscitation for a patient coming in with dehydration due to acute gastroenteritis, yet I certainly would have had no idea on what to do in the midst of a cholera outbreak. In terms of workload and learning curve, to be brutally honest, I have expected this particular posting to be a relatively relaxing one, at least when compared to core rotations such as internal medicine and surgery. However, it turned out that I was entirely mistaken. Fortunately, I have been blessed with teammates who are amazingly enthusiastic and kind. It has been a great pleasure working with them.

The time spent in the district health office has really opened up my mind. A good public health policy, when implemented properly, should theoretically be really effective in fixing public health issues, in terms of primary prevention of non-communicable diseases, for example. Public health specialists are therefore vitally important in health issues at a community level. They are the ones who deal with Hand Foot Mouth disease outbreaks. They are the ones who plan strategies in health screening of our school children. They are the ones who come up with recommendations for the government to execute better healthcare policies for our people. Having gone through this posting, I now have great appreciation for the people working in the field of public health. A physician treats the patient; a public health doctor treats the population.

‘Prevention is better than cure’, a phrase that we may have heard a thousand times, but it was after going through this posting that I truly understand the true essence behind this fancy sentence. As a developing country, the pattern and spectrum of diseases in Malaysia are largely similar to the ones in the western world, in addition of geographically specific tropical diseases. Non-communicable diseases such as cardiovascular conditions, obesity and stroke constitute a huge disease burden to our nation. During that one week when we carried out data collection on the residents of low-cost flats, I have encountered innumerable respondents who have very poor awareness on health maintenance. Most of them are obese, yet they are clueless on choices of healthy diet. A lot of them are smokers despite earning very little. It was very disheartening to think that one day they might unfortunately present to the hospitals with heart attack or stroke, which are conditions that could have been prevented if primary health interventions are implemented well.    

As peculiar as this may sound, I have found learning basic biostatistics to be rather exciting. I was thoroughly awed by how efficient and convenient the SPSS statistical software can be, once one has grasped the necessary skills on how to choose an appropriate statistical test, which is in fact to me personally, the most intellectually stimulating and challenging step in the process of conducting a research.  In the book ‘The Medical Research Handbook’ authored by Dr. Amar Singh, there is this sentence which I could not agree more: ‘medical research is best learnt by conducting one’. This posting has indeed served as a really good platform for us to learn the basics of clinical research and even conduct one. Moreover, our team has been extremely grateful to have dedicated supervisors who are always trying their best to guide us through. (How lucky I am to be able to conduct a discussion in a deputy dean’s office and have pisang goreng with her!) In the practice of evidence-based medicine, one is required to understand basic statistics well as having the skill and knowledge to appraise clinical papers and conducting researches are essential for us to be a good clinician. Being in community posting is therefore the first step towards our goal of becoming good doctors!

“Without a sense of caring, there can be no sense of community.” Anthony J. D'Angelo

All in all, being in community posting has been an exciting and fruitful experience. When the rest of the healthcare system are moving towards an era of subsubspecialisation, having the opportunity to get ourselves exposed to a relatively foreign field in medicine has been truly humbling, as it reminds us to not be ignorant, and educating our people to eat healthily is always better than trying to invent new novel drugs to lower cholesterol level.