By Sanjib Sharma, EV2010 from Nepal
Let me start by recalling our teenager days, when we saw on television how glamorous doctors saved lives using sophisticated equipment. It inspired many of us to become a doctor too, a true “hero”. After studying medicine, we did become doctors. However, now we have to face the real world which turns out to be totally different from the glamorous lifestyle we had fancied. If we look around, the huge gap between Western nations (or “privileged” people anywhere) and the poor countries (people) becomes painfully acute. When I look at my own country, Nepal, I see poverty, lack of awareness about diseases, death from very treatable simple conditions, a growing disparity between the poor and the rich, and an increasing burden of chronic diseases in a setting where communicable diseases continue to dominate. What actually do we need now – sophisticated, genomic or stem cell research, or simple, needs-driven basic applied and operational research and services to uplift the most needy ones?
In the 21st century we all agree health care should be a right. Yet, universal health coverage (UHC) remains a distant dream for many developing countries, including Nepal. In addition, most poor nations also face a double burden of disease. Nepal, for example, is witnessing an epidemic of non-communicable diseases (NCDs) similar to other countries in South Asia. Diabetes has become the most common ailment among the young urban population due to changes in life style, urbanization, and physical inactivity. Similarly, the prevalence of hypertension, obesity, and metabolic syndrome is on the rise. In order to cope with these challenges, we need to think out of the box in view of the limited resources in a country like Nepal.
Based on my own experience, I know very well that some ostensibly very simple efforts can change and save many lives. I recall here a simple intervention: using a network of motorcycle volunteers from rural Nepal coupled with simple educational messages substantially decreased snakebite mortality in Eastern Nepal. With a similar goal, we also created a network of para-professionals and volunteers to improve the education, awareness, detection and management of some of the NCDs with very positive results.
For sure, one cannot escape from the obligation to provide therapy at individual level, be it sophisticated and accessible for few. However, one can and should also engage NCDs at the population level because many of these diseases are easy to detect and treat at the beginning. In fact, effective low-cost prevention strategies to reduce the burden of chronic diseases and their complications already exist. However, people still die simply because such preventive strategies are not implemented. I have no doubt whatsoever that the greatest gains in public health in the 21st century could be derived not from breakthroughs in biomedical research but from changes in behavior. Such changes do not require sophisticated medical technology, highly trained manpower or huge investments. What they require is attitudinal and behavioural change, which can be fostered by taking full and concerted advantage of today’s amazing information and communication technologies that now even penetrate into the poor and remote communities.
Finally, at a personal level, if I was given the choice between establishing a high-tech molecular laboratory and providing cutting-edge treatment (e.g. dialysis and transplantation) on the one hand, or getting the means to create awareness and diagnose the diseases at the earliest possible time or to even prevent them on the other hand, what should I do? As an individual, a high-tech profile would obviously help me develop my career internationally but would not help the vast majority of my people. Working with them to prevent death and disability is neither lucrative nor glamorous. It is not easy either. It’s a choice many of us face in developing countries.
But yes, so far, the latter path is the path I have chosen, although with an open mind and view, embracing high-tech innovations in my field if they have the potential to advance public health in developing countries like my own in a sustainable manner. Sure enough, technological progress allows us to do more with less money in many cases – but even this amount of money may not exist in very poor nations like mine. Consequently, I fully subscribe to the principles and objectives of WHO’s global action plan for the prevention and control of NCDs, as it is taking shape.