Report of Indian Association of Preventive and Social Medicine Conference 2010, Ranchi

Report of Indian Association of Preventive and Social Medicine Conference 2010, Ranchi

The department of Preventive and Social Medicine, Rajendra Institute of Medical Science, Ranchi, Jharkhand has organized the 37th annual conference of Indian Association of Preventive and Social Medicine during 22nd to 24th Feb 2010. It was a great experience to attend a historical place for newly form state Jharkhand. The theme of conference was ‘Convergence for Health’.

On first day, the conference was inaugurated by state health and family welfare minister Hon Baijnath Ram with state health secretary, director National institute of Health and Family welfare, President IAPSM Prof. V. K. Srivastava and Secretary General IAPSM Dr. Bir Singh. The all speakers in their inaugural speech put emphasis on convergence of all activities to achieve healthy nation. They expect the association should play key role in convergence activities with all departments. The need of present scenario is to make one platform for community health.

The first session was Harcharan Singh Oration which was awarded to Dr. Bir Singh, Professor & Secretary General IAPSM, AIIMS, New Delhi. He delivered talk on innovative course ‘pre marriage counseling course for Happy Marriage life’ which was started in Center for Community Medicine (CCM), AIIMS in July 2008. CCM, AIIMS is running Sex and marriage counseling clinic since 1964. They have analyzed data for one year and they found 35% of clients had marital disharmony and majority (55%) of attendee were of young age group 15to 40 years group. Other fact was that clients of marital disharmony came within one year of marriage. Looking to the fact, the CCM has started course of two days for people. They are teaching pillars of marriage life to clients. So far they have conducted four batches and next batch is in March 2010. Further details can be collected from Dr. Bir Sing and his mail id birsingh43@gmail.com He has requested all IAPSM members to start such type of course in college and they are ready to provide technical support.

The second session was on public health teaching in medical schools. There were speakers from WHO, South East Asia Region office Prof. M E Huq, Dr. R. De Sevaratne from Sri Lanka, Dr. F Khan from Bangladesh and Prof Nilambar Jha from Nepal. Prof. Huq from SEARO had put stress on three competencies which medical (student) officer should acquire during study. They are technical, administrative and managerial and self development. The technical competencies are in area like community diagnosis, health promotion, prevention and control of public health important diseases, supervision and monitoring of national health programme, investigation and disease surveillance. The managerial competencies are in area like Health Promotion & disease prevention activity, Use of health information, Implement health legislation, Influence public health policy, Cooperation between health other sectors, Design & implement IEC, Implement in service trainings, Human resources, Quality control issues including monitoring, Environmental health & it’s hazards, Women issues and Applied research. And the self development competencies areas are Accessing & utilizing information from different sources/ web based, Computer literacy and Use of internet. But he told that the are many weaknesses in our curriculum to develop above competencies. The weaknesses are Contents are not updated, Less systemic, Not standardized, Field visit is not effective, Lack of interest/lack of fund, Not assessed separately, Not weighed duly , Lack of pedagogical skills of teachers, No faculty development programme and No Institutional Quality Assurance mechanism. What is the answer to above issues? The speakers has said that WHO has prepared book on ‘Guideline for Preventive and Social Medicine / Community Medicine / Community Health curriculum in the under graduate medical education. I think it is available on net. Please see for more details.
The second session was on ‘Teaching public health in an undergraduate hybrid medical curriculum: Colombo experience’ by Dr. Rohini, Faculty of Medicine University of Colombo. She had delivered the experience of University of Colombo for medical education curriculum framing. She told that they took five years to develop hybrid, partially integrated curriculum organized in five streams. The five parallel streams are Introductory Basic Sciences Stream, Applied Sciences Stream, Behavioural Sciences Stream, Community Stream and Clinical Sciences Stream. They are teaching public health to the students in all five years. The curricula for public health in gross as in terms 2-3 topics are- Health (concepts, determinants, and promotion); Stage 2- Demography, Statistics and Epidemiology; Stage 3- Community based learning and Research Project and in Final year: Stage 4- Community perspective of patient care. They have also incorporated evaluation in term ending. So students are assessed as per objective of curriculum.

The third presentation was from Nepal Dr. Nilamber Jha, Chief of school of public health and community medicine, B P Koirala Institute of Health Science, Dharan, Nepal. He spoke on ‘five star doctors for 21st century: A BPKIHS endeavor for Nepal’. He tried to explain the meaning of five star in words of Charles Bolen, WHO that who have competencies as Care Provider, Decision Maker, Good Communicator, Community Leader and Team Member. In their institution they have a week long orientation programme for new students which sensitize the students the socio-cultural environment of community and environment. In first year they have to learn the community diagnosis with objectives to appreciate teamwork, to know the common health problems and to identify the health needs of the people. Second year the students are learning health care delivery system of country. The objectives of learning are to familiarize the students about National Health Care Delivery System and to understand the structure and functions of the different NGOs /INGOs working in Health. They are taken for Six-field visits at Health Post / Sub-health Post, Primary Health Center, District & Zonal hospitals, Regional health directorate and NGOs / INGOs. In third year the students have to do family health study. The objectives of this family study are to analyze the social and cultural variables related to health and disease in the family and to make the student a complete family physician. For this each student has given one family and they have to visit 12 times in that family over a year. Each visit the student has to spend three hours in family. Thus they are learning family problem and making them family physician. During third year students are learning epidemiology for health management. They will learn all aspect of epidemiology theoretical and practical aspect. During forth year, the students are learning the various management skills for health services. They are exposed to various national health programme, supervision and monitoring activities, managerial skills, morbidity and mortality pattern in district and block, drug logistics, laboratory services and medical records. During internship, these students are working six months in teaching hospital and six months in zonal and district hospital with 15 days posting in district public health posting and 15 days at Primary health center. Thus during course of MBBS students are spending 352 days in field.

I would like the comments from esteem faculties of community medicine and public health expert. What we should do in present scenario? The scenario is that government is asking we are not getting doctors for rural areas. They decided to raise medical colleges in India and they permitted many colleges in country. By December 2009, there are 300 medical colleges in India. Still doctors are not moving in rural areas. The government had proposed to do compulsory rural posting before final registration with MCI. But that was just came and when lost no one knew. On the contrary, MCI has made notification and reduced the duration of internship in PSM to two months. even I heard that MCI is going to eliminate PSM teaching from first year. These are the ground facts for Indian scenario. It is high time to decide the role of department in college, community , public health and policy making.
One more recent news, which you all know that is the new course BRMS (?). Government and MCI have proposed new cadre of rural doctors. What will be the fate of these new people? God knows, it really high time to think and give inputs to government policy.

The third session was on ‘Sexual and Reproductive Health of Youth in India’. Usha Ram, International Institute for Population science, Mumbai had talk on pre-marital sex among youth. She has reported that 1 in 5 young men and 1 in 10 young women reported a romantic partner. She also reported that one in 7 young men and 4% of young women had pre-marital sex and young men tend to initiate pre-marital sex earlier than young women. But serious issue she reported is that only 27% young men and 7% of young women had ever used condoms in their premarital sex relationship and consistent use was still more problem; 13% in young men and 3% young women. Second presentation in this session was on ‘early marriage childbearing in India’ by Usha Ram. She reported that still in India 45% of women aged 20-24 years in India marry before age 18 and 63%, marry before age 20 and 22% gave birth before age 18 in 2005 and 42% gave birth before age 20. She also reported 43% of married adolescent women had an unmet need for modern contraception. Dr. Suranjeen, CINI has presented youth policy in Jarkhand various issues and advocacy.
The forth session on first day was on Health system research by National Health System Research Center, New Delhi. The first presentation was on ‘Health System Research – the context and the challenges’ by Dr. T Sundararaman. He told that IPHS services guarantees 1 ASHA, 1 AWW, village health day, drug kit and referral chain at village level; 2 ANMs, 1 MPHW at sub-center level; at PHC level 3 Staff Nurses; 1 LHV for 4-5 SHCs; MO i/c; Ayush Doctor; Emergencies that can be handled by Nurses ; Round the Clock Services Ambulance/hired vehicle; Fixed Day FP and other Clinics; Telephone; ; Drugs; Laboratory and at block level 30 beds, 5 specialists, 9 nurses/Ambulance, Obstetric/Surgical/Medical
Emergencies /Round the Clock Services with health manager, accountant and store keeper. This is the expected IPHS standards for block and below health system. He has reported that very limited studies were conducted on health system research which can generalized in country. He told to learned audience about need of health system research and role of department of PSM in same. Second ppt was from Dr. Sahay and he elaborated quality management system in district hospital. Dr. Srivastava told status of Bio-medical waste in country.

There were parallel paper presentation in three halls and one poster session in one hall. The details of paper and poster topic list is available on web page of www.iapsmcon2010.org

Second day; the day was started with Dhanvantari Oration, which was awarded to Dr. Umesh Kapil. He has talked on ‘successful efforts towards elimination IDD – transforming Indian dream into reality’.

Next plenary session on ‘Maternal and child Anemia in India: issues and way forward’. Dr. Prema Ramchandran, Director Nutrition foundation of India has focused on maternal anemia. She told that one third of global population are anemic. Prevalence of anemia in pregnant women is highest in pregnant women in India. She was serious about issue that 22000 maternal deaths are due to anemia. she explained the future strategy for controlling anemia. Dr. P V Kotecha has focused on ‘Child anemia feasibility study – approach and lesson learnt’. The big filed area of USAID is Jharkhand. They did feasibility study of anemia in state. They tried to incorporate the IFS syrup in drug kit at sub center and village level. Dr. Anchita Patil from USAID tried to explain role of breast feeding and complimentary feeding in controlling of anemia. in this plenary last lecture was from Rolf Klenm, technical director, USAID A2Zmicronutrient project, J H B School of Public health, USA. He tried to focus on iron fortified processed complementary food for infant and toddlers. But he could not able to give enough evidence for same. This area need to explore before implementation.
The other plenary on Micronutrients – programme issues, Involvement of medical college in effective implementation of RNTCP were delivered by various speakers.
On last day, the plenary session was on Adolescent girl by UNICEF. Along with other paper presentation I have presented paper with title ‘Awareness and practice about preventive method against mosquito bite in Gujarat India’ on last day. The ppt is available with me and also posted on my slideshare web http://www.slideshare.net/pampandit. It was nice experience.
It was overall great experience in Ranchi. The food and hospitality was really good. As I was member of Governing council for year 2009-10, we had great meeting and also General body meeting. Also the host has arranged cultural programme and banquet for guest. Great thanks to Dr. Haider and his team.


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Dr. Niraj Pandit